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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 20 07 Drugs of Choice Obesity Below
All of the drugs presently approved for the treatment of obesity are what general type of drug?
- They’re all appetite suppressants.
While they are effective usually, what is the main problem with them?
- They cannot be used long-term.
These appetite suppressant drugs were developed according to an older theory of obesity. What was the older theory?
- That obesity is a habit or behavioral problem.
What is the new theory of obesity?
- That it is a regulatory problem of body fat.
This means, of course, that drug therapy for obesity, if it is a regulatory problem of body fat, must be what in terms of duration?
- Chronic, long-term medication.
What is a newer drug and the only drug currently approved for the long-term treatment of obesity?
And the trade name for Dexfenfluramine?
Dexfenfluramine (trade name Redux) works through what neurological mediator?
What 2 non-prescription agents can be used to treat osteoporosis, and together have been shown in clinical trials to decrease hip fracture incidents in very elderly women?
- Calcium and Vitamin D.
In addition, for post-menopausal women, what drug is the mainstay of anti-resorptive therapy for osteoporosis?
At what point in menopause or post-menopause can estrogen be used?
- Estrogen is an important therapy for osteoporosis, both in early menopause and later.
What agent directly inhibits osteoclast activity and has been demonstrated to reduce osteoporosis in both early post-menopausal women and older patients with established osteoporosis?
In terms of duration of treatment, what is the main problem with calcitonin?
- There appears to be a loss of activity after about a year and a half to 2 years.
What type of calcitonin is used?
- Salmon calcitonin.
And how does it compare with human calcitonin?
- It is more potent and more effective.
There are 3 commercial preparations of salmon calcitonin for the treatment of osteoporosis. The 2 older preparations had to be administered via subcutaneous injection. What were the 2 older preparations?
- Calcimar and Miacalcin.
There is a newer preparation available now which works by nasal spray. What is the trade name of the nasal spray form of salmon calcitonin?
- Miacalcin Nasal Spray.
In addition to easier administration, there is another benefit of the nasal spray over the subcutaneous injected calcitonin. What is it?
- The systemic side effects are much less.
In particular, what 2?
- Nausea and cutaneous flushing.
What is the class of agents that bind to the surface of the bone and inhibit osteoclastic bone resorption, however, the mechanism of action is not understood?
- These are the bisphosphanates.
What is the older bisphosphonate, which is approved for Paget’s disease of the bone and hypercalcemia associated with malignancy, but which has a very detrimental side effect that prevents it from being approved for the treatment of osteoporosis?
- This is Etidronate.
What is the trade name for Etidronate?
At doses of this older bisphosphonate which does suppress osteoclastic activity, what is the serious side effect?
- The mineralization of the bone is impaired.
In fact, what results?
- New non-mineralized bone formation.
And what pathology can result from this, with Etidronate (trade name Didronel)?
What is the newer potent aminobisphosphate that does not cause this problem of impairing bone mineralization, but does stop bone resorption?
- This is Alendronate.
And the trade name for Alendronate?
Specifically, what is Alendronate (trade name Fosamax) approved for? It is approved for the treatment of post-menopausal women with osteoporosis.
Why is it especially useful for this patient population?
- Many of these patients prefer not to take estrogen, and Alendronate (trade name Fosamax) is a good alternative .
Can estrogen be used in combination with Alendronate (trade name Fosamax)?
- Theoretically, yes, although there are not controlled study results yet showing whether the combination of the 2 is better than either one alone.
However, an older study did show better results with what combination therapy?
- Estrogen and Etidronate, which is the older problematic bisphosphonate (trade name Didronel).
In giving any antiresorptive medication, what 2 additional agents should be also supplied?
- Calcium and Vitamin D.
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