PHARM - Chapter 36. Bone and Joint Didorders

Active form of vitamin D

Calcitriol

Inactive form of vitamin D that you can get from sun and food sources

Cholecalciferol

Bone Resorption

The process by which osteoclasts (bone-resorbing cells) break down bone tissue and release minerals (like calcium) into the blood.

Hormone responsible for bone resportion

PTH - Parathyroid Hormone

Adecuate levels of __________ (4) are needed for bone homoestasis

• Calcium

• Vitamin D

• PTH

• Calcitonin

Vitamin D deficiencies often lead to

Calcium Disorders

Cholecalciferol from foods + liver =

Calciferol

Prototype drug for Vitamin D therapy

Calcitriol ( Calcijex, Rocaltol)

Elemental calcium may be obtained from

dietary sources such as dark green vegetables, canned salmon, tofu, OJ, milk

Calcium carbonate, calcium acetate, calcium chloride are examples or

Ca salts - Ca supplements

Calcitriol increases or reduced bone resorption

Indirectly reduces bone reposition by reducing increasing Ca serum levels and reducing PTH

Treatment for osteoporosis includes

calcitonin, selective estrogen-receptor modulators, and biphosphonates

Drugs that lower Ca serum levels in the bloodstream that increase the risk of developing osteoporosis

Certain corticosteroids, anticonvulsants, and immunosuppresants

This drug in a SERMs, increases bone density and helps prevent breast cancer

Raloxifene (Evista)

*tip: SERMs end in ifene

Ex. Raloxifene, bazedoxifene

Common adverse effects of Raloxifene (evista)

• Hot flashes

• Migraine headaches

• Flu-like symptoms

• Endometrial disorder

• Breast pain

  • Vaginal bleeding

How do biphosphonates inhibit bone resorption

by supressing osteoclast activity

Important things to remember about alendronate (Fosamax)

• Used to treat osteoporosis, hypocalcemia and paget disease

• Inhibits osteoclast activity

• Ca intake with supplements and food should be reduced because Ca lowers fosamax absorption

• should be taken on an empty stomach

• takes 1-3 months to have therapeutic effects

• causes espophageal irritation, altered metallic taste perception

• Reduces serum Alkaline phosphatase

Name 3 biphosphonates

Alendronate (Fosamax), Ibandronate, Pamidronate

Key: biphosponates tend to end in “onate”

Biphosphanates are used on and off on patients with Pagets Disease. True or False

True

What is the first line of treatment for Osteoarthiritis

Acetaminophen (Tylenol)

What drug is used for osteoarthritis, is an opiod, but is not a controlled/schedule drug?

Tramadol

Name 2 NSAIDs commonly used for osteoarthritis if acetaminophen is not working:

Naproxen, ibuprofen, topical diclofenac

Non-biological therapy drug prescribed to patients with Rheumatoid Arthritis and lupus. Often considered the safest DMARD

Hydroxychloroquine (Plaquenil)

DRMAD’s stand for

Disease-modifying antirheumatic drugs

Give examples of non-biologic therapy DMRAD’s used as first line of treatment of R.A.

Hydroxychloroquine, methotrexate, leflunomide, sulfasalazine

Examples of biologic DMARDs that are TNF blockers, used to supress progression of R.A.

• Adalimumab

• Etanercept

• Cetrolizumab

Examples of biologic DMARDs are Interlukin receptor blockers, which are used to suppress the progression of R.A.

• Anakira - blocks Interlukin-1

• Tucilizumab - blocks interlukin-6

Injectable Subcutaneaus man-made protein that binds and blocks TNF

golimumab (Simponi)

Xanthine Oxidase enzyme blockers traditionally used for gout

• Allupurinol (has uri in it = uric acid)

• prophylaxis

Available in nasal spray

Calcitonin

Drugs that prevent reabsorption of uric acid from kidneys

Probenecid

Sulfinpyrazone