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Pharmacology Exam 5 > Osteoporosis > Flashcards

Flashcards in Osteoporosis Deck (29)
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1

what is osteoporosis?

changes in bone mass with age, bone mass increase until we are 30, goes stagnant, and then decreases

2

disease related osteoporosis

hypogonadism, hyperparathyroidsim, hypertyroidism

3

drug induced osteoporosis

gluccocorticoids (3rd leading cause), thyroid replacements, GnRH agonists/antagonists, aromatase inhibitors (breast cancer)

4

how fast can osteoporosis occur

fast, can deteriorate in 3-6 years

5

bone remodeling cycle

resting surface
osteoclast-mediated resorption
recruitment of osteoblasts
secretion of new matrix
calcification of said matrix

6

creating an osteoclast?

rankl binds to rank on an osteoclast precursor developing it into a mature osteoclast, this also secretes factors that allow osteoblast precursors to mature into osteoblasts

7

remember the drugs

abcder t

8

antiresorptive agents

bisphosphonates (alendronate zoledronate ibandronate)
calcitonin
denosumab
estrogen
raloxifen

9

bisphosphonates

alendronate(oral daily)
zoledronate(iv yearly)
ibandronate(oral daily, monthly or iv 3 mo.)

10

mechanism of action for bisphosphonates

high affinity for bone, ca chelator, incorporates and stabilizes structure. Inhibits bone resorption by decreasing osteoclast function and increasing their apoptosis

11

uses and admin of bisphophonates

osteoporosis due to aging, PMW, steroids

oral admin, less than 10 percent absorbed; water only; upright position to prevent heartburn, and esophageal irritation

12

high doses of bisphosphonates puts you at risk for ______.

osteonecrosis of the jaw

13

Toxicity of zoledronate

renal toxicity

14

Denosumab

binds to RANKL (receptor for activating NFKB ligand) thus decreasing activation of rank and thus decreasing osteoclast formation/activation

15

Admin and adverse effects of denosumab

admin: sc injection every 6 mo

adverse effects: increase infection risk?

16

calcitonin

thyroid gland hypocalcemic hormone

decrease bone resorption by decreasing osteoclast surface area

17

vitamin d and calcium supplements

increase calcium absorption in small intestine (increase bone mineralization)

at large doses however it act in bone resorption

18

uses of calcitonin

PMW, steroids, low efficacy(fracture prevention?)

19

estrogen

decrease bone reabsorption by decreasing rank L and cytokines thus decreasing osteoclasts proliferation and activation, and decreases osteroBLAST apoptosis

20

Long term risks of estrogen

In pmw: breast cancer, thromboembolism, stroke, cv risk

LIMITED USE: NON RESPONDERS TO OTHER TX

21

Raloxifen

selective estrogen receptor modulator
estrogen receptor agonist in breast endometrium
decreases osteoclast formation and activation thus decreasing resorption and fractures in PMW

22

Uses of raloxifen

osteoporosis in PMW w/ breast cancer or family history

23

administration of ralozifen

oral daily

24

adverse effects of raloxifen

risk of venous thrombosis, pulmonary embolism

25

bone forming agents

teriparatide

26

teriparatide

active peptide of parathyroid hormone
hyper parathyroidism= bone resorption
low, intermittent PTH (teriparatide) = bone growth
increases osteoblast number and activation

27

uses of teriparatide

severe osteoporosis, high fracture risk

28

admin of teriparatide:

daily s.c, injection for 2 years

29

adverse effects of teriparatide:

may increase risk of osteosarcoma (rats?)