Osteoporosis Drug Treatment Flashcards Preview

Endo/Repro Exam 1 > Osteoporosis Drug Treatment > Flashcards

Flashcards in Osteoporosis Drug Treatment Deck (38):
1

Osteoporosis drug classes:

PTH
Vitamin D analogs
Calcium
Bisphosphonates
Calcitonin
Selective estrogen receptor modulators
Thiazide diuretics
RANK-L inhibitors
Calcimimetics

2

Osteoprotegerin affect?

Decreased osteoclastic activity

3

What is a parathyroid hormone drug?

Teriparatide

4

What does teriparatide do?

Makes structurally-normal new bone by binding PTH receptor

5

Administration of teriparatide:

Sub Q once daily for up to two years to prevent bone fractures

6

What are the fat soluble forms of vitamin D?

D2: Ergocalciferol
D3: Cholecalciferol

7

Affect of PTH on vitamin D?

Stimulated 1,25-OH vitamin D3 formation

8

Affect of FGF 23 on vitamin D?

Inhibits 1,25-OH vitamin D3 formation and increase renal phosphate excretion

9

Vitamin D preparations:

Cholecalciferol (D3)
Ergocalciferol (D2)
Calcitriol (1,25-OH vitamin D3)
Paricalcitol (1,25-OH vitamin D2)

10

When is the active for of vitamin D preparations (calcitriol and paricalcitol) needed?

When renal pathology is present

11

Calcium preparations:

Calcium carbonate

12

What is the treatment for osteoporosis?

Calcium + Vitamin D3 supplementation (each has mixed results when used alone)

13

Bisphosphonates:

Alendronate
Etidronate

14

Mechanism of bisphosphonates?

Non-hydrolysable analogs of pyrophosphates normally present in bone; reduce osteoclastic dissolution of hydroxyapatite in bone; no affect on osteoblasts

15

Risk factors for bisphosphonates:

Osteonecrosis of jaw with dental procedures
Sickle cell disease
Radiation/chemotherapy
Local ischemia

16

Mechanism of action for selective estrogen receptor modulators?

Binds both alpha and beta receptors in bone

17

Where are alpha estrogen receptors (ERalpha) in bone found?

Cortical bone

18

Where are beta estrogen receptors (ERbeta) in bone found?

Trabecular bone

19

What specifically does estrogen cause in bones?

Decreased response of RANK-L receptor to RANK-L
Reduction of IL-6, TNF-alpha, and M-CSF
Stimulation of osteoprotegerin

20

Net effect of estrogen:

Decreased osteoclast activation
Osteoblasts left unopposed

21

What is a selective estrogen receptor agonist?

Raloxifene

22

Raloxifene affect on estrogen receptors?

ERalpha: partial agonist
ERbeta: antagonist

23

What does short-term administration of calcitonin cause?

Inhibits osteoclastic bone activity

24

What does long-term administration of calcitonin cause?

Inhibits both osteoblastic and osteoclastic activity (rarely used)

25

What do thiazide diuretics lead to?

Decrease in calcium excretion in the urine

26

What channel do thiazide diuretics affect?

Inhibit NCC leading to decreased Na+ reabsorption

27

What does inhibition of NCC lead to?

Decreased Na+ concentration in epithelial cells leading to increased basolateral Ca/Na antiporter leading to decreased Ca intracellularly driving the Ca reabsorption via apical membrane TRPV5

28

What is a RANK-L inhibitor?

Denosumab

29

What does binding to RANK cause?

Activation of nuclear factor kappa-B

30

What is osteoprotegrin?

A soluble receptor for RANK-L released to bind and inactivate RANK-L

31

What is Denosumab?

A monoclonal antibody against RANK-L

32

How does Denosumab work?

Binds RANK-L to inactivate it therefore inhibiting osteoclastic activity

33

Risks of Denosumab?

1.) Mandibular necrosis with dental work
2.) Hip fractures

34

What drug is a Calcimimetic?

Cinacalcet

35

How does Cinacalcet work?

Allosteric activator of calcium sensing receptor (in PT gland)

36

What does Cinacalcet cause?

PTH secretion inhibition

37

What is Cinacalcet used for?

Hyperparathyroidism resulting from:
1.) Chronic kidney disease
2.) Parathyroid carcinoma

38

What are the side effects of Cinacalcet?

Cardiac arrhythmia
Heart failure