Pharmacology Exam 6

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Pharmacology Exam 6
2011-04-16 17:29:21
Agents that Affect Bone

Agents that Affect Bone
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  1. Parathyroid hormone regulates
    Ca2+ and P+ flux accross cell membranes in bone and kidney resulting in increased serum Ca2+ and decreased serum P+
  2. PTH action in bone
    • increase activity and number of osteoclasts (indirect effect)
    • effect is on osteoblasts
  3. Vitamin D3
    secosteroid made in the skin
  4. Major biologic function of circulating D3
    increase efficiency of small intestine to absorb dietary calcium and phosphate
  5. Vitamin D also facilitates
    hydroxyapatite deposition in bone matrix
  6. Calcitriol
    • synthetic Vitamin D analog
    • regulates absorption of Calcium from the GI tract and utilization in the body
  7. Calcitriol used in
    • predialysis patients
    • dialysis patients
    • hypoparathyroidism patients
  8. Adverse effects with calcitriol
    hypercalcemia syndrome or Ca2+ intoxication
  9. Drug interactions with calcitriol
    • cholestyramine
    • phenytoin/phenobarb
    • thiazides
    • increases cholesterol
  10. Doxercalciferol (hectoral)
    synthetic vitamin D2 analog that undergoes metabolic activation to 1a25-dihydroxyvitamin D2
  11. Indications for doxercalciferol
    • secondary hyperparathyroidism in pt with chornic kidney disease on dialysis
    • secondary hyperparathyroidism in pt with stage 3 or 4 chronic kidney disease
  12. Adverse effects of doxercalciferol
    • infection
    • chest pain
    • constipation
  13. Drug interactions with doxercalciferol
    • cholestyramine interferes with absorption
    • hypermagnesemia
    • CYP450 inhibitors my inhibit activation of Doxercalciferol
  14. precautions with doxercalciferol
    • active vitamin D sterols should not be used as initial therapy for nutritional vitamin D deficiency
    • Dose titration is usually required
  15. Alendronate (fosamax)
    • second generation biphosphate that strengthens bones and prevents bone loss.
    • potent inhibitor of bone resorption
  16. Alendronate is indicated for
    • osteoporosis/prophylaxis
    • pagets disease
  17. Mechanism of action for alendronate
    prevents osteolclast activity and bone resoption by binding to Ca2+
  18. Contraindications for alendronate
    • GERD
    • esophageal gastritis
    • hiatal hernia
  19. Drug interactions with alendronate
    • antacids/PPIs
    • aspirin
  20. Adverse drug reactions with alendronate
    • abdominal pain
    • arthralgia
    • constipation
    • gastritis
    • diarrhea
  21. Etidronate indication
    • symptomatic paget's disease
    • prophylactic therapy for heterotrophic ossification following hip replacement or spinal injury
    • NOT approved for osteoporosis
  22. Etidronate can cause reductions in
    serum alkaline phosphatase levels
  23. Adverse effects of Etidronate
    • GI problems
    • alopecia
    • arthralgia/arthritis
    • bone fracture
    • esophagitis
  24. Ibandronate (boniva)
    nitrogen containing bisphosphonate that inhibits osteoclast mediated bone resorption
  25. Indications for ibandronate
    • therapy and prevention of osteoporosis in postmenopausal women
    • increases bone mineral density
    • reduces incidence of vertebral fractures
  26. Ibandronate is not recommended in pt w
    • severe renal impairment
    • creatinine clearance < 30 mL/min
  27. Ibandronate adverse reactions
    • Diarrhea/abd pain
    • arthralgia/myalgia
    • ocular inflammation
  28. Drug interactions with ibandronate
    • extra GI irritation with NSAIDS
    • Antacids/PPIs can inhibit absorption
  29. Residronate (actonel)
    pyridinyl bisphosphonate that inhibits osteoclast mediated bone resorption and modulates bone metabolism
  30. Residronate indications
    • therapy and prevention of osteoporosis in post menopausal women
    • treatement of pagets disease in men and women
  31. Residronate ADEs
    • Abd pain
    • diarrhea
    • gastritis
    • back pain
    • arthralgia
    • bone pain
  32. Residronate precautions
    • hypocalcemia
    • renal impairment
    • glucocorticoid induced osteoporosis
  33. Residronate contraindications
    • inability to sit upright for 30 min
    • hypocalcemia
    • hypersensitivity
  34. Zoledronic Acid (Zometa) indications
    • hypercalcemia of malignancy
    • multiple myeloma
    • bone metastases from solid tumors in conjuction with standard antineoplastic therapy
  35. Zoledronic Acid ADEs
    • Fever
    • nausea
    • constipation
  36. Zoledronic Acid Drug interactions
    • Aminoglycosides (additive Ca2+ lowering)
    • Loop diuretics (increased risk of hypocalcemia)
    • Thalidomide (risk of renal dysfunction in multiple myeloma pt)