PPNP2 - Bone conditions

Question 1

Drugs for fractures

Answer 1

Bisphosphonates
- Alendronate (PO)
- Risedronate (PO)

RANK inhibitor
- Denosumab (SC)

PTH analogue
- Teriparatide (SC)

Question 2

Ridedronate/ Alendronate MOA

Answer 2

Prevent bone breakdown

• structural analogue of pyrophosphate (natural substance that inhibits bone breakdown)
• most beneficial in 1st year of use in increasing bone density

Question 3

Risedronate/ Alendronate effects

Answer 3

GI (nausea, dyspepsia, diarrhea)
Bone pain
Back pain

Question 4

Denosumab MOA

Answer 4

Reduce bone resorption

• mAb that targets RANK
• RANK important in bone resorption pathway
• new and targeted drug (good for post menopausal women, patients with bone tumor)

Question 5

RANK inhibitor effects (Denosumab)

Answer 5

Fatigue, Asthenia, Nausea, Hypophos, Hypocal, Hypercholesterol, MSK pain, Cystitis

Question 6

PTH analogue effects (Teriparatide)

Answer 6

Dizziness, vertigo, nausea, depression, insomnia, rhinitis, cough, leg cramps, arthralgia

Question 7

Drugs for Osteomyelitis

Answer 7

Beta lactam antibiotic
- Ceftriaxone

Glycopeptide
- Vancomycin

All IV

Question 8

Ceftriaxone MOA

Answer 8

Inhibit bacterial cell wall synthesis (transpeptidation)

Question 9

Ceftriaxone effects

Answer 9

Rash, diarrhea, allergic reaction, thrombophlebitis

Question 10

Vancomycin MOA

Answer 10

Inhibit bacterial cell wall synthesis (transglycosylation)

Question 11

Vancomycin effects

Answer 11

N/V, anaphylaxis, superinfection, nephrotoxicity, ototoxicity

Red Man’s syndrome

Question 12

Drugs for M. TB

Answer 12

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

Question 13

Rifampicin MOA

Answer 13

Inhibit RNA synthesis
(Bactericidal)

Oral/ IV

Question 14

Rifampicin effects

Answer 14

GI (heartburn, epigastric pain, anorexia)

cramping, orange discoloration of urine/sweat/tears,

pseudomembranous colitis, acute renal failure, hepatotoxicity, hyperuricemia, blood dyscrasias

Question 15

Isoniazid MOA

Answer 15

Inhibit mycolic acid

• bactericidal in rapidly dividing bacteria
• bacteriostatic in dormant bacteria
• elimination through acetylation
• rate is affected by gene polymorphism (chinese > indians)

Question 16

Isoniazid effects

Answer 16

• GI (N/V, epigastric pain)
• pellagra (give w b6 esp breastfeeding, malnourished)
• anaphylaxis, skin allergic effects,
• peripheral neuropathy, optic neuritis,
• hepatotoxicity,
• blood dyscrasias

Question 17

Pyrazinamide

Answer 17

Inhibits bacterial cell membrane

Question 18

Pyrazinamide effects

Answer 18

• gouty arthritis, arthralgia
• rash, anaphylaxis,
• hepatotoxicity (highest),
• hemoptysis, hemolytic anemia,
• photosensitivity,
• GI,

Question 19

Ethambutol MOA

Answer 19

Inhibit cell wall synthesis

Question 20

Ethambutol side effects

Answer 20

GI, headache, dizziness, anaphylaxis, optic neuritis, contradicted in patients with sever liver disease

Question 21

Treatment regime for M. Tb

Answer 21

Active
- 2 months (RIPE daily, B6)
- 6 months - Isoniazid, rifampicin 2-3x/week

Latent
- 6-9 months mono therapy isoniazid with b6

Question 22

Osteoarthritis drugs

Answer 22

• NDAIDs
• topical capsaicin
• weak opioids
• corticosteroid injections

Question 23

PTH analogue (Teriparatide)

Answer 23

Increases bone formation

• mimics endogenous PTH to increase bone formation
• reserved for patients with high fracture risk (but need to SC daily)