Unit 5-Parathyroid and Bone

Question 1

Alendronate

Drug class

Answer 1

Bisphosphonate

Question 2

Alendronate

Mechanism

Answer 2

Reduce osteoclastic bone resorption

Oral formulation; patient must be sitting upright, fasting, for 30 minutes; takes several days to see effect

Question 3

Alendronate

Uses

Answer 3

Hypercalcemia; osteoporosis; Paget’s disease of bone

Question 4

Alendronate

Side effects

Answer 4

Esophageal irritation

Iritis, myalgias, AFF long-term possibly

Question 5

Risedronate

Drug class

Answer 5

Bisphosphonate

Question 6

Risedronate

Mechanism

Answer 6

Reduce osteoclastic bone resorption

Oral formulation; patient must be sitting upright, fasting, for 30 minutes; takes several days to see effect

Question 7

Risedronate

Uses

Answer 7

Hypercalcemia; osteoporosis; Paget’s disease of bone; prevention of fractures in osteogenesis imperfecta

Question 8

Risedronate

Side effects

Answer 8

Esophageal irritation

Iritis, myalgias, AFF long-term possibly

Question 9

Ibandronate

Drug class

Answer 9

Bisphosphonates

Question 10

Ibandronate

Mechanism

Answer 10

Reduce osteoclastic bone resorption

Oral and IV formulations; patient must be sitting upright, fasting, for 30 minutes; takes several days to see effect

Question 11

Pamidronate

Drug class

Answer 11

Bisphosphonate

Question 12

Pamidronate

Mechanism

Answer 12

Reduce osteoclastic bone resorption

Bypasses GI tract (given IV); takes several days to see effect for lowering calcium

Question 13

Pamidronate

Uses

Answer 13

Hypercalcemia of malignancy; Paget’s disease of bone; prevention of fractures in osteogenesis imperfecta

Question 14

Pamidronate

Side effects

Answer 14

Fever, flu-like symptoms

Iritis, myalgias, AFF long-term possibly

Question 15

Zoledronic acid

Drug class

Answer 15

Bisphosphonate

Question 16

Zoledronic acid

Mechanism

Answer 16

Reduce osteoclastic bone resorption

Bypasses GI tract (given IV); takes several days to see effect for lowering calcium

Question 17

Zoledronic acid

Uses

Answer 17

Hypercalcemia of malignancy; Paget’s disease of bone; prevention of fractures in osteogenesis imperfecta

Question 18

Zoledronic acid

Side effects

Answer 18

Fever, flu-like symptoms

Iritis, myalgias, AFF long-term possibly

Question 19

Cinacelcet

Drug class

Answer 19

Calcimimetic

Question 20

Cinacalcet

Mechanism

Answer 20

Reduces PTH and serum calcium levels

Question 21

Cinacalcet

Uses

Answer 21

Secondary hyperparathyroidism from renal disease; parathyroid carcinoma; hypercalcemia in primary hyperparathyroidism not treatable by surgery

Question 22

Cinacalcet

Side effects

Answer 22

Vision changes, palpitations, dizziness, chest pains, headache

Question 23

Calcitonin

Drug class

Answer 23

Amino acid peptide

Question 24

Calcitonin

Mechanism

Answer 24

Increases urinary calcium excretion, inhibits bone reabsorption (modest effect)

Question 25

Calcitonin Uses

Answer 25

Short-term relief of hypercalcemia; Paget's disease of bone

Question 26

Calcitonin Side effects

Answer 26

Minimal (e.g., rhinitis) No longer recommended for use in nasal spray form because of increased cancer risk. Can still use SQ or IM. Tachyphylaxis in 2-3 days; often used to bridge treatment for other medication

Question 27

Teriparatide Drug class

Answer 27

PTH analog

Question 28

Teriparatide Mechanism

Answer 28

Short bursts given SQ, stimulating bone resorption and bone formation via osteoblasts

Question 29

Teriparatide Uses

Answer 29

Osteoporosis (high risk patients who have failed other treatments)

Question 30

Teriparatide Side effects

Answer 30

Transient mild hypercalcemia Requires daily SQ injections; contraindicated in those with increased chance of osteosarcoma (e.g., Paget's disease of the bone, radiation exposure)

Question 31

Raloxifene Drug class

Answer 31

Selective estrogen receptor modulator

Question 32

Raloxifene Mechanism

Answer 32

Selectively activates certain estrogen receptors, but blocks others

Question 33

Raloxifene Uses

Answer 33

Osteoporosis

Question 34

Raloxifene Side effects

Answer 34

Increase risk of hot flashes, DVT

Question 35

Hydrocortisone; Prednisone Drug class

Answer 35

Corticosteroids

Question 36

Hydrocortisone; Prednisone Mechanism

Answer 36

Decreases production of 1,25 vitamin D; may inhibit growth of neoplastic lymphoid tissue

Question 37

Hydrocortisone; Prednisone Uses

Answer 37

Hypercalcemia from vitamin D intoxication, granulomatous diseases Hydrocortisone given IV, prednisone orally

Question 38

Calcium carbonate Drug class

Answer 38

Phosphate binder

Question 39

Calcium carbonate Mechanism

Answer 39

Binds phosphate

Question 40

Calcium carbonate Uses

Answer 40

Secondary hyperparathyroidism from renal disease

Question 41

Calcium acetate Drug class

Answer 41

Phosphate binder

Question 42

Calcium acetate Mechanism

Answer 42

Binds phosphate

Question 43

Calcium acetate Uses

Answer 43

Secondary hyperparathyroidism from renal disease

Question 44

Sevelamer Drug class

Answer 44

Phosphate binder

Question 45

Sevelamer Mechanism

Answer 45

Binds phosphate

Question 46

Sevelamer Uses

Answer 46

Secondary hyperparathyroidism from renal disease

Question 47

Calcitriol; Paracalcitol (Zemplar); Doxercalciferol (Hectorol) Drug class

Answer 47

vitamin D analog

Question 48

Calcitriol; Paracalcitol (Zemplar); Doxercalciferol (Hectorol) Mechanism

Answer 48

Binds to VDR and elevates serum calcium levels

Question 49

Calcitriol; Paracalcitol (Zemplar); Doxercalciferol (Hectorol) Uses

Answer 49

Secondary hyperparathyroidism from renal disease Given orally daily or IV several times a week

Question 50

Denosumab Drug class

Answer 50

Monoclonal antibody

Question 51

Denosumab Mechanism

Answer 51

RANK ligand inhibitor (targets early effect of osteoclasts on bone) Given SQ every 6 months; can be given at lower GFR levels

Question 52

Denosumab Uses

Answer 52

Osteoporosis

Question 53

Denosumab Side effects

Answer 53

Concern for rashes, myalgias; AFF possible