Drugs for Osteoporosis

Question 1

What are the Bisphosphonates?

Answer 1

• Alendronate and other -dronates

- Zoledronic Acid

Question 2

What are the Bisphosphonates?

Answer 2

• Alendronate and other -dronates

- Zoledronic Acid

Question 3

What are the Vitamin D’s?

Answer 3

• Ergocalciferol

- Cholecalciferol

Question 4

What are the Vitamin D’s?

Answer 4

• Ergocalciferol

- Cholecalciferol

Question 5

What is the Selective Estrogen Receptor Modulator (SERM)?

Answer 5

Raloxifene

Question 6

What is the Selective Estrogen Receptor Modulator?

Answer 6

Raloxifene

Question 7

What is the RankL (-)?

Answer 7

Denosumab

Question 8

What is the RankL (-)?

Answer 8

Denosumab

Question 9

What is the PTH Hormone?

Answer 9

Teriparatide

Question 10

What is the PTH hormone?

Answer 10

Teriparatide

Question 11

When are parenteral calcium salts given?

Answer 11

Severe hypocalcemia

Question 12

What are possible general side effects of calcium salts?

Answer 12

GI, CNS and Renal dysfunctions

Question 13

What form of Vitamin D/where is Ergocalciferol found?

Answer 13

D2 = Plant form

Question 14

What form of Vitamin D/where is Cholecalciferol found?

Answer 14

D3 = sunlight form

Question 15

What is the MOA for Calcitonin - Salmon?

Answer 15

(-) Osteoclasts to decrease bone resorption

Question 16

What is better about the Calcitonin-Salmon form?

Answer 16

Longer half life and more potent than the natural form

Question 17

When is Calcitonin-Salmon used?

Answer 17

For established osteoporosis

Question 18

When is Calcitonin-Salmon NOT used?

Answer 18

NOT used for prevention of osteoporosis

Question 19

What is the MOA for the Bisphosphonates and what are they?

Answer 19

• Alendronate and other -dronates and Zolendronic Acid
  = analogs of pyrophosphate
  ==> (-) bone resorption when incorporated into bone

Question 20

What class of drugs are analogs to pyrophosphate and (-) bone resorption by being incorporated into the bone?

Answer 20

Bisphosphonates

Question 21

What are the adverse effects (3) of Alendronate and other -dronates?

Answer 21

• Esophagitis
• Jaw Osteonecrosis
• Atypical femur fractures

Question 22

What are the adverse effects of Alendronate and other -dronates?

Answer 22

• Esophagitis
• Jaw Osteonecrosis
• Atypical femur fractures

Question 23

What should you do to try and avoid the esophagitis that can be associated with Alendronate?

Answer 23

Take with water and wait 30 mins before eating or drinking anything else

Question 24

How is Zolendronic Acid given?

Answer 24

IV 1X/year

Question 25

What is good about Zolendronic Acid compared to other Bisphosphonates?

Answer 25

Avoids GI problems

Question 26

What are the adverse effects (2) of Zolendronic Acid?

Answer 26

- Jaw osteonecrosis | - Kidney damage

Question 27

MOA for Raloxifene

Answer 27

Estrogen agonist at bone | Estrogen blocker at breast and uterus

Question 28

What are the adverse effects associated with Raloxifene?

Answer 28

Increased risk of DVT, Stroke and Pulmonary Embolism

Question 29

When should you discontinue Raloxifene?

Answer 29

Before prolonged inactivity to prevent a DVT, stroke or pulmonary embolism

Question 30

Should you take Raloxifene with pregnancy?

Answer 30

NO

Question 31

What is the MOA for Teriparatide?

Answer 31

Increases bone formation

Question 32

What drug increases bone formation?

Answer 32

Teriparatide

Question 33

When Teriparatide is given in a pulsed fashion, what occurs?

Answer 33

Osteoblast activity dominates

Question 34

When Teriparatide is given continuously, what occurs?

Answer 34

Osteoclast activity dominates

Question 35

How is Teriparatide given?

Answer 35

Once daily by using pre-filled injectors

Question 36

Denosumab (-) RANKL which causes what to occur in the cascade?

Answer 36

(-) RANKL (-) NF-KB (-) Osteoclast activation (-) Bone resorption

Question 37

How is Denosumab given?

Answer 37

Subcutaneous injection every 6 months

Question 38

What are the adverse effects (3) of Denosumab?

Answer 38

- Delays fracture healing - Increases fracture risk - Jaw Osteonecrosis

Question 39

What are the 1st line and 2nd line options for Osteoporosis?

Answer 39

``` 1st = Bisphosphonates 2nd = Denosumab ```

Question 40

What are the 1st and 2nd line agents for Osteoporosis?

Answer 40

``` 1st = Bisphosphonates 2nd = Denosumab ```