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PT-ELC133: PHARMACOLOGY > ⭐ LECTURE 4: OSTEOPOROSIS > Flashcards

⭐ LECTURE 4: OSTEOPOROSIS Flashcards

m

1
Q

Mother cells

A

OSTEOPROGENITOR CELLS

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2
Q

immature bone cells and are found on the outer surface of the bone and in the bone cavities

A

OSTEOBLASTS

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3
Q

Mature bone cells

A

OSTEOCYTES

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4
Q

Large, phagocytic, multinucleated derivatives of monocytes or monocyte-like cells formed in the bone marrow

A

OSTEOCLASTS

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5
Q

What are the 2 types of growth in BONE REMODELING?

A

Linear Growth
Appositional Growth

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6
Q

initiates remote signal by activating the macrophages

A

ACTIVATION PHASE

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7
Q

will begin once osteoclasts are activated by RANKL and M CSF to release calcium and phosphorus

A

RESORPTION PHASE

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8
Q

osteoclasts will disappear and will undergo apoptosis

A

REVERSAL PHASE

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9
Q

bone calcification will begin once collagen molecules are secreted

A

FORMATION PHASE

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10
Q

Imbalance that occurs in bone resorption and bone formation due to:
-Decrease in bone resorption
-Increase in bone resorption
-Combination of both

A

OSTEOPOROSIS

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11
Q

What are the signs and symptoms of OSTEOPOROSIS

A

For menopausal women: lose 25-30% of spongy bone and 10-15% of cortical bone

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12
Q

What are the PRIMARY HORMONES?

A

PTH, Vitamin D, Fibroblast Growth Factor 23 (FGF23)

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13
Q

What are the SECONDARY HORMONES?

A

Calcitonin, Glucocorticoids, Estrogen, Prolactin, GH, Insulin, Thyroid Hormone

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14
Q

Albumin is at low level = decrease level in calcium

A

HYPOALBUMINEMIA

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15
Q

exhibition of Low level of ionization
and in favor of ionization

A

Acidosis

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16
Q

Disfavors ionization

A

Disfavors ionization

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17
Q

This primary hormone Promotes bone formation and resorption by stimulating osteoblasts and osteoclasts

A

PTH

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18
Q

This primary hormone Stimulates intestinal absorption of Ca and phosphate and Promotes bone formation and resorption by stimulating the osteoblasts and osteoclasts

A

Vitamin D

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19
Q

This primary hormone Stimulates P excretion in the kidney = hypophosphatemia and low levels of 1,25(OH)2D3

A

Fibroblast growth factor

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20
Q

This secondary hormone Lowers Ca and P and Inhibits osteoclastic bone resorption

A

Calcitonin

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21
Q

excess PTH promotes?

A

an increase in bone resorption

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22
Q

low PTH promotes?

A

an increase in bone formation

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23
Q

What are the common sites for osteoporosis related fracture?

A

Vertebrae
Hip
Distal radius

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24
Q

WHAT ARE THE AGENTS USED TO INCREASE BONE MINERAL DENSITY

A

Calcium
Vitamin D
Bisphosphonates
Calcitonin
Estrogen therapy
PTH
Monoclonal antibody

25
2500 mg/day
MAXIMUM TOLERATED LIMIT
26
1000 mg/day
CEILING EFFECT
27
Daily requirement of calcium supplements
800-1500 mg per day
28
what are the Risks in Calcium Supplements
arterial calcification and cardiovascular disease and hypercalcemia
29
How many mg of calcium supplements are excreted daily in urine and feces?
300 mg
30
mimics effects of endogenous calcium
Calcimimetic
31
Helps prevent bone breakdown and increase in plasma calcium levels associated with excessive PTH release
CINACALCET (SENSIPAR)
32
Enhance bone formation by increasing the absorption and retention of calcium and phosphate in the body
VITAMIN D AND VITAMIN D ANALOGS
33
recommended intake of men and women from 51 to 70 yrs old of VITAMIN D AND VITAMIN D ANALOGS
600 IU/day
34
recommended intake of men and women from > 70 yrs old of VITAMIN D AND VITAMIN D ANALOGS
800 IU/day
35
Daily adult allowance of VITAMIN D AND VITAMIN D ANALOGS
2000 to 10000 units/day
36
CALCITRIOL
Calcijex, Rocaltrol
37
CHOLECALCIFEROL
Replesta, Vitamin D3
38
ERGOCALCIFEROL
Calciferol, Drisdol
39
PARICALCITOL
Zeemplar
40
Absorbed into calcium crystal and blocks excessive bone resorption and formation by inhibiting osteoclast activity
BISPHOSPHONATES
41
AR/SE of BISPHOSPHONATES
Osteonecrosis of the jaw Atypical hip fractures GI disturbances
42
1st Generation Oral Bisphosphonates
Etidronate (most common), Medronate, Clodronate, Tiludronate → Minimally modified side chain contain a chlorophenyl group → Metabolized into a non-hydrolyzable ATP analog that accumulate within osteoclasts and includes apoptosis which account for its antiresorptive effect → Least potent
43
2nd Generation Oral Bisphosphonates
→ Alendronate (most common), Pamidronate, Ibandronate → Contains nitrogen group in the side chain → Inhibits bone resorption → Antiresorptive activity involves inhibition of multiple steps in the pathway from mevalonate to cholesterol and isoprenoid lipids that are required for the prenylation of proteins that are important for osteoclast function → 10-100 times more potent than 1st Gen BP
44
3rd Generation IV Bisphosphonates
→ Risedronate and Zoledronate → Contain nitrogen atom within heterocyclic ring → 10 000 times more potent than 1st Gen BPs
45
Taken up by the osteoclast and can Cause cell apoptosis through activation of caspase pathway
NON-NITROGEN CONTAINING BPs
46
Not metabolized and Affects protein prenylation of osteoclast by inhibiting farnesyl diphosphate (FPP) synthase (key enzyme of the mevalonate pathway)
NITROGEN CONTAINING BPs
47
Lower plasma calcium levels in hypercalcemic emergencies
Calcitonin
48
Promote bone mineralization in women who lack endogenous estrogen production
Estrogen
49
Able to preferentially activate estrogen receptors
SERM (Selective Estrogen Receptor Modulators)
50
Activates receptors in bone and blocks receptors in breast and uterine tissues
RALOXIFENE (Evista 60 mg PO)
51
Monoclonal antibody (MAB) and Binds to specific receptors (RANK) on osteoclasts → inhibits ability of endogenous chemical to stimulate osteoclast activity → inhibition of osteoclast-induced bone resorption
DENOSUMAB (PROLIA)
52
Stimulates new bone formation on trabecular and cortical bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity
rPARATHYROID HORMONE [rPTH(1-34), TERIPARATIDE]
53
Synthetic form of human PTH – recombinant human PTH (1-34) analog
TERIPARATIDE (FORTEO)
54
“Dual action bone agents” (DABA)
STRONTIUM RANELATE
55
Testosterone replacement therapy increases BMD in hypogonadal men
ANDROGENS
56
Protease expressed in osteoclasts Degrades type 1 collagen in organic bone Inhibit matrix dissolution, decrease bone resorption, and improve BMD in postmenopausal women
CATHEPSIN K INHIBITORS
57
Increase osteoblast number and promotion of osteoblastic differentiation, leading onto increased bone formation by simvastatin
STATINS
58
potential new drug for osteoporosis
Echistatin
59
Calcium-sensing receptor antagonists are new drug class of orally administered agents that stimulate endogenous PTH release and have bone forming action
CALCILYTICS

PT-ELC133: PHARMACOLOGY (9 decks)

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