Drugs for Bone Mineral Homeostasis

Question 1

teriparatide

Answer 1

hrPTH; stimulates bone formation at low doses; at high doses, causes one resorption; may stimulate IGF-1

Question 2

raloxifene

Answer 2

selective estrogen receptor modulator used for osteoporosis; has the beneficial effects of estrogen without stimulating breast cancer

Question 3

denosumab

Answer 3

mAb to RANKL; blocks stimulation of osteocyte formation by RANKL and decreases osteoporosis

Question 4

calcitonin use

Answer 4

short term therapy for hypercalcemia, Paget’s disease, and osteoporosis; antibody development occurs with long-term use

Question 5

calcitriol MOA

Answer 5

stimulates Ca2+ and PO4- absorption in the small intestine; induces synthesis of calbindin; binds to transcription factor to increases mRNA and protein synthesis

Question 6

calcipotriol

Answer 6

calcitriol analog used in the treatment of psoriasis

Question 7

dihydrotachysterol

Answer 7

reduced vitamin D2, less effective than calcitriol; used in the treatment of osteoporosis

Question 8

paricalcitol

Answer 8

calcitriol analog; reduces PTH secretion

Question 9

22-oxacalcitriol

Answer 9

suppresses PTH gene expression

Question 10

bisphosphonates moa

Answer 10

reduce resorption and formation of bone by acting on the basic hydroxyappetite crystal structure

Question 11

bisphosphonates used for paget’s disease

Answer 11

etidronate (1st gen), alendronate (2nd gen) and risedronate (3rd gen)

Question 12

bisphosphonates used for osteoporosis

Answer 12

alendronate

Question 13

bisphosphonates pharmacology

Answer 13

all are absorbed poorly; must be taken after an overnight fast with a full glass of water and no food for 30 minutes

Question 14

bisphosphonates adverse effects

Answer 14

osteonecrosis of the jaw; renal impairment

Question 15

glucocorticoids

Answer 15

antagonize Ca uptake in the intestine; common cause of osteoporosis; useful in reversing lymphoma-induced hypercalcemia

Question 16

estrogens

Answer 16

effects in preventing osteoporosis; increased risk of thrombosis

Question 17

Cinacalcet

Answer 17

calcium sensor receptor mimetic; suppresses PTH

Question 18

plicamycin

Answer 18

antibiotic used for Paget’s disease and hypercalcemia (seldom used)

Question 19

strontium ranelate

Answer 19

blocks differentiation of osteoclases and promotes apoptosis and bone formation; used in Europe

Question 20

Fluoride use

Answer 20

potentially prevents osteoporosis; prevents dental caries;

Question 21

fluoride toxicity

Answer 21

osteosclerosis, mottled enamel