Unit 8 Endocrine pt. 3 ppt. slides Flashcards
Osteoporosis treatment :
Bisohosphonates
Hormones
Selective estrogen receptor modulators (SERMs)
Alendronate sodium (Fosamax) Risedronate (Actonel) Ibandronate sodium (Boniva) Zoledronic acid (Reclast are all examples of :
Bisphosponates
Osteoporosis tx.
Mechanism of action of Bisposphonates:
Fosamax, Actonel, Boniva, Reclast
Inhibit activity of osteoclasts –> normalize rate of bone turnover –> indirectly increased BMD
Mechanism of action of SERMs
Raloxifene (Evista)
Decrease reabsorption of bone
Decrease overall bone turnover
Mechanism of action of hormones:
Calcitonin & Terioaratide
Calcitonin: naturally occuring in thyroid, blocks bone reabsorption via potent inhibition of osteoclasts
Teriparatide: synthetic human PTH, stimulates new bone formation via stimulation of osteoblastic activity
Treatment principles of osteoporosis :
- Reduce fracture risk (non pharmacological tx first if possible)
- Bisposphonates (1st line tx)
- Teriparatide (2nd line tx)
- Calcitonin (reserved for unstable pts in tolerating other tx.s)
- PTH ( severe osteoporosis and unresponsive)
Nonpharmacological treatment of osteoporosis:
Calcium and Vitamin D supplementation
Weight baring exercises
Avoid tobacco and alcohol
Bone density testing
How much calcium supplementation daily in osteoporosis pt?
> 1200 mg/day
Mechanism of action Thyroid supplementation:
Levothyroxine sodium
Replacement of inadequate levels of endogenous T3 and T4. Supplementation increases basal metabolic rate and metabolism of carbohydrates, proteins and fats.
Treatment of choice for hypothyroidism :
Levothyroxine
Titration q4-6 wk until normal TSH
T/F Administration of thyroid hormone may exacerbate cardiovascular disease
True
Patient education for hypothyroidism :
Response takes about 2 weeks
Lifelong therapy
Don’t abruptly stop med
Don’t change the brand name !
Treatment principles for hyperthyroidism:
- Radioactive iodine (first line)
- Surgical intervention
- Antithyroid drugs
Preferred drug tx. for hyperthyroidism :
Methimazole
-longer acting and requires less frequent dosing schedule
Preferred drug for hyperthyroidism in pregnancy ?
PTU
Watch for PTU hepatotoxicity in pediatrics
Thyroid cancer recurrence, metastasis, or post surgical evaluation follow up may require the drug :
Thyrotropin (Thyrogen)
MOA: enhances sensitivity of thyroglobulin testing in patients maintained on thyroid hormone therapy
Thyroid hormones can induce P-glycoprotein in the intestine resulting in diminished absorption of which drugs subject to P-gp efflux?
Immunosuppressants used with transplant patients
-the only drugs believed to be effected by the thyroid hormones.
Class 2 recommendation.
Monitor levels of substrate to assure adequate immunosuppression.
What is the most accurate measure of vitamin D in humans ?
Calcidiol
Due to its long half life
What is the primary function of vitamin D?
To facilitate absorption of calcium and phosphate from the bowel
Drugs that can inactivate calcitriol (vitamin D supplement) and result in vitamin D deficiency are :
Antiepileptics: carbamazepine, clonazepam, phenobarbital, phenytoin, valproic acid
Glucocorticoids
Antiestrogens: SERMs
Patients taking Bisposphonates with NSAIDs should be cautioned about the risk of :
G.I. Bleeding
Bisposphonates, including denosumab won’t work without adequate amounts of :
Calcium and Vitamin D stores prior to use
