Msi Week 2: Therapeutics -Ihnat

Front 1

What drug does not work well if previously treated with bisphosphates?

Back 1

PTH (teriparatide)

Front 2

Fill in the following about the mechanism of action of excess teriparatide (PTH) with raises or lowers:

PTH ______ RANKL release (osteoblast) which ______ osteoclast number which then _____ bone turnover which finally _____ bone resorption

Back 2

PTH RAISES RANKL release (osteoblast) which RAISES osteoclast number which then RAISES bone turnover which finally RAISES bone resorption

Front 3

Low and intermittent doses of PTH (teriparatide) does what to bone?

Back 3

increase bone formation without first stimulating bone resorption

Front 4

What are the effects of PTH (teriparatide) on the kidney?

Back 4

PTH increases the ability of the nephron to reabsorb calcium and magnesium

and also increases 1,25-vitamin D formation

Front 5

True or False

PTH increases the ability of the kidney to reabsorb phosphate, amino acids, bicarbonate, sodium, chloride, and sulfate

Back 5

FALSE

PTH DECREASES the ability of the kidney to reabsorb phophate, amino acids, bicarbonate, sodium, chloride, and sulfate

Front 6

True or False

Vitamin D is a steroidal-like compound

Back 6

TRUE

Front 7

Vitamin D is produced from 7-dehydrocholesterol in what part of the body?

Back 7

skin

Front 8

Under the influence of what causes Vitamin D formation in the skin?

Back 8

UV irradiation

Front 9

What syllable can you find in all Vitamin D agent?

Back 9

"Calc"

Ergocalciferol
Cholecalciferol
Calcifediol
Calcitriol

Front 10

Ergocalciferol is what type of vitamin D?

Back 10

D1

Front 11

Cholecalciferol is what type of Vitamin D?

Back 11

D2

Front 12

Calcifediol is a __-hydroxylated form of Vitamin D

Back 12

di-hydroxylated form

Front 13

Calcitriol is a ___-hydroxylated form of Vitamin D

Back 13

tri

Front 14

What role does Vitamin D play in the body?

Back 14

increases calcium absorption from gut

Front 15

What effect does estrogen have on bone?

Back 15

decreases bone resorption

(by decreasing osteoclasts, IL-6 and effects of PTH on osteoclasts)

Front 16

Why is the transdermal patch (estradiol) effective?

Back 16

Because it often avoids first pass metabolism

Front 17

Where does conjugated estrogens come from?

Back 17

pregnant mare's urine

Front 18

Ethinyl estradiol is a type of what horomone?

Back 18

Estrogen

Front 19

What kinds of cancer may be induced by estrogens?

Back 19

breast and endometrial/uterine cancer

Front 20

What should non-hysterectomized patients take with estrogen to protect the endometrium?

Back 20

progestin

Front 21

Besides cancer, what other adverse drug reaction is associated with estrogen?

Back 21

thromboembolic problems

(increased clotting factors/CV risk)

Front 22

What does "SERM" stand for?

Back 22

Selective Estrogen Receptor Modulators

Front 23

What do SERMs compete with for estrogen receptor binding?

Back 23

estradiol

Front 24

The estrogenic effects of SERMs are more pronounced where in the body?

Back 24

bone

Front 25

What are SERM's used for?

Back 25

Osteoporosis (raloxifene)

(and estrogen-dependent breast cancer)

Front 26

What is a common ADR of SERMs?

Back 26

hot flashes- due to anti-estrogenic effects

Front 27

Bisphosphonates are analogs of what?

Back 27

pyrophosphates

Front 28

How do bisphosphonates work?

Back 28

they decrease osteoclasts leading to decreased bone resorption

Front 29

If osteoclasts were hungry bone-eating dogs, what would bisphosphonates be?

Back 29

a chew toy (keeps the dog/osteoclast busy so it can't eat/reabsorb bone)

Front 30

what syllables can you find in most bisphosphonate drug names?

Back 30

-(d)ronate

Front 31

Allen Rice eated zesty ibandaids. (bisphosphonate drugs)

Back 31

Alendronate
Risedronate
Etidronate
Zolendronate
Ibandronate

(see guila for picture)

Front 32

What are two adverse drug reactions with bisphosphonates?

Back 32

GI (less prominent with IV forms)
Jaw osteonecrosis

Front 33

Besides food, what interacts with bisphosphonates?

Back 33

CALCIUM SUPPLEMENTS

have pt take them at different taimes

Front 34

Denosomab is an antibody against what?

Back 34

RANKL

Front 35

What happens when denosomab blocks RANKL?

Back 35

lowers preosteoclasts thereby lowering osteoclast

Front 36

How often is denosomab given?

Back 36

every 6 months SQ

Front 37

What is the most significant adverse drug reaction with denosomab?

Back 37

hypocalcemia

Front 38

What therapy appears to be effective in preventing fractures but is less well established?

Back 38

calcitonin

Front 39

What therapy should be reserved for refractory or severe cases of osteoporosis at this point?

Back 39

PTH