Miscellaneous Quiz / Rheumatology Meds

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Can you name the Rheumatology Meds?

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HintAnswer
1-alpha hydroxyvitamin D2 name
SE: Long term -->: osteoporosis
Cinacalcet class
MOA: Secreted by the parafollicular cells of the thyroid; stimu by hyper-Ca.
SE: Hypercalcemia
MOA: Increases PTH effect on renal Ca resorption & reduced Ca excretion by blocking Na resorption in the proximal tubules.
PTH Use
SE: Has the most significant effects. Risk of femoral fx (atypical subtrochanteric & diaphyseal breaks)
P-kinetics: Poor GI absorption. 50% of the absorbed drug is taken up by bones. Eliminated in urine (unaltered). Absorbed drugs accumulate in bone for months.
Rx interactions: lipophilic-intestinal absorption reduced by statins & cholestyramine (take the drugs a few hrs apart). CS blocks GI vit D absorption.
PTH (or its analog recombinate Teriparatide 1-34) class
Tiludronate class
Riserdronate class
Alendronate class
24,25 Dihydroxyvitamin D3 name
MOA: Act on Ca sensing receptor (CaR) and LOWER its sensitivity --> block of PTH secretion.
Use: Hypocalcemia & ancillary tx for osteoporosis
Use: Tx hyper-Ca assoc w/ malignancy & granulomatous dz. Useful in Vit. D intoxication
Zolendronate class
Alternative to estrogen tx. Prevents the increased risk of breast/uterus CA. Protects spine fxs (not hip).
Use: Tx hypercalcemia, Paget's disease, osteoporosis
MOA: Prehormone made directly from cholecalciferol in the liver; low biologic activity, major form circulating in the blood
MOA: Stimulate renal Ca excretion. Blocks bone formation. Increases osteoclast differentiation.
Class MOA: Stimulates new bone formation
Calcitonin class
Route for Ca gluconate
HintAnswer
Class MOA: Binds to receptors thru-out body. Regulates Ca & phos serum levels; promotes absorption in the GI; promote renal reabsorption of Ca.
MOA: Enhance absorption of Ca from the GI (stim production of active Vit. D in the kidney). Supress of Ca loss in urine (stim reabsorption of Ca). Stim loss of phos in urine.
Use: Topical tx for psoriasis
Use: Tx secondary hyperparathyroidism in renal failure pts
MOA: Activated form made from calcidiol in the kidneys & tissues; the most potent steroid hormone in the body
Etidronate class
Use: Tx hyperparathyroidism 2nd to chronic renal dz as well as parathyroid CA. In trials for primary hyperparathyroidism
Use: Tx hypercalcemia assoc w/ malignancy, Paget's dz, & postemenopausal osteoporosis
MOA: Reduces bone resorption
NET RESULT = REDUCED SERUM CALCIUM
SE: GI symptoms, nausea, flush
SE: Overdose -> dental fluorosis (yellow teeth)
Calciprotriene name (analog)
MOA: Produced by adrenal gland. Antagonizes Vit D's effect on intestinal Ca absorption.
MOA: Regulates Ca & Phos conc in ECF. Mobilizes Ca from bone (stim osteoclast diff via RANKL).
MOA: NET RESULT = REDUCED RENAL EXCRETION OF CA
Drug MOA: Made in the lab by radiating fungus; not naturally occuring in the body
Vitamin D2 name
Pamidronate class
Glucocorticoids class
1,25-Dihydroxyvitamin D3 name
Use: serum Vit D concentration testing
SE: Long term use is assoc w/ breast cancer.
19-nor-1,25-Dihydroxyvitamin D2
Reduces serum Ca and phos, reduces osteoclastic bone resorption, decreases renal resorption of Ca & phos. Increases bone mass & reduces spine fx.
Drug MOA: Naturally occuring form made by the skin upon sun exposure; found in food & most supplements
HintAnswer
MOA: Accumulated by bone & teeth. Stabilizes the hydroxyapatite crystal. Prevents dental caries & vertebral compression fx.
25-Hydroxyvitamin D3 name
Use: Tx hypophosphatemia & hypercalcemia
Vitamin D3 name
MOA: Analogues of pyrophosphate (PPI - inhibits calcification in plasma but easily degraded by alk phos) -- P-C-P core is less degradable.
MOA: A sex hormone. Reduces PTH's effect on bone resorption (via OPG). NET RESULT = BLOCKS BONE LOSS
Drugs that induce osteoporosis
MOA: RESULT = REDUCED PTH RELEASE FROM PARATHYROID GLAND
Estrogens class
Use: Tx hypocalcemia & helps to tx hyperphosphatemia.
MOA: ____ bisphosphonate (___-BPs = more potent) (except etidronate & tiludronate)
Use: Prevent dental caries. Not yet approved for osteoporosis
SE: Major SE: gastritis, esophagitis (caused by GERD) -- to minimize: take w/ H2O and remain upright for 30 min.
Class MOA: Promotes bone formation. Inihibits PTH secretion. Promotes immunosuppression, phagocytosis, & anti-tumor activity
Rx interactions: P450 inducers (phenytoin & phenobarbital) increase liver metabolism to inactivate product.
Use: Hypercalcemia of malignancy
Ibandronate class
MOA: Binds to hydroxyapatite & retards formation & dissolution of hydroxyapatite crystals (slow down resorption) --> decreased resorption by osteoclasts & modest increase in BMD.
MOA: NET RESULT = INCREASED SERUM CA AND DECREASED SERUM PHOSPHATE.
Use: tx of hypoparathyroidism, refractory rickets, & familal hypophosphatemia
MOA: Blocks farnesyl pyrophosphate synthase in the HMG-CoA reductase pathway (mevolante pathway) --> osteoclast apoptosis. Increase bone density; reduce fx in hips, spines, etc.
Use: Hypercalciuria, prevent stone formation in idiopathic hypercalciuria (by decreasing oxalate excretion & increasing urine Mg and Zn)
SE: The least potent drug & has less side effects
Use: Tx postmenopausal osteoporosis. Long term use discouraged d/t SE on breast, uterus, & CVS

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