Chapter 31: Bone Mineral Homeostasis Flashcards Preview

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Flashcards in Chapter 31: Bone Mineral Homeostasis Deck (36)
1

Estrogen + progestin

MOA: suppreses transcription of RANKL genes = inhibits osteoclasts = prevent bone breakdown

TX: KIND OF osteoporosis, also relieves symptoms of menopause like hot flashes

2

Estrogen + progestin

Suppresses transcription of RANKL genes so that osteoclasts are inhibited

Used for osteoporosis and treatment...kind of...also menopausal symptoms

3

What are the risks of using estrogen+progestin hormone replacement therapy?

Significantly increased risk of breast cancer!

Vaginal bleeding and breast tenderness also possible

4

What drug would you use to prevent and treat osteoporosis in a woman with a familiar history of breast cancer?

Raloxifene

5

Raloxifene MOA?

HRT - estrogen receptor AGONIST in bone but estrogen receptor ANTAGONIST in the breast and endometrium

Prevents those nasty vertebral fractures

6

When would you not use Raloxifene for osteoporosis tx?

If the pt had a history or risk for thromboembolus....raloxifene can increase this risk

7

MOA for biphosphonates?

These inhibit the mevalonate pathway in osteoclasts, leading to decreased osteoclast function and eventual apoptosis

8

Which biphosphonates would you use to treat osteoporosis specifically?

ARIZ

Alendronate
Risedronate
Ibandronate
Zoledronate

9

Which biphosphonates would you use to treat Paget's Disease specifically?

ARPZ (P for paget!)

Alendronate
Risedronate
Pamidronate
Zoledronate

10

Which biphosphonates would you use to treat hypercalcemia assc. with malignancy?

Pamidronate
Zoledronate

11

Which biphosphonates would you use to treat Osteolytic lesions in myeloma or breast cancer?

Pamidronate
Zoledronate

12

Serious side effects of biphosphonate use?

Bone remodeling will STOP
Jaw osteonecrosis in cancer patients! Eek.

13

Which biphosphonates are only available by IV?

pamidronate and zoledronate

14

What is the special consideration associated with oral biphosphonates?

They must be taken after an overnight fast.

Take only with water.

Nothing for 30-60 minutes.

Must Sit UP/ Stand UP for 30-60 minutes after taking the pill!!!!

WHY? Because of poor intestinal absorption.

15

Denosumab

MOA: RANKL antagonist - so osteoclasts do not bind to RANKL and mature.

TX: osteoporosis prevention and treatment for the spine, nonspine, and hip especially

"Occupy RANKL," said the Mab (Denosumab)

16

Salmon Calcitonin MOA

Calcitonin inhibits osteoclasts by binding to and activating a G protein receptor

17

What drug would you use to target osteoporosis in the spine, nonspine, and hip especially?

Denosumab

18

What drug would you use to combat hypercalcemia?

Salmon calcitonin

19

What drug would you give for osteoporosis that only has to be injected every 6 months or once a month?

Denosumab

20

Describe the use of salmon calcitonin to treat Paget and Osteoporosis

Can do both, but:
biphosphonates are better

If patient can't tolerate other options for osteoporosis, Salmon Calcitonin comes in a nasal spray that may be easier on the patient.

21

What is the ONLY drug approved for those who already have low bone mass?

Once daily PTH

22

Which drugs INCREASE bone formation by osteoblasts?

What are the contraindications for these drugs?

hPTH 1-34
hPTH 1-84 (investigational)
Fluoride (investigational)

Do not use these if patient has Paget's, hypercalcemia, radiation therapy, or open epiphysis

23

hPTH 1-34 is used only for ___?

Patients with a high high risk of fracture...severe osteoporosis

24

Aluminum hydroxide MOA

MOA: decreases GI absorption of dietary inorganic phosphate

Not used anymore because of aluminum toxicity

25

What is the difference between intermittently or continuously used hPTH?

intermittent = increase bone production
continuous = decrease bone production

26

Calcium carbonate
Calcium acetate

MOA, TX, risk?

MOA: Bind to dietary phosphate to decrease GI absorption

TX: chronic kidney disease

Risk: Can cause hypercalcemia

27

Sevelamer MOA, TX, downfall?

MOA: binds to dietary phosphate and also bile salts
TX: hyperphosphatemia-hyperostosis syndrome
Downfall: Super $$$

28

What would you use calcitriol for?

Rickets

29

What do vitamin D analogues do? MOA?

Increase dietary absorption of calcium
Decrease PTH transcription

30

Cinacalcet MOA, TX

MOA: increase senstivity of calcium sensing receptor....causes decreased secretion of PTH

TX: secondary hyperparathyroidism
hypercalcemia

DOES NOT REVERSE OR STOP BONE LOSS

31

Calcium Carbonate
(and Calcium gluconate, calcium citrate malate)

Helps with hypocalemic states like Rickets, osteomalacia, hypoparathyroidism
Tums
Must be taken with food

32

Cinacalcet MOA, TX

MOA: increase senstivity of calcium sensing receptor....causes decreased secretion of PTH

TX: secondary hyperparathyroidism
hypercalcemia

DOES NOT REVERSE OR STOP BONE LOSS

33

Calcium Carbonate
(and Calcium gluconate, calcium citrate malate)

Helps with hypocalemic states like Rickets, osteomalacia, hypoparathyroidism
Tums
Must be taken with food

34

What drug would you give for a patient with severe hypophosphatemia?

Potassium phosphate

can cause diarrhea

35

What are the risks/concerns/adverse health effects for HRT with estrogen?

There is a significantly increased risk for breast cancer! Yikes!

also, vaginal bleeding and breast tenderness

36

Raloxifene

MOA: estrogen receptor AGONIST in bone
but is an estrogen receptor ANTAGONIST in endometrium and breast

Tx: prevent vertebral fractures