(FE) Drugs for Bone Infx Flashcards
What are the types of drugs used in treating bone fractures?
1) Biphosphonates
- ALENDRONATE
- RESEDRONATE
2) RANK (Receptor activator of nuclear factor kappa-B) ligand inhibitor
- DENOSUMAB
3) Parathyroid hormone analogue
- TERIPARATIDE
What is the MOA of bisphosphonates?
Recap: For bone fractures
Recap: Alendronate, Risedronate
- To increase bone density (for first year of therapy)
- Structural analogue of pyrophosphate
- tf Inhibits bone breakdown
What are the adverse effects of biphosphates?
Recap: For bone fractures
Recap: Alendronate, Risedronate
- Nausea, dyspepsia, diarrhea
- Bone and back pain
What is the MOA for RANK ligand inhibitors?
Recap: For bone fractures
Recap: Denosumab
- Monoclonal antibody targeting RANK (involved in bone resorption/breakdown)
- Used in post-menopausal women at high risk of fractures and in px with bone tumours
Adverse effects of RANK ligand inhibitors?
Recap: For bone fractures
Recap: Denosumab
- Hypocalcemia (IMPT)
- Fatigue
- Hypophosphatemia, hypercholesterolemia
- Nausea
- MSK pain
- Cystitis
What is the MOA of parathyroid hormone analogues?
Recap: For bone fractures
Recap: Teriparatide
- Increases bone formation
- Reserved for px with high risk of bone fractures
Adverse effects of parathyroid hormone analogues?
Recap: For bone fractures
Recap: Teriparatide
- Dizziness, vertigo
- Depression
- Insomnia
- Rhinitis, cough
- Leg cramps
- Nausea
- Arthralgia
What are the drug types used to treat osteomyelitis?
Caused by bacteria:
1) Ceftriaxone & Vancomycin
Caused by mycobacterium:
1) Antibiotics (RIPE) + Vitamin B6
What are the MOA and adverse effects of Ceftriaxone (Cephalosporin)?
//recap Ab
- Beta-lactam Ab, 3rd generation cephalosporin
- Bacterial cell wall synthesis inhibitor, by inhibiting transpeptidation
- Broad-spectrum drug
- Usually well-tolerated but
- Rash and diarrhoea
- Rare severe hypersensitivity/allergic rxn
- Thrombophlebitis
What are the MOA and adverse effects of Vancomycin (Glycopeptide)?
//recap Ab
- Non-beta lactam glycopeptide
- Cell wall synthesis inhibitor by inhibiting transglycosylation
- Used in Gram pos bacteria undergoing division
- Reserved for MRSA/serious infections
- N&V
- Anaphylaxis
- Nephrotoxicity, ototoxicity
- Red man’s syndrome
What is the MOA of Rifampicin and how long should it be used for?
Recap: To treat osteomyelitis caused by M. tuberculosis
- Inhibits RNA synthesis
- Initial phase (kill rapidly dividing bacteria): 2 months of RIPE daily + Vitamin B6 supplementation
~ To prevent pellagra (nutritional deficiency disease) - Continuation phase (target remaining microbes): 6 months of RI 2-3x a week
Adverse effects of rifampicin?
- N&V, diarrhea, flatulence, cramping
- Heartburn
- Epigastric pain, anorexia,
- Orange discoloration of urine, sweat and tears
- Pseudomembranous colitis (infl of colon due to C. diff)
- Renal failure
- Hepatotoxicity
- Hyperuricaemia
- Blood dyscrasia
What is the MOA and adverse effects of isoniazid?
- Inhibits mycolic acid (tf weakens cell wall)
- N&V, epigastric pain, pellagra
- Anaphylaxis
- Peripheral neuropathy, optic neuritis
- Hepatotoxicity
- Transpeptidation
- Blood dyscriasis
What is the MOA and adverse effects of pyrazinamide?
- Inhibits cell wall membrane
- Gouty arthritis, increase in serum uric acid
- Rash
- Anaphylaxis
- Hepatotoxicity
- Fatal hemoptysis
- Hemolytic anemia
What is the MOA and adverse effects of ethambutol?
- Inhibits cell wall synthesis
- N&V
- Headache, dizziness
- Anaphylaxis, optic neuritis
~ Need to check visual acuity to assess toxicity
~ If px is not able to get his sight tested, substitute ethambutol with streptomycin
