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31 Cards in this Set
- Front
- Back
What are the 2 major constituents of Bone?
What are the 2 major regulators of these constituents? |
Calcium and Phosphate
Vitamin D - Aids Ca++ absorption PTH - teriparatide |
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What is the MOA of PTH in the bone?
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Releases RANKL -> increased osteoclast number/activity -> Increases bone turnover
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What is the MOA of PTH in the Kidney?
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Increases calcium reabsorption
Stimulates vitamin D formation |
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What is Calcet and what does it do?
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Blocks PTH release (antagonist)
Used for hyperparathyroidism |
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Essentially what does PTH do?
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Retards bone loss but doesn't stimulate new growth
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What are the PO bisphosphonates?
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Allendronate
Risedronate Etidronate - Inhibits calcification of bone (no osteoporosis) |
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What is the IV bisphosphonates?
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Zolendronate
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What are the IV and PO bisphosphonates?
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Ibandronate - Most potent form
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What is the MOA of Bisphosphonates?
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- Analogs of pyrophosphate
- Taken up into bone -> inhibit osteoclast activity - May also kill osteoclasts |
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What are the main adverse reactions of the bisphosphonates?
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GI disturbance
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What must you do in order to take bisphosphonates to try to avoid GI problems?
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After a night-long fast
With a large glass of water While sitting or standing upright Don't take at same time as C++ Supplement |
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What is the rare adverse reaction of using bisphosphonates?
What forms are most common in causing this |
Jaw Osteonecrosis - Rare (.03-.4%)
IV Forms 94% vs 6% PO |
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What is the MOA of Denosumab?
Monoclonal Antibody |
Antibody against RANKL -> decreased osteoclast formation -> decreased bone turnover
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What is the dosage of Denosumab?
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1 Injection every 6 months
May take several months to start having an effect |
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What are the adverse reactions for Denosumab?
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Hypocalcemia
Patients must take calcium/vitamin D while on this drug |
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What are rare adverse reactions to Denosumab?
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Increased infections
pancreatitis |
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What is Gout?
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Crystals of Uric Acid in joints (esp. big toe)
Leads to inflammation and pain |
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What are the treatment strategies for gout?
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1)Treat inflammation - some NSAIDS make it worse
2)Increase Uric Acid excretion 3)Block Uric Acid production - Xanthine oxidase inhibitors |
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What is the MOA of Indomethacin?
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Treats inflammation for Gout by COX1 and 2 inhibition
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What are the adverse reactions of Indomethacin?
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GI upset (most potent), water/sodium retention
Does not decrease uric acid levels Used for short term relief |
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What type of anti-inflammatory meds are used for acute forms of gout?
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Corticosteroids - NSAIDS
Indomethacin Colchicine - NSAIDS |
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What is the MOA of Colchicine
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Microtubule inhibitor – blocks cell growth (mitosis)
Kills off immune cells that propagate the inflammatory syndrome |
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What are the adverse reactions of Colchicine?
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GI upset
neutropenia |
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What are the Uricosuric Agents?
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Probenecid
Sulfinpyrazone |
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What is the MOA of Uricosuric agents?
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Block the reabsorption of UA from kidney -> increase excretion of UA
Effects are modest though If used acutely can precipitate a gout attack - given for mild hyperurecimia |
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What are the Xanthine Oxidase Inhibitor agents?
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Allopurinol
febuxostat |
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What is the MOA for the Xanthine Oxidase Inhibitors?
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Block xanthine oxidase, the rate-limiting step in uric acid synthesis
Febuxostat – much more selective for X2O (long term neg. effects much less) |
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What are the adverse reactions associated with Xanthine Oxidase Inhibitors?
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GI upset
Allopurinol can cause myelosuppression, etc. |
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_____ itself can lead to issues with jaw bone as can treatment
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Osteoporosis
bisphosphonate |
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_____ and _____ can lead to hypocalcemia which can affect teeth
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Cincalcet
denosumab |
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_____ and _____ can predispose to infection
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Allopurinol
colchicine |