pharm 2: osteoporosis rx

Calcium Salts indication

PK?

Indication:

-mild hypocalcemia

-prevention of osteoporosis

PK:

•  PO or parenteral 

  • NO MORE THAN 600 mg at once

Calcium Salts: ADEs (2)

DRUG INTERACTION?

ADEs:

• constipation, hypercalcemia (rare)

• hypercalemia (3-4g/day) → GI disturbance, renal dysfct, lethargy, cardiac dysrhythemias

Drug interactions:

⬇ absorption of tetracycline, FQ, thyroid hormones, biphosphonates

Vitamin D MOA?

⬆ blood level of ____ and _____ by ⬆absorption

indication? (2)

PK?
Source?

MOA: ⬆ blood level of Ca and phosphorus by ⬆absorption

indication: vita D def, prevent osteoporosis

PK: PO, measured by serum concentration 25-OHD

Source: diet, sunlight

what drug is a dietary supplement with calcitriol?

used for? Used for hypo____ and hypo___ undergoing dialysis

Cholecalciferol and ergocalciferol

Used for hypoPTH and hypoCa undergoing dialysis

calcitriol is used for what type of pt?

CKD pts

what drugs are considered biphosphonate?

-nate (aldendronate, ibandronate, risedronate, zoledronic acid (once yearly and IV))

DOC for osteoporosis

MOA for bisphosphonate?

structural analog of pyrophosphate → taken up _____ by bone and ⬇ # of _____

indication?

structural analog of pyrophosphate → taken up RAPIDLY by bone and ⬇ # of osteoclasts

indication:

• osteoporosis (post menopausal and M)

• paget disease

• hypercalemia of malignancy 

Bisphosphonates stay in the bones for _________ and you should consider a ___________ in low-mod risk pts after 3-5 years

years

holiday

Bisphosphonates ADEs? (4)

CONTRAINDICATIONS? (2)

ADEs:

• Esophagitis

• MSK pain

• Osteonecrosis of JAW

• Dose dependent kidney damage

  • Zoledronic acid → stay hydrated BEFORE tx and monitor kidneys

Contraindications:

• eso disorders

• CrCl < 30/ml/min

Pt edu for bisphosphonate?

full glass of ____, on _____ STOMACH, upright x _____ mins, AVOID TAKING CATIONS for ____ HOURS=

full glass of water, on EMPTY STOMACH, upright x 30-60 mins, AVOID TAKING CATIONS for 2 HOURS

what are the alts drug for osteoporosis?

raloxifene

calcitonin

teriparatide

denosumab

raloxifene MOA?

SERM ( _____ estrogen receptors modulator) → _____ effect of estrogen on _____ and _____ the effect in ______ and ______ (cancer risk)

SERM (selective estrogen receptors modulator) → mimics effect of estrogen on bone and BLOCKS the effect in breast and endometrium (cancer risk)

raloxifene indication?

prevent and treat osteoporosis in _____ - ______ _____, protect against ____ _____

ADE? (2)

pt edu? d/c _____ hrs before prolonged IMMOBILIZATION preg

indication: prevent and treat osteoporosis in POST MENOPAUSAL W, protect against breast cancer

ADE: VTE, contraindicated preg ( ⬆ estrogen = ⬆ preg chances = ⬇ BP effectiveness)

Pt edu: d/c 72 hrs before prolonged IMMOBILIZATION, preg

Calcitonin MOA:

inhibit activity of _____ (_____ bone resorption) and inhibit tubular resorption of _____, _____ Ca excretion

inhibit activity of OSTEOCLAST (suppresses bone resorption) and inhibits tubular resorption of Ca, increasing Ca excretion

calcitonin indication?

post menopausal osteoporosis in W that ≠ tolerate _____, ______ ______, ______

PK? (2)

ADE? (1)

Indications: post menopausal osteoporosis in W that ≠ tolerate HRT (horomonal replacement therapy), paget disease, hypercalcemia

PK: intranasal spray and injection

ADE: nasal spray: increased risk for malignancy

teriparatide MOA?

stimulates ______ → stimulates NEW bone _____

MOA: stimulates OSTEOBLAST → stimulates NEW bone formation

teriparatide indication?

PK?

ADE? (4)

Indications: osteoporosis in post menopausal W and M

PK: subQ injection QD

• REGRIGERATE

ADE: arthralgia, back pain, leg cramps, orthostatic hypotension w/n 4 hrs of injection

Denosomab MOA?

_____ inhibitor

 monoclonal antibody → ⬇ formation and fct of _____ → prevent activation of receptor activator of nuclear factor _____ (RANK)

RANKL inhibitors

monoclonal antibody → ⬇ formation and fct of OSTEOCLAST → prevent activation of receptor activator of nuclear factor kappa (RANK)

denosomab indication?

treat osteoporosis in M and post menopausal W at ___ risk of ____

PK? ____ every ____ months
ADE?

• _____ pain

• Hyperc______

• _____ ______infxn

• Exacerbate pre-existing HYPO_____

• Osteonecrosis of _____

Indication: treat osteoporosis in M and post menopausal W at high risk of fractures

PK: SQ every 6 months

ADE:

• Back pain

• Hypercolestrolemia

• Urinary bladder infxn

• Exacerbate pre-existing HYPOCALCEMIA

• Osteonecrosis of JAW

general tx of osteoporosis?

1. GOAL: _____ - _____mg/day

2. _____ bearing exercises

3. ≠ excessive _____

4. ≠ ____

5. Vita _____ intake

6. ______ → 1st line

1. GOAL: 1000-1200 mg/day

2. Weight bearing exercises

3. ≠ excessive alcohol

4. ≠ smoking

5. Vita d intake

6. Bisphosphonate → 1st line