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Pharm Exam 5: Osteoporosis
n/a
47
Cosmetology
04/27/2011

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Term
PTH stimulates both osteoclasts and osteoblasts, but net effect over time is bone ______. However, In lower doses, PTH can stimulate bone _____, so lower doses used to ....
Definition
resorption
formation
...treat osteoporosis
Term
PTH: Net effect over time ____ Ca and ___ P in serum
Definition
increased
decreased
Term
Vit D: Net effect over time ___ Ca and ___ P in serum
Definition
increased
increased
Term
1,25 Vit D directly inhibits ___
Definition
PTH
Term
High levels of Ca and P:
Reduce amount of ___ produced by kidney
Reduces ___ secretion
Definition
vit D
PTH
Term
calcitonin lowers blood Ca2+ and P levels in two ways:

Definition
Inhibits Ca2+ absorption by the intestines
Inhibits osteoclast activity in bones
Term
Calcitonin Indications: (3)
Definition
Paget’s , hypercalcemia, and osteoporosis (all of which have decreased Ca)

- not really sure what to think of this b/c calcitonin lowers serum Ca, but it does so in part by decreasing osteoclast activity - so good for osteoporosis

Term
Glucocorticoids prolonged administration can cause: (2)
Definition
Osteoporosis in adults
Stunted growth in kids
Term
Estrogen MOA Hypothesis:
Definition
decreases bone resorption action of PTH and increases Vit D in blood
Term
which hormone is used for osteoporosis that doesn't have a cancer risk?
Definition
Selective Estrogen Reuptake Modulators (SERM’s)
Term
Selective Estrogen Reuptake Modulators (SERM’s) impt side effect:
Definition
hot flashes
Term
Calcimimetics (Cinacalcet)
Definition
Activates calcium sensing receptor
1° in parathyroid gland
Blocks PTH secretion
Indications: 2° hyperPTH in kidney dz and parathyroid cancer
Term
Picamycin (Mithramycin)
Definition
Cytotoxic antibiotic; unclear MOA
Indications: Paget’s and hypercalcemia
Term
Thiazides
Definition
Reduces renal Ca excretion
May increase effectiveness of PTH stimulating reabsorption of Ca by kidney and increasing Na excretion
Also, reduces hypercalcemia and stone formation
Term
What is not used to treat osteoporosis due to its toxicity at high levels?
Definition
fluoride
Term
Etidronate (Didronel)
Definition
Bisphosphonates
Term
Bisphosphonates end in ________
Definition
ronate
Term
Pamidronate (Aredia)
Definition
biphosphonate
Term
Alendronate (Fosamax)
Definition
biphosphonate
Term
Risedronate (Actonel)
Definition
biphosphonate
Term
Tiludronate (Skelid)
Definition
biphosphonate
Term
Ibandronate (Boniva)
Definition
biphosphonate
Term
Zolentronate (Reclast, Zometa)
Definition
biphosphonate
Term
which biphosphonate has the least GI side effects?
Definition
Etidronate (Didronel
Term
which biphosphonate is not oral?
Definition
Pamidronate (Aredia
Term
which biphosphonate is for paget's only?
Definition
Tiludronate (Skelid
Term
Bisphosphonates: Greatest effect on _______
Definition
osteoclasts
Term
_________ Usually Rx’d to take with full glass of water on empty stomach and remain upright for 30minutes - so a lot of GI upset
Definition
biphosphonates
Term
Vitamin D Deficiency: (2)
Definition
rickets (children) and osteomalacia (adults)
Term
Vitamin D Uses: (6)
Definition
hypophosphatemia, hyperparathyroidism due to decreased vitamin D, hypocalcemia, psoriasis, osteomalacia, and renal osteodystrophy
Term
Vitamin D OD: (2)
Definition
hypercalcemia and excess bone loss
Term
Drugs not FDA approved for osteoporosis: (4)
Definition
Calcitriol (Rocaltrol, Calcijex)
fluoride
HRT
Estrogen
Term
Drugs FDA approved for Tx of osteoporosis: (4)
Definition
Bisphosphonates
SERMs
Teriparatide (Forteo)
Calcitonin (Calcimar, Miacalcin)
Term
Paget’s disease
Definition
Uncontrolled osteoclastic bone resorption
Bone formation is increased in response but often poorly organized
Elevated serum alkaline phosphatase and urinary hydroxyproline are diagnostic
DOC: calcitonin and bisphosphoates (etidronate, alendronate, risedronate, and tiludronate)
Bisphosphonates are used for 6 months and can be repeated 6 months
Goal: reduce bone pain, prevent deformity, hearing loss, cardiac failure, hypercalcemia
Etidronate toxicity results in osteomalacia and bone pain
Plicamycin can be used in short courses if calcitonin and bisphosphonates have failed
Term
Vitamin D dependent Rickets
Definition
Autosomal recessive disease (super rare)
Same sx as rickets; but no response to low dose vitamin D supplementation
Type I – mutation in enzyme producion 1,25-dihydroxy-vitamin D
Treat with Vitamin D 4000 IU daily or calcitriol 0.25-0.4 daily
Type II – mutation in the gene for the vitamin D receptor
Treat with high doses of calcitriol
Term
Ideopathic hypercalciuria
Definition
SSx – hypercalciuria and nephrolithiasis
Normal serum Ca and PTH levels
3 subgroups having to do with Ca absorbtion, Ca secretion, and phosphate leakage
HCTZ 50-100 mg daily
D not use loop diuretics (increase urine Ca secretion)
Allopurinol is an alternative
Term
Intestinal osteodystrophy
Definition
Malabsorption of vitamin D due to GI and hepatic diseases
Bile contains vitamin D which should be reabsorbed in the jejunum and ileum
Mild malabsorption
Vitamin D 25000-50000 IU 3x/week
Severe disease rarely responds to vit D
Calcitrol may be helpful along with Ca and P monitoring
Term
Nephrotic Syndrome
Definition
Lose vit D in urine by losing vit D-binding protein
No treatment approved or in clinical trials at this time.

Term
Enteric Oxaluria
Definition
Associated with short bowel syndromes with fat malabsorption
Many renal stones of calcium and oxalate
Treat with calcium supplementation which binds oxalate and prevent its absorption
Term
Vitamin D deficiency/insufficiency
Definition
Deficiency: 25-vit D levels <10ng/mL
Insufficiency: 25-vit D levels 10-32 ng/mL
Common in pediatric, geriatric, and vegetarian patients and those with reduced sun exposure
800-1200 IU of vitamin D
Term
Chronic kidney disease
Definition
Causes loss of 1,25-vit D production due to impact on bone mineral homeostasis:
Decreases Ca absorption from intestine
Retains P levels
Hyperparathyroidism results
Osteomalacia and osteitis fibrosa results
Doxercalciferol (Hectoral) and paricalcitol (Zemplar) are approved for treatment of 2° hyperhparathyroidism due to chronic kidney disease
Term
1° hyperhparathyroidism
Definition
Sx associated with Hypercalcemia
Surgery is best
Cinacalcet (calcimimetic) in clinical trial for 2° hyperparathyroidism (future treatment?)
Term
Hypoparathyroidism
Definition
Usually caused by absence of PTH causing hypocalcemia and hyperphosphatemia and low vitamin D levels
Vitamin D 25000-100000 IU 3x per week with Ca supplementation
Calcitriol is also an option
Term
Hyperphosphatemia
Definition
Causes: Renal failure, hypoparathyroidism, vitamin D intoxication
Treatment: dialysis, glucose and insulin infusions, dietary restriction
Rarely an emergency
Term
Hypophosphatemia
Definition
Causes: Hyperparathyroidism, vit D deficiency, hypercalciuria, rickets
Longterm Sx: proximal muscle weakness, osteomalacia
Rarely an emergency
In X-linked and autosomal dominant disease, treatment with oral phosphate and calcitriol has offered encouraging results.
Term
Hypocalcemia
Definition
Sx: neuromuscular – tetany, paresthsias, laryngospasm, muscle cramps, convulsions
Causes: hypoparathyroidism, vit D deficiency, kidney dz, malabsorbtion
Treatment:
Calcium – IV, IM, PO forms
Calcium gluconate is least irritating to veins
Calcium carbonate is PO choice because of ready availability
Vitamin D
1,25 vit D is form of choice raising Ca in 24-48 hours
Term
Hypercalcemia
Definition
Sx: CNS depression including coma
Causes: hyperparathyroidism, cancer, sarcoidosis, hypervitaminosis D, etc.
Requires emergency lowering of serum calcium:
Saline diuresis with furosemide
Bisphosphonates (pamidronate, zoledronate)
Calcitonin – (ancillary) lacks toxicity
Gallium nitrate – inhibits bone resorption (toxic)
Plicamycin – toxic causing thrombocytopenia
Phosphate – fastest way to reduce Ca, used after other methods fail
Glucocorticoids – reponse over days