Week 11: Bisphosphonates

Question 1

Bisphosphonates:
Alendronate (Fosamax), Risedronate (Actonel) indications / MOA

“-dronate”

Answer 1

indication: osteoporosis (1st line), high fracture risk, hypercalcemia, pagets dz, metastatic bone dz

MOA: reduces osteoclasts which inhibits bone resorption
-works best 1st year, then plateaus after 2-3 yrs

Question 2

how to take bisphosphonates?

“-dronate”

Answer 2

Alendronate, Risedronate 
zoledronic acid (Reclast) 

EMPTY stomach, 8 oz water ONLY
sit up right 30-60 mins after due to esophagitis / gastric irritation

Question 3

bisphosphonates contraindications

Alendronate (Fosamax), Risedronate (Actonel) zoledronic acid (Reclast)

Answer 3

NO in :

• CKD < 35 CrCl
• uncorrected hypocalcemia
• delayed esophageal emptying (stricture)
• can’t sit up/stand for 30 mins
• inc aspiration risk
• bariatric surgery (upper GI inflammed)

Question 4

Alendronate (Fosamax), Risedronate (Actonel) , zoledronic acid (Reclast) adverse effects

Answer 4

-atypical femur fractures (don’t stay on med > 5 years)
-severe bone/joint/muscle pain
-upper GI mucosa irritation
-hypocalcemia
-jaw osteonecrosis
drug holiday after 5 yrs after bone density stable

• zoledronic acid: IV
• check CrCl before therapy -> renal toxicity risk, flush, tylenol after to reduce reaction

Question 5

drug interaction with bisphosphonates

Answer 5

ranitidine. doubles alendronate bioavailability

Question 6

What’s gout? and risk factors

Answer 6

Crystals only form in hyperuricemia from meds (diuretics), normal breakdown of purines from body nucleic acid or diet alcohol or meats 
Risk factors:
-Obesity
-dehydration 
-canned, processed foods
-alcohol
-seafood

Question 7

Antigout agents:

Xanthine oxidase inhibitors MOA & indication

Answer 7

allopurinol and febuxostat

Decrease uric acid lvls by selectively inhibiting xanthine oxidase, which is the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid
Uric acid then decreases reducing risk of crystallization and gout attack
- chronic gout (allopurinol first line)

1 week for full effects

febuxostat- inc cardiac deaths, give w/ NSAID or colchicine x 6 months

Question 8

xanthine oxidase inhibitors caution/contraindications

Answer 8

• NO with azathioprine, mercaptopurine, theophylline
• NO pregnancy
• korean, hans chinese, thai pts = test for HLA- B5801 allele = steven jonson syndrome

Question 9

xanthine oxidase inhibitors SE’s

Answer 9

Hypersensitivity (rare)
maculoapular skin rash
-Arthralgia
n/d
Elevated transaminases
Hepatotoxicity (rare)

Question 10

what is used 2nd line for chronic gout or adjunct to allopurinol/colchicine ?
cautions? pregnancy?

Answer 10

probenecid
ONLY ONE GOOD FOR PREGNANCY AND ELDERLY!!!!

NO blood dyscrasia, cc < 30, aspirin, G6PD def, SULFA ALLERGY

Question 11

what can you use for acute gout?

how long does it take for effect?

Answer 11

colchicine

takes 18-24 hrs to take effect, 48 for full

Question 12

colchicine MOA

Answer 12

inhibits neutrophils to area of gout attack –> dec inflammation/pain

antiinflamm fo r pain but NOT analgesic

Question 13

colchicine cautions & SE’s

Answer 13

NO grapefruit juice
-caution in renal,hep, elderly, preg

SE:

• GI
• agrunulocytosis
• aplastic anemia
• alopecia
• abd pain, myopathy
• if pain started more than > 36 hrs prior, colchicine no longer preferred agent. NSAID or corticosteroids!

Question 14

Prednisone indications / MOA

Answer 14

suppress migration leukocytes so decrease inflammation
anti-inflammatory

ind: acute gout, rhematoid arthritis

Question 15

prednisone c/c

Answer 15

no active infxns
adrenal suppression
diabetics (causes hyperglycemia)

Question 16

prednisone AE

Answer 16

hypertension, insomnia, mood changes, increased appetite, glucose intolerance.
with chronic use, like osteoporosis, growth suppression.
With long-term use, use calcium and vitamin D as supplementation