Parathyroid Gland Drugs

Plasma Ca2+ is regulated

by PTH, vitamin D, and
calcitonin
Calcitonin dec. calcium
when plasma calcium is
too high
PTH inc. calcium when
plasma calcium is too low
o Requires vitamin D
PTH (+) osteoclasts (+)
RANKL* inc. # &
activity of osteoclasts
bone resorption
PTH inc. kidney
reabsorption of Ca2+ &
dec. kidney reabsorption
of phosphate
PTH (+) production of 1,25-dihydroxyvitamin D in liver
PTH inc. absorption of Ca2+ from GIT
Recombinant
MOA: (+) bone formation
Teriparatide
PTH
Use: Osteoporosis (intermittent administration)
Calcitonin
MOA: secreted by perifollicular C cells of thyroid gland released
Calcitoninwhen plasma Ca2+ levels are high
Salmon
(-) osteoclast resorption in bone
(-) Ca2+ and PO4 reabsorption in kidney
Use:
Pagets disease
Hypercalcemia
Osteoporosis
Vitamin D

D3
(Cholecalcifer
ol)
D2
(Ergocalciferol
)
Calcitri
ol

Bisphosphona
tes

Etidronate
Pamidronate
(IV)
Alendronate
Risendronate

MOA:
Inc. absorption of Ca2+ and PO4 in intestine
Inc. Ca2+ and PO4 resorption in bone
Dec. excretion of Ca2+ and PO4 from kidney
Use:
Prophylaxis and treatment of vitamin D deficiency
Vitamin D resistant rickets (familial hypophosphatemia)
Vitamin D dependent rickets
Renal rickets (caused by renal-tubular acidosis)
Hypoparathyroidism
MOA: localize to regions of resorption slow formation &
dissolution of hydroxyapatite crystals (-) farnesyl pyrophosphate
osteoclast apoptosis
Use:
Osteoporosis

*Most effective
Rx for Tx of
osteoporosis
*Calcium
chelators

Monoclonal
antibody

Denusomab

Calciumsensing Rx

Cinacalcet

(false calcium
which acts like
calcium)

Cytotoxic
antibiotic

Plicamycin (IV)

Pagets disease
Hypercalcemia of malignancy DOC (caused by leukemia, breast
cancer, lung cancer, multiple myeloma)
Osteoclastic bone metastasis
AE: Dec. renal function, esophageal motility disorders, peptic ulcer
disease, osteonecrosis of the jaw (zolendronate)
MOA: (-) RANKL* (-) bone resorption
Use:
Osteoporosis
Giant cell tumor of bone
MOA: (+) Ca2+ sensing receptor on parathyroid gland (calcimimetic)
(-) PTH secretion
Use:
Secondary hyperparathyroidism in chronic kidney disease
Parathyroid carcinoma
MOA: (-) protein synthesis (-) bone resorption
Use:
Hypercalcemia
Pagets disease
Use: Hypercalcemia

Gallium
Nitrate
*RANKL: Receptor Activator of Nuclear factor Kappa-B Ligand
Drugs for treatment of HYPERcalcemia:
-

Bisphosphonates
Plicomycin
Gallium Nitrate
Loop diuretics