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Pharmacology > Calcium and Bone Drugs > Flashcards

Calcium and Bone Drugs Flashcards

1
Q

Calcium supplements

A

Calcium carbonate

Calcium citrate

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2
Q

Calcium supplements - MoA

A

Important for: Bone remodeling, nerve, muscle function, gland secretion, blood coagulation, enzyme activities

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3
Q

Calcium supplements - Clinical use

A

Hypocalcemia, osteoporosis

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4
Q

Calcium supplements - Adverse effects

A

Modestly increased risk of MI

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5
Q

Calcium supplements - Interactions

A

Decreased absorption of ciprofloxacin, fluoride, phenytoin, levothyroxine, tetracycline

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6
Q

Vitamin D supplements

A

Cholecalciferol (Vitamin D3)

Ergocalciferol (Vitamin D2)

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7
Q

Cholecalciferol - MoA

A

Increased synthesis of calcium-binding protein
increases calcium absorption.
Stimulation of bone resorption

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8
Q

Ergocalciferol - MoA

A

Activated in liver and kidneys to form calcitriol. Increases Ca and phosphorous absorption from the gut

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9
Q

Vitamin D supplements - Clinical use

A

Prevention and treatment of rickets (vit D-dependant and -resistant).
Prevention of osteoporosis.
Hypocalcemia (by hypoparathyroidism)
Tetani (post-op and idiopathic).
Prevention of vit D deficiency in chronic renal failure

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10
Q

Vitamin D supplements - Adverse effects

A

Hypercalcemia

Hypercalciuria

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11
Q

Vitamin D supplements - Interactions

A

Cholestyramine inhibits absorption.

Phenytoin and barbiturates: increased vit D metabolism and deficiency.

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12
Q

Bisphosphonates - Classification

A

Bone resorption inhibitors

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13
Q

Bisphosphonates - MoA

A

Absorb hydroxyapatite and become permanent parts of the bone structure (terminal half life is 10 years). Inhibits osteoclast activity by preventing them to attach to bone

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14
Q

Bisphosphonates - Clinical use

A

Osteoporosis, Paget disease of the bone, hypercalcemia, osteolytic bone lesions in metastatic cancer

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15
Q

Bisphosphonates - Contraindications

A

Dull, aching pain in the thigh or groin

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16
Q

Bisphosphonates - Adverse effects

A

Espohageal erosion, GI distress.

Long-term use: atypical (subtrochanteric & diaphysial) femur fractures. Poor oral health: Osteonecrosis of the jaw

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17
Q

Bisphosphonates reduces the risk of?

A

Breast cancer

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18
Q

Bisphosphonates - Interactions

A

Calcium supplements & antacids: decreases absorption of bisphosphonate

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19
Q

1st generation bisphosphonate

A

Etidronate

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20
Q

2nd generation bisphosphonates

A

Alendronate
Pamidronate
Risedronate
Tiludronate

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21
Q

2nd generation bisphosphonates - Clinical use

A

ALL: Paget disease of the bone (symptomatic/candidates for surgery)

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22
Q

Alendronate - Clinical use

A

Osteoporosis (all forms)

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23
Q

Alendronate - Adverse effects

A

GI distress only with high doses, mild and transient nausea, dyspepsia, constipation, diarrhea

24
Q

Pamidronate - Clinical use

A

Hypercalcemia associated with cancer.

25
Q

Risedronate - Clinical use

A

Prevention and treatment of osteoporosis in postmenopausal women.

26
Q

Tiludronate - MoA

A

Decreases tyrosine phosphase activity in osteoclasts, causing osteoclast detachment from bone. Inhibits osteoclastic proton pumps

27
Q

3rd generation bisphosphonates

A

Ibandronate

Zoledronic acid

28
Q

Ibandronate - Clinical use

A

Prevention and treatment of osteoporosis in postmenopausal women

29
Q

Zoledronic acid - Clinical use

A

Hypercalcemia associated with cancer

30
Q

Estrogen + related drugs

A

Estrogen

Raloxifene

31
Q

Estrogen - MoA

A

Inhibits production of bone cell cytokines (IL-1, TNF, IL-6, ect.), causing reduced bone resorption by decreasing formation and activation of osteoclasts.

32
Q

Estrogen - Clinical use

A

Relief of menopausal symptoms

33
Q

Estrogen - Contraindications

A

high doses in treatment for osteoporosis (increased risk of breast cancer and cardiovascular events)

34
Q

Raloxifene - MoA

A

Activates estrogen receptors in bone while having antiestrogen effects in breast and uterine tissues

35
Q

Raloxifene - Clinical use

A

Postmenopausal osteoporosis

36
Q

Raloxifene - Adverse effects

A

Intensify hot flashes, increased risk of stroke, pulmonary emboli, DVT

37
Q

Calcitonin - MoA

A

Binds to osteoclastic receptors, increases cAMP levels.

Short-term effect: inhibits osteoclast activity, decreases bone resorption, decreases serum Ca concentrations

38
Q

Calcitonin - Clinical use

A

Osteoporosis: women who cannot tolerate other treatments: parenterally/nasal adm.
Paget disease of bone, hypercalcemia (adm subcut/IM)

39
Q

Denosumab - Classification

A

Human immunoglobulin G2 monoclonal antibody, RANKL antibody

40
Q

Denosumab - MoA

A

Inactivation of osteoclastic gene transcription by inhibition of RANKL (transmembrane protein).

41
Q

Denosumab - Clinical use

A

Osteoporosis, prevention of skeletal-related events in breast, prostate cancer + other tumors

42
Q

Denosumab - Adverse effects

A

Back, extremity, musculoskeletal pain, hypercholesterolemia, cystitis, skin reactions, hypocalcemia, slight increase in malignancies (not established)

43
Q

Teriparatide - Classification

A

Recombinant form of human PTH

44
Q

Teriparatide - MoA

A

Increase bone formation (short-term).

Long-term: stimulate bone resorption

45
Q

Teriparatide - Clinical use

A

Osteoporosis (postmenopausal women and hypogonadal men at high risk bone fracture)

46
Q

Teriparatide - Contraindications

A

Rapid cessation of the drug, treatment should be followed by bisphosphatonates

Not given to people at increased risk for osteosarcoma (Paget disease of the bone)

47
Q

Teriparatide - Adverse effects

A

Increased incidence of osteosarcoma

48
Q

Strontium ranelate - MoA

A

Decreases osteoclastic activity & bone resorption in newly formed bone. Induces proliferation of osteoblasts

49
Q

Strontium ranelate - Clinical use

A

Prevention of osteoporosis

Prevent vertebral and non vertebral fractures

50
Q

Strontium ranelate - Adverse effects

A

Minor GI distress

Increased risk or venous and pulmonary thromboembolism and MI

51
Q

Sodium fluoride - MoA

A

Stored in bone and teeth. Replaces the hydroxyl group in calcium phosphate salts and form fluorapatite (more resistant to erosion)

52
Q

Sodium fluoride - Clinical use

A

Prevention of tooth decay and caries. Potential application for osteoporosis

53
Q

Sodium fluoride - Adverse effects

A

Excessive hardening of the bone (osteosclerosis), formation of demineralized bone, GI distress, interfere with Ca and Mg absorption

54
Q

Cinacalet - MoA

A

Increase the sensitivity of calcium-sensing receptors in the parathyroid gland to extracellular calcium, leading to decreased secretion of PTH and lowering of serum calcium levels

55
Q

Cinacalet - Clinical use

A

Hyperparathyroidism in adult patients with chronic kidney disease who are on dialysis

Hypercalcemia in patients with parathyroid cancer.

Pharmacology (55 decks)

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