Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

pharmacology > osteoporosis > Flashcards

osteoporosis Flashcards

(85 cards)

Start Studying
1
Q

Osteoporosis: Occurs when rate of bone _______ exceeds rate of bone _______

A

resorption

formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the normal bone resorption process?

A

osteoclasts activation stimulated by RANKL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the activation of bone resorption in the pathologic process?

A

osteoclasts activation stimulated by PTH

metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the process of bone formation? what are the 4 natural substances that promote this?

A 
Inhibition of osteoclast, stimulation of osteoblasts
Osteoprotegerin (OPG)
calcitonin
estrogen
 IL-10 inhibit osteoclast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what two main groups of natural substances regulate bone metabolism? what does is group include?

A

Hormones:
PTH, calcitonin, estrogen, androgens
Steroids:
Vitamin D, glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do osteocytes do?

A
  • formed after osteoblast activity

- release chemicals that say we need more osteroblast or clast activity (regulators)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is OPG? (where does it come from and what does it do?)

A

released by osteocyte, it inhibits bone resorption by binding RANKL (holding it hostage so it cant activate osteoclasts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does RANKL do?

A

binds to RANK on osteoclast - activates the osteoclast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how does PTH exposure differ with release low intermittent vs high chronic?

A

low intermittent- bone formation (anabolic axn)

high chronic- bone resorption (breakdown) (catabolic axn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how does PTH increase bone turnover?

A

PTH stimulate osteoblast to secrete IL-1, IL-6 and RANKL to activate osteoclast activity
RANKL binds to RANK proteins triggering the osteoclasts
Result is bone turnover and remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PTH regulates what two substances? using what 3 organs?

A

Regulates calcium & phosphate using bone, kidney, and intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what does PTH do in the kidney?

A

Stimulates 1- α hydroxylase to convert calcidiol to calcitriol (to give active vitamin D - allows us to absorb Ca+ from intestine)
-tell kidney to keep Ca+ (DistalT) but get rid of phosphate (ProximalT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what does PTH do in the intestine?

A

Indirectly increases intestinal calcium absorption by stimulation of 1,25 dihydroxyvitamin D production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vitamin D: Increases serum ___and contributes to bone ______

A

calcium, mineralization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why is it so important to maintain Ca+ and phosphate balance? - (what if they get too high?)

A

need to maintain so they dont precipitate and accumulate in places like the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the net effect of calcitonin?

A

Increase serum calcium -> calcitonin secretion -> inhibition of osteoclast -> decreased serum calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a hypocalcemic hormone that OPPOSES the effect of PTH?

A

calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

estrogen’s effect on osteocyte, blasts and clasts

A
  • decrease osteocyte and osteoblasts apoptosis

- increase osteoclast apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is estrogen good for in regards to bone health? why is this important?

A

Estrogen is better at preventing bone loss than building bone.
dont give post- menopausal women estrogen to increase bone density unless last resort (other agents are better)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

glucocorticoid’s effect on bones?

A

Antagonize vitamin D effect (decreasing intestinal calcium transport)
Blocks bone formation by inhibiting osteoblast activity
=overall : block bone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

prolonged exposure to steroids can cause what effects in adults? children?

A

prolonged exposure to steroids can cause osteoporosis in adults and stunts skeletal development in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what Can be useful at reversing hypercalcemia associated with lymphomas?

A

glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

7 agents used to affect bone mineralization

A 
Bisphosphonates
Human parathyroid hormone related peptide analogs
Monoclonal Antibody
Sclerostin Inhibitor
Conjugated Estrogens/SERMS
Calcitonin
Calcium
Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Drug of choice (first line) for treatment of osteoporosis

A

bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the bisphosphonate drugs?
*Alendronate (Fosamax) *Risedronate (Actonel, Atelvia) Ibandronate (Boniva) Zolendronic acid (Reclast)- IV formulation (once a year infusion)
26
only bisphosphonate that is not first line b/c no help for hip/nonvertebral fractures
ibandronate (boniva)
27
which bisphosphonate is IV formulation - (once a year infusion)
zolendronic acid
28
bisphosphonate MOA
bind Ca+ - taken into bone in high concentrations they are taken up by osteoclast (and destroy the proteins that make their fringe border so they can’t chew up the bone) = osteoclast apoptosis = decr rate of resorption
29
what is important to remember about the abs. of oral bisphosphonates?
When given orally little is absorbed – less than 1% | must take on empty stomach for max absorption
30
any metabolism for bisphosphonates?
no!
31
1/2 life of bisphosphonates
After binding to bone, clearance is hours up to 10 years (what does get abs. - that 1%- stays around for a while)
32
#1 ADR for bisphosphonates?
GI irritation
33
rare ADRs of bisphosphonates?
Osteonecrosis of jaw. AVN=avascular necrosis of jaw. (due to lack of blood flow to bone.) -dental procedures in patients with cancer after prolonged chemo therapy
34
which type of administration of bisphosphonates has higher risk for AVN - high dose IV or oral?
High dose IV administration
35
contraindications for bisphosphonates? (3)
Renal dysfunction Esophageal motility disorders (tablet sits in throat and erodes it) PUD
36
instructions for taking oral bisphosphonate
Taken alone on empty stomach in morning with 8 oz of water (Water reduces risk of tablet getting stuck in esophagus) Remaining upright for 30 minutes to minimize risk of reflux (ibandronate is 60min)
37
which is the one bisphosphonate that actually SHOULD be taken with food?
Risedronate sodium delayed release (Atelvia) must be taken with food
38
what type of fractures are the fractures with greatest morbidity & mortality?
Vertebral and hip
39
why are bisphosphonates so good for a first line for osteoporosis?
They increase bone density and prevent vertebral & hip fx (they hit BOTH)
40
before starting bisphosphonates, what should pts be evaluated for?
to detect potentially treatable causes for osteoporosis - is there anything else causing the osteo that we can stop? Labs: Calcium (hypocalcemia); 25-hydroxyvitamin D (Vit D Deficiency); Creatinine (Renal impairment)
41
what is a "Tscore" ?
measurement of bone density - measured in std deviations (lower than -2.5 is definition of osteoporosis)
42
for what pts can we discontinue bisphosphonates and reevaluate in 2-3 years? why can we do this?
if they were on alendronate or risendronate for 5 years or Z. acid for 3 years AND have stable BMD, no previous fractures and low risk for fracture. *it stays in body for 10 years.
43
what is the reevaluation rules for if a pt has a low Tscore?
this means they are at high risk for future fractures Taking alendronate/risedronate-continue 10 years Taking zoledronic acid – continue 6 years
44
what are the human PTH -related peptide analogs (recombinant PTH)? what is the MOA?
Teriparatide (Forteo) & Abaloparatide (tymlos) | MOA: PTH in pulse form = osteoblast increase
45
The only anabolic therapy for bone; it increases bone mineral density, bone mass & strength (other meds prevent resorption)
recombinant PTH analogs- "paratides"
46
3 contraindications for teriparatide & abaloparatide
1. hx of bone metastases 2. if at risk for osteosarcoma 3. hypercalcemia
47
whose at risk for osteosarcoma?
(Paget’s disease, unexplained increase in alkaline phosphatase, pediatric patient, h/o radiation therapy to the bones)
48
teriparatide + abaloparatide- Only give for __ years (during a patients life time) then switch to _________ for further treatment. why?
2 years | Bisphosphonates for further treatment b/c of potential risk of bone cancer
49
Human parathyroid hormone related peptide analogs ("paratides" ) are used for what 2 groups of pts?
1. women at high risk of fracture, including those with very low BMD and a previous vertebral fracture 2. hypogonadal osteoporosis in men w/ high risk of fracture
50
"paratides" and bisphosphonated together?
no! it decreased BMD
51
what should you remind pts when they are prescribed the "paratides" ?
take first dose lying down b/c of orthostatic hypotension | 1xday injectable
52
Denosumab (Prolia/Xgeva) MOA
binds to RANKL, prevents differentiation of osteoclast, leads to inhibition of osteoclast fxn and survival --> osteoclast apoptosis
53
denosumab ( prolia or xgeva) what are they used for?
Prolia – osteoporosis/steroid induced osteoporosis Xgeva – bone metastases from solid tumors, multiple myeloma (same drug, just different dosing)
54
what is our one sclerostin inhibitor drug?
Romosozumab-aqqg (Evenity)
55
MOA of romosozumab (evenity)
inhibits axn of sclerostin . stimulating osteoblast activity while slightly decreasing osteoclast activity (increases bone formation)
56
sclerostin inhibitor (romosozumab-aqqg) is indicated for what use?
treatment of osteoporosis in postmenopausal women at high risk for fracture
57
what defines "high risk of fracture"
Defined as a history of osteoporotic fracture OR multiple risk factors for fracture OR patients who have failed or are intolerant to other available osteoporosis therapy
58
how long can you use the sclerostin inhibitor for? if osteoprosis remains after this time period, what can you switch to?
12 monthly doses (doesnt work anymore after a year) | * continued therapy with an anti-resorptive agent should be considered
59
what is the one SERM we may use for osteoporosis?
Raloxifene (Evista)
60
MOA of Raloxifene (Evista) ?
estrogen agonist used to reduce resorption of bone and decrease in overall bone turnover
61
what is raloxifene (evista) good for?
Treatment and prevention of osteoporosis in postmenopausal women Reduces risk of vertebral fractures by 30-50% (not for hip fractures)
62
major ADR to look out for raloxifene (evista) ?
clots (First 4 months) (DVT)
63
MOA of conjugated estrogen/bazedoxifene
Estrogen is agonist, Bazedoxifine is agonist on bone and antagonist in uterine tissue to prevent endometrial hyperplasia (SERM)
64
what does calcitonin (miacalcin) do to PTH? from where do they get this hormone ?
Antagonizes effects of PTH and inhibits bone resorption (increases bone density but DOES NOT prevent fractures) -salmon derived hormone
65
when would you use calcitonin for osteoporosis?
doesnt work very well - only really good for BONE PAIN | 3rd line if you go to it at all
66
why is Calcium recommended for all osteoporosis pts to take? (2 reasons)
- maintain normal calcium concentrations | - to prevent hypocalcemia associated with other drug treatments
67
what is the dosing for calcium?
1000 mg daily (19-50 years women & 51-70 years men) 1200 mg daily (51-70 years women & >70 men & women) Avoid doses higher than 2000 mg/day
68
what does total daily calcium include?
Total daily calcium includes diet and supplements - obtaining it naturally better than taking tablet
69
why is Vit D recommended for all osteoporosis pts?
Maximizes absorption of calcium by intestine
70
minimal dosing of vitamin D: men 70+ and post-menopausal women vs premenopausal women and men <70
Men over 70 and postmenopausal women is 800 IU/day | Premenopausal women and men < 70 is 600 IU/day
71
*txt of osteoporosis: no prior fracture/moderate risk: 1st line (4)
Bisphosphonates: Alendronate, Risedronate, Zoledronic acid | Denosumab
72
*txt of osteoporosis: no prior fracture/moderate risk: alternative options (3)
Bisphosphonate: ibandronate (for vert. fracture risk) SERM: Raloxefine, Conjugated estrogen/Bazedoxifene (Duavee)
73
*lifestyle measures for txt of osteoporosis (5)
``` adequate calcium and vitamin D exercise smoking cessation counseling on fall prevention avoidance of heavy alcohol use ```
74
*txt of osteoporosis: Hx fracture/high risk: 1st line (3)
Denosumab Teriparatide, abaloparatide Zoledronic acid (IV)
75
*txt of osteoporosis: Hx fracture/high risk: 1st line (2)
Bisphosphonates: Alendronate or Risedronate
76
special case of osteoporosis: men. txt? what if testosteron is low?
Avoid risk factors, treat with bisphosphonates. | If serum testosterone level is low can give testosterone injections
77
special cases of osteoporosis: men - severe. what drugs can you use?
Denosumab, teriparatide
78
special case: glucocorticoid-induced osteoporosis. txt?
higher doses Ca+ and Vit D | bisphosphonates
79
special case: glucocorticoid-induced osteoporosis - severe. txt?
Severe cases: teriparatide
80
special case: premenopausal women. what 3 things should be recommended as far as prevention?
Calcium, vitamin D, weight bearing exercise
81
special case: premenopausal women- hypogonadism vs steroid-induced txt
Hypogonadism – estrogen replacement | Steroid induced – alendronate, risidronate; severe – teriparatide
82
what 3 drugs to avoid for premenopausal women with osteoporosis
NO SERM’s, calcitonin, denosumab
83
what is paget's disease?
Resorb bone and then lay down, new poorly organized bone. Results in overgrowth of bone at single or multiple sites - spikes and bony nodules- painful for pt
84
goal of txt for paget
Goal of treatment is to reduce bone pain & reduce rate of bone remodeling
85
txt options for bisphosphonates (2 main options)
Bisphosphonates 1st line agents - at higher dosing than for osteop. Zoledronic acid Alendronate Risedronate Calcitonin Reserved for bone pain or when bisphosphonates not tolerated

pharmacology (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions