Flashcards in Chapter 31: Bone Mineral Homeostasis Deck (36)
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
Estrogen + progestin
Suppresses transcription of RANKL genes so that osteoclasts are inhibited
Used for osteoporosis and treatment...kind of...also menopausal symptoms
What are the risks of using estrogen+progestin hormone replacement therapy?
Significantly increased risk of breast cancer!
Vaginal bleeding and breast tenderness also possible
What drug would you use to prevent and treat osteoporosis in a woman with a familiar history of breast cancer?
HRT - estrogen receptor AGONIST in bone but estrogen receptor ANTAGONIST in the breast and endometrium
Prevents those nasty vertebral fractures
When would you not use Raloxifene for osteoporosis tx?
If the pt had a history or risk for thromboembolus....raloxifene can increase this risk
MOA for biphosphonates?
These inhibit the mevalonate pathway in osteoclasts, leading to decreased osteoclast function and eventual apoptosis
Which biphosphonates would you use to treat osteoporosis specifically?
Which biphosphonates would you use to treat Paget's Disease specifically?
ARPZ (P for paget!)
Which biphosphonates would you use to treat hypercalcemia assc. with malignancy?
Which biphosphonates would you use to treat Osteolytic lesions in myeloma or breast cancer?
Serious side effects of biphosphonate use?
Bone remodeling will STOP
Jaw osteonecrosis in cancer patients! Eek.
Which biphosphonates are only available by IV?
pamidronate and zoledronate
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.
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)
Salmon Calcitonin MOA
Calcitonin inhibits osteoclasts by binding to and activating a G protein receptor
What drug would you use to target osteoporosis in the spine, nonspine, and hip especially?
What drug would you use to combat hypercalcemia?
What drug would you give for osteoporosis that only has to be injected every 6 months or once a month?
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.
What is the ONLY drug approved for those who already have low bone mass?
Once daily PTH
Which drugs INCREASE bone formation by osteoblasts?
What are the contraindications for these drugs?
hPTH 1-84 (investigational)
Do not use these if patient has Paget's, hypercalcemia, radiation therapy, or open epiphysis
hPTH 1-34 is used only for ___?
Patients with a high high risk of fracture...severe osteoporosis
Aluminum hydroxide MOA
MOA: decreases GI absorption of dietary inorganic phosphate
Not used anymore because of aluminum toxicity
What is the difference between intermittently or continuously used hPTH?
intermittent = increase bone production
continuous = decrease bone production
MOA, TX, risk?
MOA: Bind to dietary phosphate to decrease GI absorption
TX: chronic kidney disease
Risk: Can cause hypercalcemia
Sevelamer MOA, TX, downfall?
MOA: binds to dietary phosphate and also bile salts
TX: hyperphosphatemia-hyperostosis syndrome
Downfall: Super $$$
What would you use calcitriol for?
What do vitamin D analogues do? MOA?
Increase dietary absorption of calcium
Decrease PTH transcription