Chapter 61: Calcium Levels And Bone Mineralization Flashcards

Question

Calcitonin

Answer 1

Inhibits the activity of osteoclasts Decreases bone resorption Inhibits tubular resorption of calcium Increases calcium excretion Therapeutic uses: Osteoporosis, Paget disease, hypercalcemia Adverse effects: nausea, flushing of face and hands, intranasal dryness

Answer 2

Structural analogs of pyrophosphate Incorporate into bone: Inhibit bone resorption by decreasing activity of osteoclasts Indications: Postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget disease of bone, hypercalcemia of malignancy May also help prevent and treat bone metastases in patients with cancer Adverse effects: May include ocular inflammation, osteonecrosis of the jaw (ONJ), atypical femur fractures, atrial fibrillation (A-fib) -monitor jaw pain

Answer 3

Most widely used oral bisphosphonate Uses: Postmenopausal osteoporosis, male osteoporosis, glucocorticoid-induced osteoporosis, Paget disease of bone Oral bioavailability: Poor Adverse effects: Generally safe; esophageal ulceration, atypical femoral fracture, esophageal cancer, musculoskeletal pain, ocular problems, ONJ, hyperparathyroidism, A-fib Don’t want pt to eat or drink until 30 min after med Wait 2 hr to take any Ca products or any other mineral supplements

Answer 4

Uses: Postmenopausal osteoporosis, male osteoporosis, glucocorticoid-induced osteoporosis, Paget disease of bone Adverse effects: Arthralgia, diarrhea, headache, rash, nausea, flulike syndrome, esophagitis, atypical femoral fractures, ocular problems, musculoskeletal pain Take in morning Delayed release form -> they can eat

Answer 5

Uses: Prevention and treatment of postmenopausal osteoporosis Dosing: Once a month or once every 3 months Adverse effects: GI effects, including esophagitis, dyspepsia, abdominal pain; ocular inflammation; atypical fractures; ONJ; renal damage if IV administered too rapidly Oral dosing on empty stomach in the morning with full glass of water an stay upright for 60 min after If given IV, needs to be slow admin

Answer 6

Use: Paget disease of bone Adverse effects: Nausea, diarrhea, dyspepsia, esophagitis, ocular problems, musculoskeletal pain, possibly esophageal cancer, chest pain, edema, paresthesias, hyperparathyroidism, vomiting, flatulence

Answer 7

Structurally similar to estrogen and binds to estrogen receptors Comparison to estrogen Therapeutic uses Osteoporosis Breast cancer Adverse effects Thromboembolic events, such as deep vein thrombosis (DVT), pulmonary embolism, stroke, and fetal harm, weight gain Daily tablet

Answer 8

Form of PTH Treat GIOP –glucocorticoid induced OP Produced by recombinant DNA Only drug that increases bone formation Generally well tolerated Nausea, headache, back pain, leg cramps

Answer 9

First-in-class RANKL (RANKL, receptor activator of nuclear factor kappa-B ligand) inhibitor with three indications: Osteoporosis in postmenopausal women and in men at high risk for fractures Bone loss in women and men receiving certain anticancer therapy Prostate or breast cancer Prevention of skeletal-related events in patients with bone metastases from solid tumors Treat GIOP

Answer 10

Hypocalcemia Serious infections Dermatologic reactions Dermatitis, eczema Osteonecrosis of the jaw Wary about dental implants and dental procedures

Answer 11

Prolia store in fridge an warm this ~15-30 min at room temp before admin. Should be clear an colorless or very pale yellow. Any cloudiness –do not Admin

Answer 12

Calcimimetic drug Approved for primary hyperparathyroidism and secondary hyperparathyroidism (caused by CKD) Increases the sensitivity of calcium-sensing receptors to activation by extracellular calcium Suppresses PTH secretion Adverse effects: Nausea, vomiting, diarrhea, hypocalcemia

Answer 13

Furosemide Promote renal excretion of Ca Glucocorticoids Decrease intestinal absorption of Ca Bisphosphonates Decrease bone reabsorption by osteoclasts Inorganic phosphates Decrease plasma levels of Ca Edetate disodium Chalating agent Bind with Ca to ensure renal excretion occurs

Answer 14

Most common disorder of calcium metabolism Low bone mass and increased bone fragility OP seen with aging typically in women –small boned, small frame women. Can also be seen small framed men Weight bearing exercise offset OP Primary prevention Calcium, vitamin D, lifestyle Diagnosis Measurement of bone mineral density (BMD) Dual-energy x-ray absorptiometry (DEXA) Effects ~ 10 million Americans ~34 million have reduced bone mass Common fx sites: vertebrae (spinal), distal forearm around the wrist, femoral neck (hip)

Answer 15

Agents that decrease bone resorption: Estrogen, raloxifene, bisphosphonates, calcitonin, denosumab; sufficient calcium and vitamin D are important Agent that promotes bone formation: Teriparatide (Forteo) Agents that reduce fractures: Teriparatide, denosumab, zoledronate Treat anyone with hip or vertebrae fx, OP t score of

Answer 16

Five drugs have been approved for osteoporosis treatment in men: Alendronate [Fosamax] Risedronate [Actonel] Zoledronate [Reclast] Teriparatide [Forteo] Denosumab [Prolia] 2 million men 3 million at risk