Bone Drugs

Question 1

What cells in what organ produce calcitonin?

Answer 1

parafollicular C cells of thyroid

Question 2

What cells in what organ release PTH?

Answer 2

Chief cells of the parathyroid gland

Question 3

What are the effects of PTH on plasma phosphate and calcium?

Answer 3

Decrease phosphate

Increase calcium

Question 4

What are the effects of calcitonin on serum phosphate and calcium?

Answer 4

Decrease phosphate
Decrease calcium

(opposite of vit D)

Question 5

moderate decline in what ion enhances PTH secretion?

Answer 5

Mg+2 - but if severe decrease -> decrease in PTH

Question 6

What are the effects of active vitamin D on serum phosphate and calcium?

Answer 6

increase phosphate
increase calcium

(opposite of calcitonin)

Question 7

What are the effects on bone of pulsatile PTH vs continued secretion?

Answer 7

pulsatile: bone formation
excess: bone resorption

Question 8

which drug is a PTH analog and is used in the treatment of osteoporosis. How must it be given?

Answer 8

Teriparatide

give pulsatile to stimulate bone growth

Question 9

Which drug is a RANKL inhibitor and is used in osteoporosis? How does it work? 1 Adverse effect?

Answer 9

Denosumab - monoclonal Ab binds RANKL and prevents it from stimulating osteoclasts

AE: increased risk of infections (same with all monoclonal Abs)

Question 10

What is the difference between type I and type II Rickets?

Answer 10

Type I: defective 1alpha hydroxylase (dec calcitriol)

Type II: defective vit D receptor

Question 11

Which drug is used to treat secondary hyperparathyroidism in patients with chronic renal disease and liver disease?

Answer 11

Calcitriol - vitamin D

Question 12

What topical drug is used to treat psoriasis?

Answer 12

Calcipotriol - vitamin D

Question 13

Overdose of vitamin D leads to what two major symptoms?

Answer 13

Hypercalcemia

Hyperphosphatemia

Question 14

What are the two generic drug names for vit D3 and vit D2? what are they used for?

Answer 14

D3: Cholecalciferol
D2: Ergocalciferol

commonly added to calcium supplements and dairy products

Question 15

What drug is given to patients with hyperphosphatemia in chronic renal failure? how does it work?

Answer 15

Sevelamer - binds dietary phosphate and prevents absorption

Question 16

Which drug can be given IV to treat hypocalcemic tetany?

Answer 16

IV calcium gluconate

Question 17

Which drug can be given to counteract overdose of magnesium sulfate used in eclampsia?

Answer 17

Calcium gluconate

Question 18

What are the two important adverse effects of calcium gluconate? (1 when given IM, 1 when given IV)

Answer 18

IM: injection can cause necrosis and abscess
IV: can cause thrombophlebitis

Question 19

Which drug used to treat osteoporosis has been shown to increase bone mass and reduce spine fractures? How is it given?

Answer 19

Calcitonin

injection or nasal spray

Question 20

Which SERM is estrogen antagonistic in breast, but agonistic in bone and uterus? AE?

Answer 20

Tamoxifen (selective estrogen receptor modulator)

increased risk of endometrial cancer

Question 21

Which SERM is estrogen antagonistic in breast, agonist in bone and has no effect on endometrium?

Answer 21

Raloxifene (selective estrogen receptor modulator)

Question 22

Which SERM is approved for treatment of osteoporosis in post-menopausal women?

Answer 22

Raloxifene

Question 23

Which class of drugs is useful in treating osteoporosis, malignancy associated hypercalcemia, and Paget’s disease of the bone?

Answer 23

Bisphosphonates (the -dronates)

Question 24

What class of drugs inhibits osteoclastic activity by decreasing farnesyl pyrophosphate synthesis? How are they given?

Answer 24

Bisphosphonates (the -dronates)

IV or orally (less than 10% bioavailability orally)

Question 25

What drugs used to treat osteoporosis can cause erosive esophagitis?

Answer 25

Bisphosphonates (the -dronates) | oral ones: Alendronate and Risedronate

Question 26

Which drug is a calcium receptor agonist that leads to suppression of PTH synthesis and release in secondary hyperparathyroidism (chronic renal disease) and in patients with parathyroid carcinoma?

Answer 26

Cinacalcet

Question 27

Exposure to what can lead to new bone synthesis that is denser, but brittle?

Answer 27

Fluoride

Question 28

Which drug inhibits bone resorption in cancer-related hypercalcemia, but is nephrotoxic?

Answer 28

Gallium nitrate

Question 29

Which cytotoxic anticancer drug can be used to treat cancer-related hypercalcemia, but is hepatic and renal toxic?

Answer 29

Plicamycin

Question 30

Which class of drugs can prevent renal stones by decreasing the renal excretion of calcium?

Answer 30

thiazide diuretics

Question 31

what are the major signs of hypercalcemia?

Answer 31

``` Stones (renal stones) Bones (bone pain) Groans (abdominal cramps) Thrones (polyuria) Psych overtones (fatigue, depression, anxiety) ```

Question 32

Which drug is used to treat osteoporosis, but if used long term can lead to osteomalacia?

Answer 32

Etidronate (>12 mo use) (bisphosphonate)

Question 33

Name 5 drugs that can cause osteoporosis

Answer 33

``` Corticosteroids Heparin Lithium Anastrazole Alcohol ```