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Teriparatide Acetate
- Synthetic PTH which in
- Bone- increases ca2+ mobilization
- Kidney- increases Ca2+ and Mg2+ reabsorption, decreases phosphate reabsorption, increases Vit D production
- Intestine- increases Ca2+ absorption cause of Vit. D being produced in Kidney
- Uses: Osteoporosis if given intermittently, Hypoparathyroidism, Diagnoses pseudohypoparathyroidism (increase in cAMP after challenge denotes normal PTH responsiveness).
- Adverse Effects: NOT USED FOR HYPOCALCEMIA!!!!, Hyperparathyroidism, May increase risk of osteomalacia so do not use in patients with other bone issues
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Calcitonin
- Human CT or synthetic salmon CT with longer halflife decreases serum Ca2+ by decreasing osteoclast activity and increasing Ca2+ excretion
- Use: OSteoporosis, Paget's disease, Hypercalcemia
- Adverse Effects: nausea, facial flushing, swelling of hands, inflammatory reactions at injection sites, urticaria (rash), salmon form shows hypersensitivity or resistance.
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Etidronate
- Biphosphonates (pyrophosphate analog)
- Uses: Osteoporosis, Paget's disease, Hypercalcemia associated with malignancy, Given during Glucocorticoid therapy to prevent bone mineral loss
- MOA: Binds hydroxyapatite in bone and incapacitates osteoclast breakdown;
- Adverse Effects: Upper GI distress (sit upright 30 min after dose), Hypocalcemia, Hypophosphatemia, Poorly absorbed cus oral bioavailability very low
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Alendronate
- Biphosphonates (pyrophosphate analog)
- Uses: Osteoporosis, Paget's disease, Hypercalcemia associated with malignancy, Given during Glucocorticoid therapy to prevent bone mineral loss
- MOA: Binds hydroxyapatite in bone and incapacitates osteoclast breakdown;
- Adverse Effects: Upper GI distress (sit upright 30 min after dose), Hypocalcemia, Hypophosphatemia, Poorly absorbed cus oral bioavailability very low
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Risedronate
- Biphosphonates (pyrophosphate analog)
- Uses: Osteoporosis, Paget's disease, Hypercalcemia associated with malignancy, Given during Glucocorticoid therapy to prevent bone mineral loss
- MOA: Binds hydroxyapatite in bone and incapacitates osteoclast breakdown;
- Adverse Effects: Upper GI distress (sit upright 30 min after dose), Hypocalcemia, Hypophosphatemia, Poorly absorbed cus oral bioavailability very low
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Denosumab
- human anti-RANK ligand monoclonal antibody
- Uses: Osteoporosis in postmenopausal women
- MOA: binds RANKL and inhibits maturation of preosteoclasts, decreases bone remodeling, increases bone mineral density
- Adverse Effects: Hypocalcemia, infections, skin reactions, osteonecrosis of jaw, contraindicated in hypocalcemia
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Vitamin D (Calcitrol)
- Vitamin D increases calbindin surface protein to increase intestinal absorption of Ca2+, synthesises bone matrix osteocalcin, enhances osteoclast formation and ca2+ mobilization; Stored in fate
- Use: Rickets, Osteomalacia, Osteoporosis, Hypoparathyroidism, Pseudohypoparathyroidism
- Adverse Effects: Hypervitaminosis D and Hypercalcemia (treat with fluid support, withdraw Vit D from diet, and glucocorticoids)
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