DRUGS IN MANAGING MUSCULOSKELETAL CONDITIONS Flashcards
what are some risk factors for osteoporosis?
low oestrogen being a woman low serum calcium alcohol smoking drugs like glucocorticoids, heparin and L-thyroxine physical inactivity diseases like DM, klinefelter syndrome and turner syndrome
which fractures are most common for those with osteoporosis?
vertebral
femoral neck
distal radius
how should you treat osteoporosis in postmenopausal women?
oral bisphosphonates e.g. alendronic acid and risedronate sodium
HRT
Teriparatide if very severe and at very high risk of fractures
why is HRT usually restricted to younger postmenopausal women for treating osteoporosis?
risk of adverse effects e.g. CVD and cancer
how do we treat glucocorticoid-induced osteoporosis?
oral bisphosphonates e.g. alendronic acid and risedronate sodium
how do nitrogen containing bisphosphonates work?
By inhibiting farnesyl diphosphate synthase in the cholesterol synthesis pathway in the osteoclast which causes osteoclast inactivation.
whats a concern over bisphosphonate use?
that when used to treat cancer it can cause osteonecrosis of the jaw
what are treatment options for osteoporosis?
bisphosphonate drugs thiazide diuretics SERM exercise monoclonal antibodies e.g. denosumab
how do thiazide diuretics help in osteoporosis?
they boost calcium retention in the kidney and directly stimulate osteoblast differentiation
how does denosumab help in osteoporosis?
its a monoclonal antibody which inhibits osteoclasts
what do osteoblasts release to activate osteoclasts?
RANK-L
what do osteoblasts rekease to prevent further maturation of osteoclasts?
OPG
what are the risks of HRT?
increased risk of breast cancer and ovarian cancer
can affect womb cancer
can increase risk of conditions like heart dosease and strokes
what are the benefits of HRT?
reduce menopause symptoms
improve QoL
may slightly reduce risk of bowel cancer
what are the treatment options for rheumatoid arthritis?
NSAIDs steroids DMARDs biologicals immunosuppression
