BOME MINERAL HOMEOSTASIS

Question 1

hormone replacement

Answer 1

estrogen + progestin

Question 2

estrogen + progestin MOA

Answer 2

estrogen: decrease RANKL/IL-6
progestin: reduce risk for endometrial cancer

Question 3

side effects of hormone replacement

Answer 3

breast cancer

venous thrombosis

Question 4

SERM

Answer 4

raloxifene

Question 5

SERM MOA

Answer 5

ER agonist at bone

ER antagonist at endometrium and breast

Question 6

which drug to treat osteoporosis + prevent breast cancer

Answer 6

SERM

Question 7

analogues of pyrophosphate that decrease osteoclast activity

Answer 7

bisphosphonates

Question 8

name the important BISPHOSPHONATES

Answer 8

-DRONATE
alendronate
pamidronate
zoledronate

Question 9

which bisphosphonates are IV

Answer 9

pamidronate and zoledronate

Question 10

purpose of bisphosphonates**

Answer 10

osteoporosis
paget disease
osteolytic bone lesions of multiple myeloma+breast
hypercalcemia associated w maligancy

Question 11

big side effect of bisphosphonates

Answer 11

jaw osteonecrosis in cancer patients

Question 12

when do bisphosphonates need to be taken

Answer 12

empty stomach

Question 13

denosumab

Answer 13

RANKL antagonist - decrease osteoclast activity

Question 14

when is denosumab given

Answer 14

monthly-malignancy
6 months- osteoporosis
both subQ

Question 15

main tx for hypercalcemia

Answer 15

nasal spray salmon calcitonin

Question 16

side effect of salmon calcitonin

Answer 16

tachyphylaxis a few days later

-flushing, nausea, diarrhea

Question 17

PTH analogue

Answer 17

teriparatide

• pulsatile NOT CONTINUOUS
• stimulates osteoblasts

Question 18

hPTH 1-34 purpose

Answer 18

severe osteoporosis

Question 19

teriparatide given with what to reduce side effects

Answer 19

aledronate

Question 20

oral phosphate binder

Answer 20

calcium carbonate
calcium acetate

aluminum hydroxide

sevelamer

Question 21

purpose of oral phosphate binders

Answer 21

chronic kidney disease
tumoral calcinosis
hyperPTH-hypertosis sydrome

Question 22

which oral phosphate binder needs acidic gastric pH for activation

Answer 22

CaCO3 absorption

Question 23

which oral phosphate binder lowers serum cholesterol

Answer 23

sevelamer

Question 24

MOA - cinacalcet

Answer 24

increases sensitivity of calcium sensing PTH cells, causing decrease PTH secretion

Question 25

purpose of calcimimetic

Answer 25

chronic kidney disease 2ndary PTH hypercalcemia associated with PTH carcinoma

Question 26

calcium analogues

Answer 26

``` calcium gluconate (IV) calcium carbonate (oral) calcium citrate-malate ```

Question 27

purpose of calcium analogues

Answer 27

2ndary PTH hypoPTH rickets osteomalacia

Question 28

inorganic phosphate

Answer 28

potassium phosphate pH 7

Question 29

purpose of inorganic phosphate

Answer 29

serve hypoPTH

Question 30

* how to treat SEVERE SYMPTOMATIC ACUTE HYPERCALCEMIA

Answer 30

1. saline diuresis w furosemide 2. calcitonin 3. bisphosphonate

Question 31

* how to treat HYPOCALCEMIA

Answer 31

1. give magnesium chloride | 2. oral calcium, vit D

Question 32

inherited deficiency in RANK/RANKL

Answer 32

osteopetrosis | b/c of defective osteoclast activity and increased bone mass

Question 33

inherited deficiency in OPG

Answer 33

osteoporosis | b/c osteoclast activity increases

Question 34

deficiency in carbonic anhydrase

Answer 34

osteopetrosis

Question 35

osteoblasts secrete which serum marker

Answer 35

alkaline phosphatase | - which inhibits pyrophosphate

Question 36

glucocorticoid effect on bone

Answer 36

increases apoptosis of osteoblast>osteoclast

Question 37

FGF-23 effects

Answer 37

kidney- decrease Pi reabsorption and calcitriol secretion GI- decrease absorption b/c of less calcitriol bone- decrease mineralization so Ca and Pi increase