Osteoporosis and Gout Pharm Flashcards
Calcium Homeostasis PTH Role (4) Calcitonin Role (3)
Parathyroid Hormone Increases Ca2+ resorption from bone Increases Ca2+ absorption in intestines Increases Ca2+ reabsorption by kidneys Increases Vit D hydroxylation in kidneys
Calcitonin (from thyroid)
Increases Ca2+ deposition in bone
Decreases Ca2+ absorption in intestines
Decreases Ca2+ reabsorption by kidneys
Calcitonin-Salmon
MOA (2) Use
Similar to calcitonin with longer half life and greater potency
Osteoporosis treatment (not prevention)
Bisphosphonates
MOA (2) Indications (4) Adverse Effects (3)
Inhibits bone resorption by decreasing Osteoclasts
Osteoporosis
Male osteoporosis (first line)
Hypercalcemia
Paget Disease
Esophagitis (use zolendronic acid instead)
Osteonecrosis of jaw
Atypical femur fractures
Bisphosphonates
Examples (5) with Formulations
“ART IZ”
Alendronate: Oral
Risedronate: Oral
Tiludronate: Oral
Ibandronate: Oral, IV
Zolendronic Acid: IV
Raloxifene
Classification, MOA (2) Indications (2) Formulation, Adverse Effects (3)
Selective Estrogen Receptor Modulator (SERM)
Estrogen agonist at bone: inhibits resorption
Estrogen antagonist at breast and uterus
Post-Menopausal Osteoporosis
Prevention of breast cancer
Oral
DVT
Pulmonary embolism
Stroke
Teripratide
Classification, MOA (2) Indication, Formulation, Adverse Effects (4)
Truncated PTH 1-34
Increases bone formation
Pulsed therapy increases osteoblast activity
Osteoporosis
Once daily injection
Generally well tolerated
HA, Nausea, Back pain, Leg Cramps
Denosumab
MOA (2) Indications (3) Formulation (2) Adverse Effects (3)
RANKL Inhibitor
Decreases formation and function of osteoclasts
Osteoporosis
Male osteoporosis
Bone metastases
Subcutaneous injection every 6 months
Given with Vit D and Calcium
Fracture Risk
Delayed Fracture Healing
Osteonecrosis of Jaw
Cinacalcet
Classification, MOA (3) Indications (2) Formulation, Adverse Effects (3)
Calcimimetic
Binds CASR on parathyroid
Increases sensitivity to calcium
Decreases PTH secretion to increase Calcium wasting
Primary hyperparathyroidism Secondary hyperparathyroidism (from CKD)
Oral
Nausea
Vomiting
Diarrhea
Pharmacological Treatment of Osteoarthritis
Oral (4) Topical (1) Intra-Articular (3)
NSAIDs
Duloxetine
Opioids
Acetaminophen (non-inflammatory OA, no longer rec.)
Diclofenac (topical NSAID)
Hyaluronic acid
Glucocorticoids
Platelet rich plasma
Osteomyelitis Treatment Difficulties (2) Drugs Used (4) Treatment Timeline
Canaliculi too small for white blood cells
Blood flow may be compromised, Abx delivery difficult
"CRaFT" Clindamycin Rifampin Fluoroquinolone Trimethoprim-Sulfamethoxazole
Give Abx for 4-6 weeks
Gout
Purine Metabolism Steps (4) and Under-Excreters (2) vs Over Producers (3) Etiologies
Purines become Guanine and Hypoxanthine
Xanthine oxidase turns them into Xanthine
Xanthine oxidase turns Xanthine into Uric Acid
HGPRT recovers Hypoxanthine to make AMP
Under Excreters (majority)
Kidney damage
Drug induced decrease in uric acid excretion
Over Producers
Excess purine intake
HGPRT deficiency
Tumor lysis syndrome
Anti-inflammatory drugs for Gout
Examples (4) Indication
Naproxen
Indomethacin
Celecoxib
Corticosteroids
Acute gout exacerbations to decrease pain
Colchicine
MOA (2) Indication, Formulation, Contraindications (2) Adverse Effects (4)
Binds to tubulin to block microtubule formation
Inhibits leukocyte migration and phagocytosis
Acute gouty arthritis if NSAIDs contraindicated
Oral
Renal failure
Hepatic failure
GI distress
N/V/D
Allopurinol
MOA (2) Indications (2) Formulation, Adverse Effects (4) Severe Reaction Description (2)
Competitive xanthine oxidase inhibitor
Causes excretion of Hypoxanthine and Xanthine
Recurrent gout
Tumor lysis syndrome
Oral
Skin Rash
Increased liver enzymes
N/V
Acute gout exacerbation
Stevens Johnson Syndrome: fatal hypersensitivity
HLAB-5801 increases risk of SJS
Febuxostat
MOA (2) Indication, Formulation, Adverse Effects
Non-competitive xnathine oxidase inhibitor
Causes excretion of Hypoxanthine and Xanthine
Gout if intolerant of allopurinol
Oral
Well tolerated but expensive
