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Flashcards in Bone Drugs Deck (28):
1

Effects of VitD/calcitrol

Increase plasma Ca and PO4

2

Effects of PTH on Ca/PO4

Inc plasma Ca2
Decrease PO4

3

Effects of FGF23 on Ca/PO4

Dec plasma PO4
No effect on Ca

4

Why is Ca maintained at higher levels in the body?

Hypocalcemia is super dangerous vs hypercalcemia and can be more easily attained --> maintain Ca at the expense of PO4

5

How does estrogen relate to osteoporosis?

Inc osteoblasts, dec osteoclasts
Inc OPG, dec RANKL

6

What is the role of RANKL?

Activates osteoclasts

7

What is the role of OPG?

Inhibits the production of osteoclasts

8

2 phases of bone loss

Loss of trabecular bone
Thinning of cortical bone

9

Menopause related vs age related bone loss

Menopause: first, 3-5 yr, trabecular bone deteriorate
Age: second, 10-20 yr, trabecular and cortical loss

10

How do steroids cause osteoporosis?

dec in osteoblast activity, dec GI absorption of calcium

11

how does excess thyroid hormone cause osteoporosis?

Inc bone turnover and bone loss (since bone formation takes 5x longer than resorption)

12

Prevention strategies for at risk women

Daily Ca/VitD
Avoid weight loss/low BMI
Physical activity
Stop smoking
Fall prevention

13

How does daily Ca help osteoporosis

Dec PTH and therefore bone resorption

14

How does Vit D dec osteoporosis

Inc GI absorption of Ca
Inc type 2a muscle fibers
Dec PTH and therefore resorption

15

How does weight bearing exercise help osteoporosis

reduce falls
osteocytes respond to mechanical stress to inc bone mass

16

How does smoking worsen osteoporosis

Dec GI Ca absorption
Inc bone loss
Inc liver induction of estrogen metabolism (HRT less effective)

17

Osteoporosis in cortical vs trabecular bone

Remodel/yr: 25% trabecular, 3% cortical (trabecular more affected in osteoporosis)

18

M/c fractures

Vertebral > hip > limb

19

First line pharm for osteoporosis

Bisphosphonates
Denosumab

20

Which drugs are the only bone FORMING agents?

Teriparatide, intact PTH

21

Ca supplements AE, contra

AE: constipation, urolithiasis, prostate cancer, GI
Contra: hypercalcemia, VFib

22

Vit D supplements (calciferol, diol, triol)

AE: may cause more hypercalcemia
Contra: hyper Ca, Vit D, or malabsorption syndrome

23

Teraparatide use, AE, Contra

Use: Osteoporosis w/ high fx risk
AE: angina, hypotension
Contra: paget's, open epiphyses, prior radiation or bone malig

24

Cinacalcet MOA, AE, contra

MOA: inc Ca sensitivity in parathyroid cells (less PTH release)
AE: arrhythmia, CHF, seizure, electrolyte
Contra: hypocalcemia

25

Raloxifene MOA, AE, contra

MOA: SERM, agonist in bone
AE: retinal occlusion, VTE
Contra: preg, hx of VTE

26

Bisphosphonates (-dronate) AE, other notes

AE: arthralgia, myalgia, esophageal ulcer, GI upset
Other: need good kidneys, drug holiday after 5 yrs, flu like sx with initiation

27

Denosumab MOA, AE, contra

MOA: MAB against RANKL
AE: endocarditis, cellulitis, pancreatitis
Contra: hypocalcemia, preg

28

Calcitonin use, MOA, AE

Use; Hypercalcemia, Paget's dz, osteoporosis
MOA: lowers blood Ca levels by dec Gi absorption, kidney reabsoption and Ca deposition in the bone
AE: hypokalemia, seizure, cancer