Lecture 4 - Bone Drugs Flashcards
Calcium Supplements
clinical application: Ca2+ deficiency
MOA: increase bone mineralization and decrease PTH release
SE: constipation urolithiasis prostate cancer GI upset
Contraindications:
Hypercalcemia
Ventricular fibrillation (Ca-gluconate only)
give Ca-carbonate with food because stomach H+ secretion is needed to free Ca2+
Ca-citrate for pts taking a PPI
subcutaneous infiltration of IV infusion is less toxic with Ca-gluconate than CaCl2
What are the SE of Ca2+ supplements?
constipation
urolithiasis
prostate cancer
GI upset
What is the MOA of Ca2+ supplements?
increase bone mineralization and decrease PTH release
What are the contraindications of Ca2+ supplements?
Hypercalcemia Ventricular fibrillation (Ca-gluconate only)
What are the different types of Ca2+ supplements?
Ca2+ gluconate (IV)
Ca2+ chloride (IV)
Ca2+ carbonate (PO)
Ca2+ citrate malate (PO)
What should you tell pts who you prescribe ca-carbonate in regards to timing of taking the medication?
take with food because stomach H+ secretion is needed to free Ca2+
When prescribing Ca2+ supplements to pts, what must you do?
also prescribe Vitamin D when osteoporosis medicines are taken
Ca2+ + Vitamin D = vertebral fracture decreased up to 16% and hip fx by up to 30%
What are the different vitamin D supplements?
Cholecalciferol (VtD3) Ergocalciferol (VtD2) Calcifediol (25-OH D3) Calcitriol (1,25 OH D3) Doxercalciferol (A alpha OH D2) Paricalcitol
What is the MOA of Vitamin D supplements?
increase Gl Ca2+ and PO4 absorption
decrease PTH gene transcription
What are the indications for vitamin D supplements?
Vt D deficiency Hypoparathyroidism Rickets Ostemalacia Osteoporosis Secondary hyperparathyroidism
What are the adverse effects of Vitamin D supplements?
hypervitaminosis D Hypercalcemia Hypophosphatemia Hypercalciuria GI hemorrhage Angioedema Abnormal lipids, GI upset, edema, HA
What are the contraindications for Vitamin D supplements?
hypersensitivity to drug
hypercalcemia
hypervitaminosis D
malabsorption syndrome
Which vitamin D supplement is most commonly used?
calitriol is often the preferred agent due to fast onset and offset (12h) and faster approach to steady state (72-96h)
calcitriol may cause more hypercalcemia than either paricalcitol or doxercalciferol
hPTH 1-34
teriparatide
indications:
severe osteoporosis
(only in pts at high risk of fx)
SE: angina hypotension rash swelling hyperuricemia GI upset asthenia dizziness cough rhinitis
contraindications: hypersensitivity to teripartide Paget's disease open epiphyses (kids and adolescents) prior radiation bone malignancy hypercalcemia
long term use casues osteosclerosis and osteosarcomas in rodents
What are the indications for teriparatide?
severe osteoporosis
only in pts at high risk of fx
What are the SE of teriparatide?
angina hypotension rash swelling hyperuricemia GI upset asthenia dizziness cough rhinitis
What are the contraindications of teriparatide?
hypersensitivity to teripartide Paget's disease open epiphyses (kids and adolescents) prior radiation bone malignancy hypercalcemia
Calcimemetics
cinacalcet
increases sensitivity of Ca2+ sensing receptors to Ca2+ in parathyroid cells
decreases PTH release
Cinacalcet
a calcimemtic
indications:
hyperthyroidism
hypercalcemia associated with parathyroid carcinoma
SE: cardiac arrythmia heart failure seizure electrolyte imbalance anemia bone fx
paresthesia GI upset arthralgia myalgia asthenia HA depression dehydration fatigue
contraindications:
hypocalcemia
sometimes used off label to treat forms of secondary hyperparathyrodisim
What are the indications for cinacalcet?
hyperthyroidism
hypercalcemia associated with parathyroid carcinoma
sometimes used off label to treat forms of secondary hyperparathyrodisim
What are the SE of cinacalcet?
cardiac arrythmia heart failure seizure electrolyte imbalance anemia bone fx
paresthesia GI upset arthralgia myalgia asthenia HA depression dehydration fatigue
What are the contraindications of cinacalcet?
hypocalcemia
SERMs
replace continuous estrogen-progestin that increases the risk of breast cancer, pulmonary embolism, stroke, and coronary heart disease
estrogen receptor agonist in bone, while estrogen receptor antagonist in endometrium and breast
reduce breast cancer, but not stroke or embolism
Raloxifene
SERM
indication:
prevention and treatment of osteoporosis
prophylaxis of invasive breast cancer
SE:
retinal vascular occlusion, venous thromboembolism (d/t increase in hepatic clotting factor production)
hot flashes
leg cramps
contraindications:
pregnancy
hx of venous thromboembolism
decreases breast cancer incidence
