inhibit bone resorption

pamidronate, zoledronic acid

normalizes serum Ca in malignancy

se: acute flu-like

others: alendronate, risedronate, ibandronate

GI irritation, taken in the morning, no meds or food, upright for 30 mins

modest, rapid, 

repeated->receptor downreg

intranasal,

analgesic to spine fx

rhinitis

used in vitamin D tox, granulomatous dz, hema malignancies,

decr 1.25 vit D

1)Phosphate directly stimulates PTH release, 2)could be lack of 1-a hydroxylase activity

3)vitamin d deficiency

tx:low phosphate diet, phosphate binders, vit D supplement

vit d supplement (paracalcitol, doxercalciferol)

phosph binders- calcium carbonate, calcium acetate, sevelamer

calcimimetics

can be caused by hypo-vit D-->rickets or osteomalacia

x-linked and AR hypophosph rickets

tx: replacing phosph, and calcitriol

raloxifene

selective for bone---no breast cancer

se: hot flashes, increased DVT risk,

pth- only anabolic agent

only for high risk patients

subQ

dizziness, palpitations, transient hyperCa

RANK ligand inh- antiresorptive

subQ

heritable disorder in type I collagen

osteopenia, fx, teeth, ligaments

propylthiouracil, methimazole, carbimazole

inhibit thyroid peroxidase--used in hyperthyr

inhibits organification of iodide, and coupling of iodotyrosine

meth-most active form

t: agranulocytosis, hepatitis, lupus-like

aminoglutethimide- blocks chol->pregnenalone

ketoconazole- blocks adrenal/gonad steroid synth

mitotatone- non-selective cytotoxic on adrenal, se's

metyrapone- inh of 11-hydroxylation

mifepristone- receptor antagonist

tamoxifen, clomiphene

tam: anti on breast, pro on bone and uterus

prolonged->endometrial carcinoma

clom:inh estr neg feedback in hypothal-> incr in gonadotrophs and LH->ovulation

medroxyprog, norethindrone, norgestrel, megestrol

strong androgen activity--> hirsutism

edema, abd bloating, anxiety, 

natural: micronized-limits first pass, increases t1/2

sulfonylureas

stimulates insulin secretion from b cells

se: weight gain, hypoglycemia, renal, nutrition, liver, hypoalbumin

contra: type I, pregnancy/lactation, sulfa allergy, DKA

cause short rise in insulin--dose before meal

some hypogly, glucose level dependent effectiveness

metformin

decreases liver glu production, increased skel musc utilizatin

activates cAMP, activates PKA, enhanced glu/lipid metab

rosiglitazone, pioglitazone,

increased insulin dependant glu disposal in sk mu, decreased liver prod, binds PPARg and activates

se: resumption of ovulation, fluid retention, 

amylin analog

inject before meal

risk of hypogly

lispro, aspart, glulisine

detemir- can be long in high dose, 

(NPLispro, NPAspart) premixed

BAL, British anti-lewisate

lead, arsenic, inorganic mercury

in peanut oil, best if given early--only IM

need to make urine alkaline in order to prevent renal toxicity

lead poisoning in kids

cadmium, lead, mercury, arsenic

orally available, n/v/d

CaNa2EDTA, lead poisoning...NOT NA2EDTA

some problems in tubules and glomeruli, fever, liver enzymes

cesium in rats, thalium and cesium poisoning

not absorbed, gets rid of thalliumin gut...pulls from systemic circulation, 

free iron into urine

(not ferritin, hb, transferrin or cyt)

se: yersinia enterocolitis, hypotension, anaphylaxis, acute lung injury