Chapter 31: Bone Mineral Homeostasis Flashcards
(36 cards)
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?
Raloxifene
Raloxifene MOA?
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?
ARIZ
Alendronate
Risedronate
Ibandronate
Zoledronate
Which biphosphonates would you use to treat Paget’s Disease specifically?
ARPZ (P for paget!)
Alendronate
Risedronate
Pamidronate
Zoledronate
Which biphosphonates would you use to treat hypercalcemia assc. with malignancy?
Pamidronate
Zoledronate
Which biphosphonates would you use to treat Osteolytic lesions in myeloma or breast cancer?
Pamidronate
Zoledronate
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.
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)
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?
Denosumab
What drug would you use to combat hypercalcemia?
Salmon calcitonin
What drug would you give for osteoporosis that only has to be injected every 6 months or once a month?
Denosumab
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 1-34
hPTH 1-84 (investigational)
Fluoride (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
