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Pharmacology > Drugs that Affect Bone and Mineral Homeostasis > Flashcards

Drugs that Affect Bone and Mineral Homeostasis Flashcards

1
Q

Actions of PTH

A

(-) calcium excretion – increased serum calcium

promotes phosphate excretion – decreased serum phosphate

stimulates production of active vit. D metabolites
promotes bone turnover

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2
Q

Signs and Symptoms of Excess PTH

A

painful bones
renal stones
abdominal groans
psychiatric overtones

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3
Q

Regulates synthesis and secretion of Parathyroid Hormone (PTH)

A

Free Ionized Calcium

decreased free ionized calcium stimulates PTH release

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4
Q

Regulates gene transcription via the vitamin D receptor

A

Vitamin D (INACTIVE)
Ergocalciferol
Cholecalciferol

Vitamin D (ACTIVE)
Calcitriol
Doxercalciferol
Paricalcitol
Calcipotriene
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5
Q

Used for management of secondary hyperparathyroidism in patients w/ CKD and management of hypocalcemia

A

Calcitriol

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6
Q

Used for management of secondary hyperparathyroidism in patients w/ CKD

A

Doxercalciferol

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7
Q

An analog of Calcitriol used for management of secondary hyperparathyroidism in patients w/ CKD

A

Paricalcitol

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8
Q

An analog of calcitriol approved for PSORIASIS

A

Calcipotriene

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9
Q

Suppresses the activity of osteoclasts and (-) bone resorption

A

BISPHOSPHONATES

Alendronate
Risedronate
Ibandronate
Pamidronate
Zoledronate (Zoledronic acid)

Osteoporosis, Paget’s disease

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10
Q

Side effects of Bisphosphonates

A

GI irritation
esophagitis

take lots of water and keep patient in an upright position for 30 mins after intake of bisphophonates

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11
Q

Acts through PTH receptors to produce a net increase in bone formation

A

PTH ANALOG

Teriparatide
Natpara

osteoporosis

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12
Q

Acts through calcitonin receptors to (-) bone resorption

osteoporosis
Paget’s disease
TUMOR MARKER - thyroid cancer

A

Calcitonin
Salcatonin

SE:
rhinitis
N/V
facial flushing
tingling
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13
Q

Actions of Calcitonin

A

(-) bone resorption and renal excretion –> decrease serum calcium and phosphate

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14
Q

Estrogen agonist effect - BONE

Estrogen antagonist - BREASTS and ENDOMETRIUM

for osteoporosis

A

SERMS

Raloxifene

SE:
increased risk of VTE

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15
Q

Monoclonal antibody

Binds to RANKL and prevents it from stimulating osteoclast differentiation and function

for osteoporosis

A

RANK LIGAND INHIBITORS

Denosumab

SE - increase risk of infection, osteonecrosis

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16
Q

Activates the calcium sensing receptor –> (-) PTH secretion

for hyperparathyroidism

A

CALCIMIMETIC

Cinacalcet

SE - nausea, hypocalcemia, adynamic bone

17
Q

MINERALS

osteoporosis
osteomalacia

A

Strontium
Calcium
Phosphate

SE - ectopic calcification

18
Q

Binds to dietary phosphate and prevents its absorption

for
hyperphosphatemia (CKD)
hypoparathyroidism
vitamin D intoxication

A

PHOSPHATE BINDING RESIN

Sevelamer

19
Q

Which of the following drugs is routinely added to calcium supplements and milk for the purpose of preventing rickets in children and osteomalacia in adults?

(A) Cholecalciferol
(B) Calcitriol
(C) Gallium nitrate
(D) Sevelamer
(E) Plicamycin
A

(A) Cholecalciferol

The 2 forms of vitamin D—cholecalciferol and ergocalciferol— are commonly added to calcium supplements and dairy products

20
Q

Which of the following drugs is most useful for the treatment of hypercalcemia in Paget’s disease?

(A) Fluoride
(B) Hydrochlorothiazide
(C) Pamidronate
(D) Raloxifene
(E) Teriparatide
A

(C) Pamidronate

Paget’s disease is characterized by excessive bone resorption, poorly organized bone formation, and hypercalcemia.

Bisphosphonates and calcitonin are first-line treatments.

Pamidronate is a powerful bisphosphonate used parenterally to treat hypercalcemia

21
Q

The active metabolites of vitamin D act through a nuclear receptor to produce which of the following effects?

(A) Decrease the absorption of calcium from bone
(B) Increase PTH formation
(C) Increase renal production of erythropoietin
(D) Increase the absorption of calcium from the gastrointestinal tract
(E) Lower the serum phosphate concentration

A

(D) Increase the absorption of calcium from the gastrointestinal tract

The active metabolites of vitamin D increase serum calcium and phosphate by promoting calcium and phosphate uptake from the gastrointestinal tract, increasing bone resorption, and decreasing renal excretion of both electrolytes.

They inhibit, rather than stimulate, PTH formation

22
Q

A 59-year-old female was referred to your clinic for evaluation of osteopenia. She was diagnosed with adult-onset cystic fibrosis (CF). She reported being treated with prednisone 2 times in the past for CF exacerbations. Since menopause at 52 years of age, she had been treated with raloxifene for osteoporosis prevention. She also was on daily calcium and
vitamin D supplementation. Her bone mineral density test revealed a T score of –1.6 at the lumbar spine, –2.2 at the left femoral neck, and –1.6 at the total left hip.

Which of the following drugs can be used to reduce the fracture risk by further stimulating bone formation in this patient?

(A) Cholecalciferol
(B) Ergocalciferol
(C) Furosemide
(D) Tamoxifen
(E) Teriparatide
A

(E) Teriparatide

Teriparatide increases bone formation and bone resorption; during the first 6 months, it causes a net gain in bone.

Teriparatide should not be used longer than 2 years due to risk of osteosarcoma

23
Q

A 58-year-old postmenopausal woman was sent
for dual-energy x-ray absorptiometry to evaluate the bone mineral density of her lumbar spine, femoral neck, and total hip. The test results revealed significantly low bone mineral density in all sites.

Chronic use of which of the following medications is most likely to have contributed to this woman’s osteoporosis?

(A) Lovastatin
(B) Metformin
(C) Prednisone
(D) Propranolol
(E) Thiazide diuretic
A

(C) Prednisone

Long-term therapy with glucocorticoids such as prednisone is associated with a reduction in bone mineral density and an increased risk of fractures

24
Q

A 58-year-old postmenopausal woman was sent
for dual-energy x-ray absorptiometry to evaluate the bone mineral density of her lumbar spine, femoral neck, and total hip. The test results revealed significantly low bone mineral density in all sites.

If this patient began oral therapy with alendronate, she
would be advised to drink large quantities of water with the tablets and remain in an upright position for at least 30 min and until eating the first meal of the day.

These instructions would be given to decrease the risk of which of the following?
(A) Cholelithiasis
(B) Diarrhea
(C) Constipation
(D) Erosive esophagitis
(E) Pernicious anemia
A

(D) Erosive esophagitis

25
Q

The patient’s condition was not sufficiently controlled with alendronate, so she began therapy with a nasal spray containing a protein that inhibits bone resorption. The drug contained in the nasal spray was which of the following?

(A) Calcitonin
(B) Calcitriol
(C) Cinacalcet
(D) Cortisol
(E) Teriparatide
A

(A) Calcitonin

26
Q

A 67-year-old man with chronic kidney disease
was found to have an elevated serum PTH concentration and a low serum concentration of 25-hydroxyvitamin D. He was successfully treated with ergocalciferol. Unfortunately, his kidney
disease progressed so that he required dialysis and his serum PTH concentration became markedly elevated

Which of the following drugs is most likely to lower this
patient’s serum PTH concentration?

(A) Calcitriol
(B) Cholecalciferol
(C) Furosemide
(D) Gallium nitrate
(E) Risedronate
A

(A) Calcitriol

In patients with chronic kidney disease that requires dialysis, the impaired production of active vitamin D metabolites compounded with elevated serum phosphate due to renal impairment leads to secondary hyperparathyroidism.

Administration of the active vitamin D metabolite calcitriol acts directly on the parathyroid to inhibit PTH production

27
Q

Although the drug therapy was effective at lowering serum PTH concentrations, the patient experienced several episodes of hypercalcemia. He was switched to a vitamin D analog that suppresses PTH with less risk of hypercalcemia.

Which drug was the patient switched to?

(A) Calcitriol
(B) Cholecalciferol
(C) Furosemide
(D) Paricalcitol
(E) Risedronate
A

(D) Paricalcitol

Paricalcitol is an analog of 1,25-dihydroxyvitamin D3 (calcitriol) that lowers serum PTH at doses that rarely precipitate hypercalcemia.

The molecular basis of this selective action
is poorly understood but is of value in the management of
hyperparathyroidism and psoriasis

28
Q

In the treatment of patients like this with secondary hyperparathyroidism due to chronic kidney disease, cinacalcet is an alternative to vitamin D-based drugs.

Cinacalcet lowers PTH by which of the following mechanisms?

(A) Activating a steroid receptor that inhibits expression of the PTH gene
(B) Activating the calcium-sensing receptor in parathyroid cells
(C) Activating transporters in the GI tract that are involved in calcium absorption
(D) Inducing the liver enzyme that converts vitamin D3 to 25-hydroxyvitamin D3
(E) Inhibiting the farnesyl pyrophosphate synthase found in osteoclasts

A

(B) Activating the calcium-sensing receptor in parathyroid cells

Cinacalcet is a member of a novel class of drugs that activate the calcium-sensing receptor in parathyroid cells. When this receptor is activated by cinacalcet or free ionized calcium, it activates a signaling pathway that suppresses PTH synthesis and release.

29
Q

Net effect of elevated PTH at high doses

A

increased bone resorption

hypercalcemia

hyperphosphatemia

30
Q

Net effect of intermittent doses of PTH

A

net increase in bone formation

31
Q

Vitamin D (INACTIVE)

added to dairy products and other food products

for PSORIASIS

A

Ergocalciferol

Cholecalciferol

32
Q

Vitamin D (ACTIVE)

A

Calcitriol
Doxercalciferol
Paricalcitol
Calcipotriene

33
Q

Preferred in patients with CKD, chronic liver disease and hyperparathyroidism

A

Calcitriol

34
Q

Analogs of calcitriol and used topically for psoriasis

A

Paricalcitol

Calcipotriene

35
Q

SE of Vitamin D

A

hypercalcemia
hyperphosphatemia
hypercalciuria

36
Q

BISPHOSPHONATES

Suppresses the activity of osteoclasts in part via (-) of Farnesyl Pyrophosphate synthesis

(-) bone resorption and secondarily bone formation by acting on hydroxyapatite crystal structure

for Paget’s disease of bone
hypercalcemia (malignancies)
osteoporosis
bone metastases

A

BISPHOSPHONATES
-DRONATE

Alendronate
Zoledronic acid (prototype)
Etidronate
Ibandronate
Pamidronate
Risedronate
Tiludronate
SE:
adynamic bone
esophagitis
osteonecrosis of the jaw
renal impairment
GI irritation

Pharmacology (72 decks)

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