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Endocrine - DVR > 160b Ca/PO4/Bone pharm > Flashcards

160b Ca/PO4/Bone pharm Flashcards

1
Q

what form of serum calcium is active?

A

ionized only

50% of serum calcium (rest is bound to proteins)

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2
Q

What percentage of Ca from the diet is absorbed in the intestine?

A

10-20% absorbed

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3
Q

How is calcium absorbed in the intestine?

A

1) passive diffusion throughout

2) Vit-D controlled in proximal duodenum (+ PO4)

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4
Q

What effect do glucocorticoids have on Ca absorption in the intestine?

A

Reduce

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5
Q

diuertics: thiazide vs furosemide and Ca

A

loops (furosemide) lose Ca to urine

thiazides save Ca from urine

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6
Q

what increases PO4 excretion in the kidney?

A

FGF-23 and PTH

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7
Q

axial bone vs appendicular

A

axial - highly trabecular with more marrow and fat

affected with Ca diseases

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8
Q

osteoclast - from what cell type?

A

from precursor monocyte (also gives rise to macrophages)

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9
Q

what ligand controls osteoclast differentiation?

A

osteoblasts –> RANKL cytokine –> increases fusion, activity, survival via RANK on osteoclast

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10
Q

osteoprotegerin - function?

A

Blocks RANKL activity thus decreasing OC activity

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11
Q

osteoblast - markers for activity?

A

osteocalcin

alkaline phosphatase

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12
Q

OB - from what cell type?

A

pluripotent precursor which also makes adipocytes

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13
Q

what signals activate OB?

A

IGF-1

wnt pathway

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14
Q

sclerostin - what makes it and fxn?

A

Osteocytes

–I wnt signals and OB differentiation –> blocks bone formation

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15
Q

osteoporosis - basic disease process?

A

OB can’t keep up with increases OC activity

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16
Q

pagets disease of bone - basic disease process?

A

local increased OC activity followed by disordered OB activity –> abnormal bone

17
Q

vitamin D - active form

A

1,25 (OH)2 D3 aka calcitriol

18
Q

what is the storage form of Vit D

A

25 (OH) vit D –> measure this when testing for Vit D deficiency, not 1,25 form

19
Q

1a-hydroxylation - where does it occur? what is made?

A

kidney

makes calcitriol (1,25 (OH)2 Vit D)

20
Q

calcitriol receptors type? fxn?

A

steroid –> nuclear receptors

increases transcription

21
Q

calcitriol effect on PTH?

A

decreases PTH secretion

22
Q

alphacalcidol -Rx? form?

A

Rx - 2ndary hyper PTH from renal disease

1-OH vit D – converted via liver to active form

23
Q

calcipotriol - topical

A

psoriases treatment to increase cell differentiation

24
Q

teriparatide - what is it? Rx? dosing? SE?

A

PTH analog with full activity (1st 34 aa of PTH_

Rx for osteoporosis –> anabolic

once a day = intermittent affect (anabolic)

osteosarcoma?

25
Q

PTH secretion pattern normally?

A

pulsatile manner –> anabolic effect

26
Q

what decreases PTH secretion?

A

calcimimetics
Ca
Vit-D

27
Q

cinacalcet - what is it? what does it treat?

A

calcimimetic –> allosteric activator of CaSR (increases sensitivity to Ca)

suppresses excess PTH secretion

28
Q

PTH - continuous exposure vs intermittent?

A

continuous - bone resorption from increased RANKL expression on OB

intermittent - bone formation via decreased OB apoptosis, suppresses sclerostin

29
Q

PTHrP - what is? what can it cause?

A

8 of first 13 aa like PTH

can cause hypercalcemia in cancers

30
Q

calcitonin - from what? what causes releases? what does it do? Rx for what?

A

c-cells of thyroid gland

increased secretion by high Ca

inhibits bone resorption on OC

Rx - Paget’s disease

31
Q

CGRP

A

calcitonin gene related peptide

potent vasodilator in migraines

32
Q

estrogen effect on bone?

A

–I RANKL and IL-6 –> blocks resorption

osteoclast apoptosis

33
Q

androgen effect on bone?

A

aromatased to estrogen

34
Q

raloxifene

A

selective estrogen response modulators (SERMS)

acts as estrogen on bone but anti-estorgen effect elsewhere (mammary gland)

35
Q

bisphosphonates

A

alendronate
_dronate

analogs of pyrophosphate –> interfere with OC action

Rx- osteoporosis, paget’s, hypercalcemia, metastases

36
Q

denosumab

A

human monoclonal AB –I RANKL

inhibits osteoclast

Rx- osteoporosis and bone metastases

37
Q

what is the only anabolic bone Rx?

A

teriparatide

Endocrine - DVR (22 decks)

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