Thyroid, Obesity, Osteoporosis

• What are drugs for treatment of hypothyroidism

  levothyroxine (levoxyl, synthroid)

  thyroid desicated
• what are drugs for treatment of hyperthyroidism

  radioactive iodide

  • sodium iodide I-131

  thioamide drugs

  • methimazole
  • Propylthiouracil

  other antithyroid agents

  • potassium iodide solution
• what are the types of treatment for osteoporosis

  vitamins/minerals

  antiresorptive therapy

  anabolic agents
• what vitamins/minerals are used for osteoporosis

  calcium citrate

  calcium carbonate

  vitamin D3

  vitamin D2
• what antiresorptive are used for osteoporosis

  calcitonin

  denosumab (subq)

  estrogen (oral for osteoporosis)

  raloxifene (oral)

  biphosphonates

  • ibrandronate (Boniva) (oral, IV)
  • risedronate(actonel) (oral)
  • alendronate (Fosamax) (oral for osteoporosis)
  • zoledronic acid (IV)
• what anabolic agents are used for osteoporosis

  teriparatide (subq)

  abaloparatide (subq)

  romosozumab (subq)
• what drugs are used for obesity

  
  

  Anorexiants/Symapthomimetics

  Lipase Inhibitor

  GLP-1 RA

  Combination products
• Ibrandronate brand name

  Boniva
• Risendronate brand name

  Actonel
• Alendronate brand name

  Fosamax
• Levothyroxine brand name

  Levoxyl, Synthroid
• Phentermine brand name

  Adipex P
• Orlistat brand name

  Xenical, Ali
• When does bone mineralization increase

  as extracellular Ca rises; bone demineralization increases as extracellular Ca decreases
• What is required for normal fcn of nerves, muscles, gland secretion, blood coagulation, enzyme activities, and others

  proper extracellular Ca2+ concentration
• How does Vitamin D lead to increased extracellular Ca

  facilicates Ca absorption from gut
• How does PTH lead to increased extracellular Ca2+

  Stimulate Ca resorption by renal tubules

  Decrease phosphate resorption by renal tubules

  Stimualte vitamin D hydroxylation in kidneys

  Increase bone resorption (stimulate osteoclasts)
• How does calcitonin lead to increases extracellular Ca

  inhibit bone resorption
• What is the role of sclerostin

  Inhibit osteoblast formation + function

  Inhibit new bone formation by process of modeling (bone formation w/out resorption)

  Reduces bone resorption
• Anorexiants/Sympathomimetics

  Phentermine (Adipiex P)
• Lipase Inhibitor

  Orlistat (Xenical, Ali)
• GLP-1 RAs

  Liraglutide

  Semaglutide (Ozempic, Wegovy)

  Tirzetapide (Mounjaro)
• Obesity Comination products


  Naltrexone/Bupropion ER

  Phentermine/Topiramate ER
• Phentermine (Adipex P)
• Orlistat - Xenical, Ali
• Semaglutide - Ozempic, Wegovy
• Tirzetapide - Mounjaro
• What is MOA of calcium carbonate and calcium citrate?

  Improve/sustain bone mineral density

  Incomplete gut absorption

  • CA carbonate - requires acidic enviro
  • Ca citrate - doesn’t require acidic enviro
• what is clinical uses of Calcium Carbonate and Calcium Citrate

  Adequate amounts of both required for 

  • bone growth and development in children 
  • osteoporosis prevention

  Can meet requirements via diet/supplements 

  Calcium 

  • excess dose unlikely bc limited intestinal absorption 
  • prolonged use - hypercalcemia
  • upper limit - 6250 mg/day
• What are adverse effects of Calcium Carbonate and Calcium Citrate 


  Constipation, GI discomfort 

  Questionable increase in MI risk if used w/out vitamin D

  Monitor hypercalcemia in CKD pt
• what are drug interactions of Calcium Carbonate and Calcium Citrate 


  Decrease absorption of ciprofloxacin, fluoride, phenytoin, levothyroxine, and tetracycline (take 2 hrs before or 4 hrs after)
• What do you need to monitor for calcium carbonate and calcium citrate

  • Serum Ca
  • Corrected Ca (0.8 * (normal albumin - pt albumin)) + serum Ca
• What is Vitamin D

  Fat soluble vitamin 

  How its made 

  • made by body via UV 
  • diet
  • supplement 

  D3

  • most active form 
  • activated via kidney/liver
  • available as supplement

  D2

  • doesn’t naturally occur naturally in humans
  • available as supplement
• What is MOA of vitamin D

  • stimulate Ca transport in intestine and resorption in bones and tubular reabsorption in kidney
  • suppresses PTH secretion + synth
• What is clinical use of Vitamin D

  Adequate amounts of both required for 

  • bone growth and development in children 
  • osteoporosis prevention

  Can meet requirements via diet/supplements 

  Vitamin D 

  • highest intake - 4000 IU 
  • higher doses may be needed to replete
  • VIt D intoxication bc “megadoses” - 60,000 

  Uses 

  • osteoporosis
  • hyperparathyroidism
  • hypocalcemia from hyperparathyroidism
  • hypocalcemia
  • psoriasis
  • rickets
• What are adverse effects of vitamin D 


  Hypercalcemia

  Hypercalciuria

  Constipation
• What are drug interactions of vitamin D

  Absorption of vit D inhibited by cholestyramine 

  • space by 2 hours

  Phenytoin and barbiturates can lead to Vit D deficiency
• What to monitor in giving Vitamin D

  25(OH) D serum conc
• What is MOA of bisphosphonates

  inhibit osteoclast mediated bone resorption

  First gen - etidronate no longer use bc long term use -> osteomalacia  (soft bone disease) 
• what are clinical uses of bisphosphonates


  • osteoporosis tx + prevention
  • Paget’s disease (larger + weaker bones) 
  • Hypercalcemia 

  Reevaluate need to continue therapy after 5 years