Bone Pharm

Question 1

Hormones

Answer 1

Teriparatide

calcitonin

Question 2

Vit D

Answer 2

choecalciferol (D3)
ergocalciferol (D2)
Calcitriol

Question 3

Estrogen R modulators

Answer 3

Raloxifene

Question 4

Bisphosphonates

Answer 4

Alendronate

Question 5

MABs

Answer 5

denosumab

Question 6

appendicular bone

Answer 6

80% of bone mass

mostly compact cortical bone

Question 7

axial bone

Answer 7

trabecular

alteration in bone turn-over occur here

Question 8

OPG

Answer 8

decoy R for RANKL
produced by osteoblasts
suppressed by estrogen deprivation

Question 9

normal Ca

Answer 9

8.5-10.5

Question 10

normal Phosphate

Answer 10

2.5-4.5

Question 11

PTH and bone

Answer 11

increases activity and number of osteoclasts by binding osteoblasts which release RANKL which activates osteoclasts
inhibits sclerostin (inhibits osteoblasts) from osteocytes, but net effect is still bone break down

Question 12

PTH and kiindey

Answer 12

increase Ca resorption
increases Phosphorous excretion
sitimulates vit D activation
increases Mg resorption

Question 13

teleparatide

Answer 13

synthetic recombinant human parathyroid hormone

Question 14

teleparatide MOA

Answer 14

continuous administration causes bone demineralization

intermittent promotes growth

Question 15

uses of teleparatide

Answer 15

women w/Hx of osteoporotic fracture and failed other drug therapy
men with primary hypogonadal osteoporosis

Question 16

ADRs teleparatide

Answer 16

orthostatic hypotension
hypercalemia
dizziness, nausea
hyperuricemia
anggina

Question 17

teleparatide CI

Answer 17

pts with increased risk of osteosarcoma: pagets, elevated alk phos, open epiphyses, prior radiation therapy of skeleton

Question 18

Calcitriol actions

Answer 18

augments intestinal absorption and retention of Ca and phos
increases bone turnover by
-recruitment and activation of osteoclasts
-increasing RANKL and osteocalcin

Question 19

otherwise healthy what type of vit D do you Tx with?

Answer 19

ergocalciferol or cholecalciferol

Question 20

liver dis what type of D do you Tx with?

Answer 20

25-hydroxy

Question 21

kindey dis what type of D do you Tx with?

Answer 21

calcitriol

Question 22

what can vit D be used to Tx

Answer 22

rickets
hypoparathyroidism
prevention and Tx of osteoporosis

Question 23

ADRs to vit D

Answer 23

hypercalcemia -> n/v constipation
hyperphosphatemia
arrhythmias and pancreatitis

Question 24

FGF23

Answer 24

inhibits 1,25 (OH)2D production and phosphate resorption in kidney
produced by osteocytes and osteoblasts

Question 25

calcitonin

Answer 25

decreases serum Ca and phos inhibits osteoclasts decreases Ca and Phos resorption in kidney

Question 26

uses of calcitonin

Answer 26

pagets osteoporosis hypercalcemia

Question 27

ADRs of calcitonin

Answer 27

nausea, hand swelling, urticaria, intestinal cramping

Question 28

estrogens

Answer 28

prevent bone loss post-menopause | SERM (raloxifene) less ADRs then E

Question 29

raloxifene ADRs

Answer 29

hot flashes leg cramps thromboemoblism (3x increased risk)

Question 30

CI of raloxifene

Answer 30

Hx of venous thromboembolism CAD strokes

Question 31

bisphosphonate mOA

Answer 31

analogs of pyrophosphonate with C chelate Ca incorporate into bone decrease formation and dissolution of hydroxyapatite crystals and inhibit osteoclasts

Question 32

PK of bisphosphonates

Answer 32

must be taken on empty stomach 30 min before meal | must be sitting upright and taken with full glass of water

Question 33

uses of bisphos

Answer 33

osteoporosis hypercalcemia of malignancy pagets

Question 34

ADRs of bisphos

Answer 34

osteonecrosis of the jaw | subtrochanteric femur fractures

Question 35

Denosumab MOA

Answer 35

binds RANKL | mimics osteoprotegrin

Question 36

PK of denosumab

Answer 36

sub-q every 6 months

Question 37

denosumab ADRs

Answer 37

possible immunosuppression risk of osteonecoris of jaw and subtrochanteric fractures (maybe) transietn hypocalcemia

Question 38

cincalcet MOA

Answer 38

activated CaSR -> inhibits PTH secretion

Question 39

uses of cincalcet

Answer 39

secondary hyperparathyroidism

Question 40

hypercalcemia Tx

Answer 40

``` saline diuresis +/- furosemide bisphos calcitonin (takes 4-6hrs) IV phosphate (fastest, but must be very careful) glucocorticoids ```

Question 41

hypocalcemia Tx

Answer 41

Ca (IV, IM, or PO) If IV Ca gluconate preferred Vit D

Question 42

hyperphosphotemia Tx

Answer 42

- restrict dietary phosphate - phosphate binding gels (Ca) - aboid aluminum antacids

Question 43

primary hyperparathyroidism

Answer 43

surgery

Question 44

secondary hyperparathyroidism

Answer 44

vit D | cinacalcet

Question 45

hypoparathyroidism

Answer 45

Ca | Vit D

Question 46

pagets

Answer 46

calcitonin and bisphosphonates (only for 6 months at a time)