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PHARMA – endocrinology > treatment of OSTEOPOROSIS > Flashcards

treatment of OSTEOPOROSIS Flashcards

1
Q

non-drug strategies to REDUCE BONE LOSS in postmenopausal women:

A
  1. dietary intake of → vit. D & Ca
  2. weight-bearing exercise & smoking cessation
  3. AVOID glucocorticoids
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2
Q

reasons to AVOID glucocorticoids for reducing of bone loss:

A
  1. antagonize vit. D-stimulated intestinal Ca transport
  2. stimulate renal Ca excretion
  3. block bone collagen synthesis
  4. increase PTH-stimulated bone resorption (?)
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3
Q

CALCIUM: (name of drugs)

A
  1. calcium carbonate → 400mg elementary Ca

2. calcium gluconate → 90mg elementary Ca

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4
Q

VITAMIN D: (name of drugs)

A
  1. vit. D3 → cholecalciferol
  2. vit. D2 → ergocalciferol
  3. 25-hydroxy D3 → calciferol
  4. 1,25-hydroxy vit. D3 → calcitriol
  5. 24,25- hydroxyl vit. D3 → secalcifediol
  6. alfacalcidol → undergoes hepatic hydroxylation → to calcitriol
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5
Q

VITAMIN D → mechanism of action:

A
  1. INTESTINE → increased Ca & P absorption by 1,25(OH)2 D
  2. KIDNEY → Ca & P excretion may be decreased by calciferol & calcitriol
  3. BONE → increased Ca & P resorption by calcitriol, bone formation increased by → secalcifediol
  4. regulation of PTH & insulin secretion
  5. modulation of cytokine production by macrophages & T-cells
  6. influence proliferation of other cells including cancer cells
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6
Q

VITAMIN D → indications:

A
  1. osteomalacia (in children → rickets)
  2. osteoporosis
  3. vit. D deficiency → due to malabsorption & liver disease (ergocalciferol)
  4. hypocalcemia ass. with hypoparathyroidism (ergocalciferol)
  5. osteodystrophy of chronic renal failure (calcitriol & alphacalcidol)
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7
Q

VITAMIN D → side effects:

A

HYPERCALCEMIA:

  1. constipation
  2. depression
  3. weakness
  4. fatigue
  5. reduced ability to concentrate urine → polyuria, polydipsia
  6. Ca deposit in kidney → renal failure & kidney stones
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8
Q

BISPHOSPHONATES: (name of drugs)

A
  1. etidronate & clodronate → NOT for osteoporosis

drugs for OSTEOPOROSIS:

  1. alendronate (2nd gen.)
  2. ibandronate (2nd gen.)
  3. risedronate (3rd gen.)
  4. zoledronate (3rd gen.)

drugs for disorders of BONE REMODELING:

  1. clodronate (1st gen.)
  2. etidronate (1st gen.)
  3. tiludronate
  4. pamidronate (2nd gen.)
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9
Q

BISPHOSPHONATES → mechanism of action:

A
  1. inhibition of recruitment & promotion of apoptosis of osteoclasts
  2. indirect stimulation of osteoblast activity
  3. ↑ bone mass → ↓ risk of fractures
  4. poorly absorbed from gut
  5. should be taken in vertical position 30min before meal, followed by 200ml water
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10
Q

BISPHOSPHONATES → indications:

A
  1. paget disease of bone
  2. malignant hypercalcemia
  3. multiple myeloma
  4. postmenopausal osteoporosis
  5. glucocorticoid-induced osteoporosis
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11
Q

BISPHOSPHONATES → CONTRAindications:

A
  1. severe renal impairment

2. bone necrosis

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12
Q

BISPHOSPHONATES → side effects:

A
  1. upset GI-tract → diarrhea, pain
  2. bone pain (musculoskeletal)
  3. esophagitis & esophageal ulcers → alendronate, risedronate & ibandronate
  4. long-term use etidronate → osteomalacia → ↑ risk of fracture (due to reduced calcification of bone)
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13
Q

CALCITONIN → mechanism of action:

A
  1. reduces bone resorption

2. relieve pain in osteoporotic fracture

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14
Q

CALCITONIN → indications:

A
  1. osteoporosis > 5y postmenopausal
  2. hypercalcemia & Paget ́s disease (by block bone resorption & ↓ serum calcitonin)
  3. recent vertebral fracture
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15
Q

CALCITONIN → CONTRAindication:

A
  1. rhinitis & other nasal symptoms
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16
Q

CALCITONIN → side effects:

A

↑ risk of malignancy → therefore reserved for pat. intolerant to other osteoporotic drugs

17
Q

ESTROGEN: (name of drug)

A

HRT = hormone replacement therapy

18
Q

ESTROGEN → mechanism of action:

A
  1. reduction of bone-reabsorbing action of PTH
  2. increase calcitriol in blood
  3. protect against fractures at hip & spine
  4. the increased 1,25(OH)2 D levels in vivo following estrogen treatment → may result from decreased serum Ca & P + increased PTH
19
Q

ESTROGEN → indications:

A
  1. menopausal symptoms
  2. osteoporosis in pat. <60y.
  3. early menopause
20
Q

SERM’s → name of drug: (selective estrogen receptor modulators)

A
  1. raloxifene
21
Q

SERM’s → mechanism of action:

A
  1. estrogen-like effect on bone
  2. estrogen ANTAGONIST effect on breast & endometrium → ↑ bone density WITHOUT risk of endometrial cancer
  3. ↓ risk of invasive BC
  4. ↓ level of total & LDL cholesterol
22
Q

SERM’s → indications:

A
  1. alt. to BISPHOSPHONATES in postmenopausal osteoporosis

2. prevention & treatment of osteoporosis

23
Q

SERM’s → side effects:

A
  1. hot flashes
  2. leg cramps
  3. risk of venous thromboembolism → similar to estrogen
24
Q

PTH → name of drug:

A
  1. teriparatide
25
Q

PTH → mechanism of action:

A

stimulates bone formation → by stimulating osteoblastic activity in bone remodeling

26
Q

PTH → indications:

A
  1. secondary parathyroidism
  2. parathyroid cancer
  3. primary hypoparathyroidism
  4. pat. at high risk of fractures
  5. pat. who failed or cannot tolerate other therapies
27
Q

PTH → side effects:

A
  1. nausea
  2. vomiting
  3. loss of appetite
  4. muscle pain
  5. hypocalcemia
28
Q

STRONTIUM RANELATE: (general info)

A
  1. antiresorptive drugs → ONLY effective in bones with high turnover
  2. effective independently of rate of bone turnover
29
Q

STRONTIUM RANELATE → indications:

A
  1. postmenopausal osteoporosis
  2. senile osteoporosis (all types of osteoporotic fractures)
  3. can be long-term applied
30
Q

STRONTIUM RANELATE → side effects:

A
  1. nausea

2. diarrhea

31
Q

denosumab = prolia: (general info)

A
  1. Ca2+ level MUST be controlled → highest risk of HYPOCALCEMIA at 10-14 days after administration
  2. SC injection → every 6 months
32
Q

denosumab → mechanism of action:

A

monoclonal antibody → targets receptor activator of nuclear kappa-B ligand & inhibits osteoclast formation & function

33
Q

denosumab → indications:

A
  1. postmenopausal osteoporosis in women at high risk of fracture
  2. those intolerant or unresponsive to other therapies
  3. bone metastases
  4. MALES with hormonal ablation & osteoporosis
34
Q

denosumab → side effects:

A
  1. infections, cataract
  2. constipation
  3. atypical bone fractures
  4. dermatological reactions
  5. hypocalcemia
  6. osteonecrosis of jaw

PHARMA – endocrinology (18 decks)

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