Pharm: L18: Osteoporosis Flashcards Preview

Pharm Winter 2013 Midterm 2 > Pharm: L18: Osteoporosis > Flashcards

Flashcards in Pharm: L18: Osteoporosis Deck (14)
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1
Q

Calcium & Vit D

  1. Can it prevent or treat osteoporosis alone?
    a. Which calcium preparation is probably the best?
    b. Vitamin D levels have to be Adequate for what?
A
  1. NO! Adequate Ca2+ intake is needed for any other Tx to work!
    a. Chewable
    b. for Optimal Absorption of Calcium
2
Q

blah

A

blah

3
Q

Hormone Drugs

Calcitonin

a. When is it secreted?
b. Decreases Circulating Ca2+: how?
c. Will maintain bone in what 2 times? Stimulated by what?

  1. Bone Pain/Loss; Bone Density; Osteoporotic Fractures?
  2. Adverse Effects?
  3. Pharmacokinetics?
  4. Indications?
A
  1. a. Circulating Ca2+ is too high
    b. Inhibits Osteoclasts to Decrease Resorption
    c. in PREGNANCY and LACTATION (stimulated by estrogen)
  2. Decrease; Increase; Decrease
  3. Can cause Allergic RxNs; Nasal RHINITIS/SINUSITIS —> Nasal Spray; Nausea and Vomiting –> Injection
  4. Nasal Spray and Injection
  5. Osteoporosis (Not 1st Line) and Paget’s Disease
4
Q

Hormone Drugs

TERIPARATIDE

a. What is it?
b. What does PTH Stimulate?
c. What PRODUCES BONE GROWTH?

  1. Indications?
  2. Pharmacokinetics
  3. Adverse Effects
  4. CIs
A
  1. a. RECOMBINANT PTH
    b. REMODELING, causing bone resorption and new bone formation
    c. INTERMITTENT ADMINISTRATION!
  2. Tx for Osteoporosis and Hypoparathyroidism
  3. Subcutaneous Injection (Intermittent: Once or Twice a Day)
  4. Hypercalcemia and Hypercalciuria; Injection site Reactions; Dizziness and Leg Cramps
  5. OSTEOSARCOMA (black label).
5
Q

Hormone Drugs

Estrogen and Progestin

A

Estrogen Helps prevent Post-menopausal development of Osteoporosis

6
Q

Hormone Drugs

Raloxifene

A

?????

7
Q

Bisphosponates

ALENDRONATE, Ibandronate, Zoledronic Acid

a. What are they?
b. FDA approved?

A
  1. a. PCP bond analogs of Pyrophosphate. Powerful drugs used in HIGH RISK FRACTURE PATIENTS
    b. No.

*ALENDRONATE: Take Orally: Poor ABSORPTION; 2 Hrs before Breakfast, w/o Ca2+ or Mg. (taken Weekly)

Ibandronate: Take MONTHLY

*Zoledronic Acid: Injected IV Once/year

8
Q

Bisphosponates

  1. Mech of Action
  2. Indication
  3. Pharmacokinetics?
A
  1. Inhibit Osteoclast Activity and bone Resorption; Strengthen bone.
  2. FIRST LINE DOC for POST-MENOPAUSAL OSTEOPOROSIS; Paget’s disease
  3. Oral: ABSORPTION is POOR. TAKE on EMPTY STOMACH!. only 1/2 GLASS of WATER and stay upright for 30 minutes AFTER to dECREASE ESOPHAGEAL IRRITATION!
9
Q

Bisphosponates

Adverse Effects?

  1. CIs?
A

ABDOMINAL PAIN, NAUSEA, VOMITING

IV and Oral Administration increase POTENTIAL for JAW OSTEONECROSIS!

  1. ORAL ones DO NOT USE in Pts w/SERIOUS ESOPHAGEAL DISEASE or Pts w/BEDREST and can’t stay upright for an hour!
10
Q

Rank-Ligand Inhibitors

DENOSUMAB
a. What does it stand for?

  1. Mechanism of Action?
  2. Indications
  3. Pharm
  4. Adverse Effects
  5. CI?
A
  1. a. Den = DENSITY; OS = Osteo; U = Human; MAB = Monoclonal Antibody
  2. Inhibits Bone Resorption. Antibody to RANK-L (factor made by Osteoblasts that’s needed for the formation of Mature Osteoclasts)
  3. SEVERE OSTEOPOROSIS in Postmenopausal women; Increase Bone mass and strength in Both cortical and Trabecular Bone
  4. S.C. Injection; Once/6 months
  5. Hypocalcemia; Cellulitis, OSTEONECROSIS of the JAW!!!! (in cancer studies)
  6. Absolute: HYPOCALCEMIA (fix first)

Relative: Pregnancy/Lactation; Chronic Kidney Disease; Pts at risk for serious infections

11
Q

Bone Remodeling

  1. What is dominant?
  2. Goal of Osteoporosis Tx?
A
  1. Resorption Dominant

2. DECREASING BONE RESORPTION

12
Q

Regulation

  1. PTH
    a. Stimulated when?
    b. How does it INCREASE Circulating Ca2+?
A
  1. a. Blood Calcium is Low
    b. Increase Osteoclast Activity and Number (RANKL)
    * Increased Renal Ability to REABSORB Calcium: Decreased Ca2+ Excretion and Increased PO4 Excretion.

Why? Ca2+ Cant get into the bone

*STIMULATES CALCITRIOL (Production of 1,25-dihydroxy Vitamin D)

13
Q

Regulation

  1. Vitamin D
  2. Increases Circulating Ca2+: How?
A
  1. a. Stimulates COLAGEN synthesis in Osteoblasts (RANKL)

–> Stimulates Osteoclast Activity (Increased intestinal absorption and decreased renal excretion)

Works in conjunction with PTH

14
Q

Risk Factors for Osteoporosis?

A

Postemenopausal Women; Long-Term Glucocorticoid use; Thyrotoxicosis; Alcoholism; Malabsorption Syndrome