Week 2 - Drugs and Treatments Flashcards
What is the daily requirement of calcium for adults (>age 50), teenagers, and pregnant women?
Adults > 50: 1200 mg/d.
Teenagers and pregnant women: 1300 mg/d.
What is the daily requirement of vitamin D for low-risk (< 50 years old) and high-risk (> 50 years old) people?
Low-risk or younger <50 yr old: 400-1000 IU/day.
High-risk or older adult: 800-2000 IU/day.
Name some bone anti-resorptive agents:
- Estrogen
- Androgens
- Bisphosphonates
- Raloxifene {SERM - Selective Estrogen Receptor Modulator}
- Denosumab
Name a bone formation stimulating agent:
- PTH
Which cells produce calcitonin and where is it produced?
The C cells in the thyroid gland.
What is the function of calcitonin?
Calcitonin increases deposition of calcium and phosphate on the bone, simultaneously decreasing blood level concentrations. It inhibits osteoclasts by binding to receptors on them.
What is raloxifene?
An oral selective estrogen receptor modulator (SERM) that has estrogen like (pro-formation and anti-resorption) actions on bone.
What does SERM stand for?
Selective Estrogen Receptor Modulator
What is PTH?
A peptide hormone formed by the parathyroid glands and released by chief cells; it raises the serum calcium levels by causing bone resorption, reduced renal clearance of calcium, and increasing the efficiency of calcium absorption in the intestines.
A narrow therapeutic level of ______ may cause bone growth.
PTH
The sex steroid hormones stimulate?
Osteoblasts and inhibit osteoclasts, cause bone maturation and termination of growth.
What do bisphosphonates do?
Reduce the turnover of bone by inhibiting recruitment and promoting apoptosis of osteoclasts.
What does cathepsin K act on?
Is secreted by osteoclasts to break down collagen, inhibitors of cathepsin K inhibit the break down of bone.
What is denosumab?
A monoclonal antibody against RANKL and prevent bone resorption.
What is sclerostin?
A substance secreted by osteocytes which inhibit the actions of osteoblasts.
Sclerostin has antagonistic actions with _____?
Wnt
What is Osteoprotegerin?
A protein which binds RANKL hiding it from RANK and preventing osteoclast development.
What is RANKL?
A protein produced by osteoblasts which stimulates the differentiation of osteoclast precursors into osteoclasts by binding with RANK.
What is PTH-RP?
Parathyroid Hormone - Related Peptide
What is CaSR?
Calcium Sensing Receptor
What do the thiazides do?
Reduce calcium excretion; may cause hypercalcemia but the precise mechanism of improvement in bone density is unknow; may decrease vertebral fracture rate.
How effective are bone formation and anti-resorptive drugs in fracture prevention?
- All the drugs reduce fracture rate by ~50% and reduce fracture rates within 1 year.
- All agents except raloxifene reduce non-vertebral fractures.
- Some reduce hip fractures by ~40%.
Which drugs should be used to treat bone diseases?
- In early menopause or peri-menopause is often treated with estrogens.
- Bisphosphonates are the overall treatment of choice because of efficacy and safety.
- Raloxifene decreases breast cancer risk and possibly reduced cardiac disease risk.
Which drug decreases breast cancer risk and possibly reduces the risk of cardiac disease?
Raloxifene
What is orlistat and how does it function?
It is a weight loss drug. It blocks uptake of lipids from the gut to decrease fat absorption.
