Name Ca acetate

Class Calcium salts

Ca carbonate

Calcium salts

Mechanism of Action Very soluble, released rapidly; decreases GI phosphate absorption in end-stage renal disease Needs acid take with food;

Use/Indications Mild chronic hypocalcemia and treatment of hyperphosphatemia

Contraindications

Side Effects Hypercalcemia, calcification

Route of Administration Oral

Mild chronic hypocalcemia

Oral

Vitamin D Ergocalciferol/ Cholecalciferol/VitD supplements

25-hydroxy-vitamin D

Activated in two Supplement of Vit D steps in liver and and ensure adequate kidney; slow intake of Ca onset of action and long duration of action Major circulating form

Hypercalcemia and Oral hyperphosphatemia, calcification

Calcitriol

Active form of Vitamin D

No activation in liver or kidney; Fast onset & short duration of action

Hypocalcemia, hypoparathyroidism, moderate-chronic renal failure

Paricalcitol

Vitamin D2 analog Advantage over of calcitriol caclitriol: effect on PTH>effect on Ca and Pi absorption in gut

Secondary hyperparathyroidism in chronic renal disease

Ovedose Oral, IV hypercalcemia, hypercalciuria, hyperphosphatemia; soft tissue calcification IV

Sevelamer HCl

Drugs that decrease phosphate absorption

Raloxifene

Pos. charge polymer, not absorbed from gut, binds negcharged Pi in gut, preventing Pi absorption, works as well as CaAc w/o risk of hypercalcemi Selective Estrogen ER agonist and Receptor ER antagonist; Modulators acts as both (SERMs) estrogens and antiestrogens Bisphosphonates Inhibit bone resorption by osteoclasts; can lower blood Ca; low oral bioavail Smaller doses so less frequent admin Increases activity of osteoblasts than osteoclasts, increase in plasma Ca and decrease in Pi More potent and longer half life; effects on bone and kidney

Hyperphosphatemia

Lowers serum LDL Oral and total cholesterol

Alendronate

Indicted for tx and prophylaxis of osteoporosis in postmenopausal women; incidence of breast CA Osteoporosis in postmenopausal women; osteoporosis in men, Pagets disease in men and women Osteoporosis, hypercalcemia of malignancy Osteoporosis in men and women w/ high risk of fracture

Hot flashes and leg cramps, increases risk of thrombosis

Hypocalcemia; renal toxicity, upper GI mucosa irritation, esophagitis Drug Interactions!

Severe hypocaclecmia so use w/ caution in pts w/ low 25hydroxy-vitamin D Fever, GI effects, osteonecrosis of jaw

Oral

Zoledronate

Bisphosphonates

IV

Teriparatide

Analog of PTH

Pts w/ Pagets disease, young ppl w/ open epiphyses, prior rx tx

Osteosarcoma

Daily SC injection

Calcitonin-salmon

Peptide hormone isolated from salmon

Pagets disease, PM osteoporosis, Hypercalcemia

IM, SC, nasal spray

Cinacalcet

Drugs that inhibit PTH release

Denosumab

IgG2 human monoclonal antibody

Allosteric activator of Ca sensing receptor on chief cells of PTH gland, decreases bone turnover rate and decreases serum PTH, Ca, and Pi Binds to membrane of ODF produced by osteoblasts to decrease bone resorption

Hyperparathyroidism in chronic kidney disease pts on dialysis

Oral

Osteoporosis in PM women at high risk of fracture

Hypocalcemia if renal function low, jaw osteonecrosis, atypical fractures

SC injection