Bone Mineral homeostasis drugs Flashcards Preview

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Flashcards in Bone Mineral homeostasis drugs Deck (27):
1

Intracellular calcium is where?

mitochondria/ER

2

Extracellular calcium is 40% albumin boundand 10% complexed to phosphate, citrate and 50% free ionized calcium

Parathyroid responds to the free ionized calcium

3

Denusomab

mAB to RANKL. It blocks osteoclasta ctivation by RANKL and thus inhibits osteoporosis. Also used to increase bone mass in patients with breast/prostate cancer

4

Calcitriol---in active Vit D.

Stimulates calcium and phosphate absorption in the GI. Induces Calbindin. Not a vitamin!!!

5

Calcipotriol

used in psoriasis

6

Cinacalcet

Binds allosterically to Calcium sensing receptors and makes the body think there is more calcium in the blood than there really is. Turns off PTH at lower calcium levels.

7

When would you use cinacalcet?

hyperparathyroidism and parathyroid carcinoma

8

What are bisphosphonates

non-hydrolyzable pyrophosphate analogs. They inhibit bone resorption. Effective in osteoporosis

9

How are bisphosphonates absorbed

Poorly in the gut. Must take them after overnight fast with water and no food for 30min. Now given in weekly dose form.

10

Big AE of bisphosphonates

Osteonecrosis of the Jaw...jaw bone exposure, swelling, loosening of teeth. Dentists make it worse as 80% of the instances of osteonecrosis follow dental work

11

Which type of bisphosphonates are most likely to cause osteonecrosis of the jaw?

The 3rd generation drugs that are used to treat ppl with cancer.

12

Why would you give a cancer pt bisphosphonates

Prevent bone loss caused by chemo

13

Which type of cancers are bisphosphonates receommended in?

Bone Mets, Breast, prostate

14

Ibandronate

2nd generation (10-100x potency)

15

Risedronate

3rd gen bisphosphonate (1k to 10k potency) . Cancer pts with bone mets. IV, may onlyneed one dose

16

WHat else can you give Risedronate for?

Paget's disease

17

Raloxifene

Estrogen Receptor modulator

18

What is Raloxifene for?

Osteoporosis

19

Raloxifene mech

Inhibits osteoclasts without causing breast cancer.

20

What is a PTH analog

Activates adenylyl cyclase which raises cAMP levels. High cAMP can be measured in the urine for parathyroid function

21

PTH analogs used for

hypoparathyroidism

22

Teriparatide

PTH analog...only first 34 amino acids.

23

HOw does Teriparatide work?

Stimulates bone formation directly. We know that low doses of PTH activate osteoblasts without ativating osteoclasts...maybe thats whats going on.

24

When would you give Teriparatide?

after bisphosphonate therapy in women

25

Zoledronate?

the other 3rd gen bisphosphonate

26

When would you use Teriparatide?

In women post bisphosphonate...bisphosphonates like Ibandronate would prevent reabsorption and then you use the Teriparatide to kick start bone growth

27

Zoledronic acid

bisphosphonate...cancer pts with bone mets