[PHARM] Pharm of Osteoporosis and Gout [Wolff]

Question 1

What are calcium salts used to treat?

Answer 1

Mild hypocalcemia

Simply as dietary supplements

Question 2

What symptoms can hypercalcemia cause?

Answer 2

GI disturbances (constipation)

CNS effects (lethargy)

Renal dysfunction (polyuria, kidney stones)

Question 3

What is given to pts with severe hypocalcemia?

Answer 3

PARENTERAL calcium salts

Question 4

What are the two compounds that we are referring to when talking about vitamin D?

Answer 4

Ergocalciferol

Cholecalciferol

Question 5

What compound of vitamin D occurs in plants?

What compound of vitamin D is produced when exposed to sunlight?

Answer 5

Plants = ergocalciferol

Sunlight = cholecalciferol

Question 6

Calcitonin-Salmon

MOA?

Effects?

Clinical applications?

Answer 6

Similar in fxn to human calcitonin, but has longer half life and greater potency

Inhibits osteoclasts; Decrease bone resorption

Established osteoporosis

Question 7

What is the suffix for bisphonphonates?

Answer 7

-dronate

Question 8

Name examples of bisphosphonate drugs

Answer 8

Alendronate

Risedronate

Ibandronate

Tiludronate

Zolendronic acid

Question 9

Alendronate

MOA

Effects

Clinical applications

Toxicities

Answer 9

Structural analog of pyrophosphate; normal constituent of bone

Incorporates into bone, then inhibits bone resorption by decreasing activity of osteoclasts; kills them

Osteoporosis, Paget dz, Hypercalemia of malignancy

Esophagitis, Osteonecrosis of the jaw, atypical femur fractures

Question 10

What is the one bisphosphonate drug that avoids GI problems?

Answer 10

Zolendronic acid

Question 11

What is the one SERM drug that is useful in treating osteoporosis?

Answer 11

Raloxifene

Question 12

Raloxifene

MOA

Effects

Clinical applications

Toxicities

Answer 12

SERM

Blocks estrogen in breast and uterus, but AGONIZES estrogen in bone

Postmenopausal osteoporosis

DVT, PE, Stroke

Question 13

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

Answer 13

Teriparatide

Question 14

What is teriparatide?

How does it work to form bone?

Answer 14

(1-34) Version of endogenous PTH

When given daily pulsed therapy, OSTEOBLAST activity predominates

Question 15

What class is denosumab in?

Answer 15

RANKL inhibitor

*monoclonal antibody

Question 16

Denosumab

Effects?

Clinical applications?

Toxicities?

Answer 16

By binding RANKL, it decreases formation and function of osteoclasts

Osteoporosis

Delays fracture healing, new fractures, osteonecrosis of the jaw

Question 17

What is an important consideration in the treatment of osteoporosis in men?

Answer 17

Testosterone replacement

Question 18

What is the one calcimimetic drug?

Answer 18

Cinacalcet

Question 19

Cinacalcet

Effects?

Clinical applications?

Answer 19

Binds to Ca2+ sensing receptors in PT gland, increases sensitivity to extracellular Ca2+ and decreases PTH secretion

Primary hyperparathyroidism, Secondary Hyperparathyroidism due to CKD

Question 20

What is osteomeylitis?

Answer 20

Bacteria induced break of the bone that won’t heal

The canaliculi and too small for white cells, large enough for bacteria

Question 21

What are some foods that have HIGH purine diet (not recommended for GOUT patients)?

Answer 21

Mussles

Meat extracts

Internal organs

Yeast

Fruits

Fish

Nuts

Question 22

What are examples of LOW purine containing foods?

Answer 22

Cheese

Eggs

Cereals

Bread

Butter

Milk

Coffee/tea

Vegetables

Question 23

Gout patients one either one of two categories to develop their disease…

They are uric acid…

Answer 23

Underexcreters

Overproducers

Question 24

Most gout patients are uric acid…

Answer 24

UNDEREXCRETERS

Question 25

What are the steps in the initial management of acute gout?

Answer 25

NSAIDs Colchicline Glucocorticoids

Question 26

What are the (3) primary NSAIDS indicated for gout?

Answer 26

Naproxen Indomethacin Celecoxib

Question 27

Colchicine MOA? Effects? Clinical applications?

Answer 27

Blocks formation of **microtubules** Inhibits leukocyte migration and phagocytosis Pts with NSAID intolerance with gout

Question 28

Allopurinol MOA Effects Toxicities

Answer 28

Competitive inhibitor of **xanthine oxidase** Without conversion to urate, hypoxanthine and xanthine are excreted; both are more soluble than urate Stevens-johnson

Question 29

Febuxostat MOA Effects What priority Downside

Answer 29

Inhibitor of **xanthine oxidase** Without conversion to urate; hypoxanthine and xanthine are excreted 2nd line; if allopurinol isn't tolerated Expensive

Question 30

Pegloticase MOA Effects Toxicities

Answer 30

Recombinant mammalian uricase Converts uric acid to the far more soluble **allantoin** Infusion reactions

Question 31

Probenecid MOA Effects Clinical application

Answer 31

Organic acid that blocks urate resorption Increases excretion of **urate** **Underexcreters** with GFR \>60ml/min and NO STONES