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MSK II Exam I > Osteoporosis Pharmacology > Flashcards

Osteoporosis Pharmacology Flashcards

1
Q

Two OTC supplements commonly used that affect calcium regulation

A

Calcium salts

Vitamin D supplements

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2
Q

Similar in structure and function to human calcitonin synthesized by thyroid, but has a longer half-life and greater potency

A

Calcitonin-salmon

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3
Q

Effects of calcitonin-salmon on calcium regulation

A

Inhibits activity of osteoclasts to decrease bone resorption

Inhibits renal tubular resorption of calcium to increase calcium excretion

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4
Q

Clinical applications of calcitonin-salmon

A

Used for tx of established osteoporosis, but not prevention

Also used in Paget disease of bone

Can treat hypercalcemia but not a preferred target

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5
Q

AEs of calcitonin salmon

A

Generally very safe

Intranasal dosing can cause dryness and irritation

Parenteral dosing can cause inflammatory reaction at the injection site

Neutralizing antibodies appear in some pts over time

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6
Q

Name the bisphosphonates used to inhibit bone resorption in osteoporosis

A 
Alendronate
Risedronate
Ibandronate
Tiludronate
Zolendronic acid
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7
Q

MOA of the bisphosphonates (i.e., alendronate)

A

Structural analogs of pyrophosphate, a normal constituent of bone

Undergo incorporation into bone, then inhibit bone resorption by decreasing both the number and activity of osteoclasts

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8
Q

Clinical applications of the bisphosphonates

A

Drugs of first choice for:

Postmenopausal osteoporosis

Osteoporosis in men

Glucocorticoid-induced osteoporosis

Paget disease of bone

Hypercalcemia of malignancy

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9
Q

AEs of the bisphosphonates

A

Esophagitis +/- ulceration (minimized by taking with glass of water on empty stomach)

Ocular inflammation

Osteonecrosis of the jaw

Atypical femur fractures

Atrial fibrillation

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10
Q

Bisphosphonate most commonly associated with osteonecrosis of the jaw (often occurring after tooth extraction or some other dental procedure in cancer pts), and is also associated with dose-dependent kidney damage and rarely atrial fibrillation

A

Zolendronic acid

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11
Q

MOA of raloxifene

A

Selective estrogen receptor modulator (SERM)

Exerts estrogen effects in bone

Anti-estrogenic in breast and uterus

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12
Q

SERM that is not generally used to tx osteoporosis

A

Tamoxifen

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13
Q

Clinical applications of raloxifene

A

Due to its estrogen agonist effects on bone, it is used to prevent AND treat postmenopausal osteoporosis

Due to its antiestrogenic effects on the breast, used to reduce the risk for development (but not treat) estrogen-dependent breast cancer

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14
Q

AEs of raloxifene

A

Increased risk of DVT, PE, and stroke (discontinue in anticipation of prolonged immobilization)

Pregnancy risk category X — leads to many fetal anomalies and fetal death

Can cause hot flashes in women previously asymptomatic

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15
Q

What is the only drug for osteoporosis that increases bone formation?

A

Teriparatide (PTH 1-34)

[Clinical indications include tx of postmenopausal osteoporosis, osteoporosis in men, and glucocorticoid-induced osteoporosis]

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16
Q

MOA of teriparatide

A

Truncated (1-34) version of endogenous 1-84 PTH made by recombinant DNA technology that retains the activity of full length PTH

17
Q

Teriparatide is the only drug that increases bone formation. How does it do this?

A

Increases bone resorption by osteoclasts and increases bone deposition by osteoblasts

When given continuously, bone resorption by osteoclasts predominates

When given daily using PULSED therapy, osteoblast responses predominate

18
Q

Monoclonal Ab that is a first-in-class RANKL inhibitor; thus, by binding to RANKL it decreases the formation and function of osteoclasts, decreasing the bone resorption with increased bone mass density and bone strength

A

Denosumab

19
Q

Clinical applications of denosumab

A

Treatment of osteoporosis in postmenopausal women at high risk for fractures

Prevention of skeletal-related events in pts with bone metastases from solid tumors (uses a much higher dosage)

20
Q

Denosumab should be taken with ____ and ______ to prevent hypocalcemia

A

Calcium; vitamin D

21
Q

AEs of teriparatide [not an LO]

A

Generally well tolerated but AEs include nausea, headache, back pain, and leg cramps

Levels of serum Ca, Mg, and uric acid rise transiently but return to normal over several weeks

22
Q

AEs of denosumab [not an LO]

A

In women with osteoporosis, AEs include back pain, pain in extremities, MSK pain, hypercholesterolemia, UTI

In bone mets pts, AEs include fatigue, hypophosphatemia, and nausea

In all pts: delayed fracture healing, increased risk of new fractures, osteonecrosis of the jaw, skin reaction not limited to injection site, and slightly increased risk of severe infections

23
Q

“Calcimimetic” drug that binds to the calcium-sensing receptors on the parathyroid gland, both increasing their sensitivity to extracellular calcium, and decreasing PTH secretion

A

Cinacalcet

24
Q

Clinical applications for cinacalcet

A

Primary hyperparathyroidism (parathyroid carcinoma)

Secondary hyperparathyroidism due to CKD

25
Q

T/F: No pharmacotherapy convincingly reverses (or even slows) the joint damage seen in osteoarthritis

A

True

26
Q

List dietary supplements used for osteoarthritis despite a lack of evidence of meaningful benefit

A

Glucosamine

Chondroitin

Dimethyl sulfoxide (DMSO)

S-adenosyl-L-methionine (SAMe)

27
Q

OTC Herbal remedies used for osteoarthritis that lack both reliable evidence of benefit and consistency in preparation

A

Devil’s claw

Stinging nettle

Rose hips

Avocado soybean unsaponifiables

28
Q

_______ is utilized to treat the pain of noninflammatory osteoarthritis

A

Acetaminophen

29
Q

_______ are used to treat inflammatory osteoarthritis, or non-inflammatory OA that is refractory to acetaminophen

A

NSAIDs

30
Q

Topical treatments utilized to treat pain of osteoarthritis

A

Topical NSAID: 1% diclofenec gel

Capsaicin

31
Q

Osteoarthritis pain that is resistant to acetaminophen, NSAIDs, or capsaicin, may be treated with what other options?

A

Opioid analgesics

Intra-articular hyaluronans

Glucosamine and chondroitin compounds (safe to use even if lack of benefit)

32
Q

Challenges associated with antibiotic treatment of osteomyelitis

A

Canaliculi are big enough for bacteria, but too small for white cells, so the antibiotic needs to penetrate in there or the bone needs to be destroyed to get at them

Blood flow may also be compromised

33
Q

Effective oral antibiotics used to tx osteomyelitis

A

Clindamycin

Rifampin

Trimethoprim-sulfamethoxazole

Fluoroquinolones

MSK II Exam I (8 decks)

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