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Special pops Exam 3 > Bone > Flashcards

Bone Flashcards

1
Q

What does the release of PTH increase?

A

Calcium in the body

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2
Q

What are the 3 places where PTH acts to enhance the concentration of calcium?

A
  1. Kidneys
  2. Bone
  3. Intestine
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3
Q

What would a decrease in calcium trigger in regards to the PTH glands?

A

PTH release from the PTH glands

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4
Q

What is the role of calcitriol?

A

To increase calcium absorption in the intestine

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5
Q

What does PTH activate?

A

Osteoclasts

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6
Q

What does PTH stimulate the production of?

A

cAMP production in osteoblasts

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7
Q

How does PTH indirectly regulate the absorption of calcium through the intestine?

A

Via the formation of calcitriol in the kidney

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8
Q

What does PTH promote in the kidneys? Where at in the kidneys?

A

Calcium reabsorption; distal convoluted tubules (DCT)

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9
Q

What does PTH prevent reabsorption if in the proximal convoluted tubule?

A

Phosphate

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10
Q

What is calciferol used to treat?

A
  1. Rickets
  2. Osteomalacia
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11
Q

What are 2 other disease states that vitamin D can be used to treat?

A
  1. Hypoparathyroidism
  2. Osteoporosis
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12
Q

What are the two drugs of choice to stimulate the osteoblasts?

A
  1. PTH analogs
  2. Sclerostin inhibitors
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13
Q

How are the two PTH analogs given to stimulate osteoblasts?

A

Pulsatile

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14
Q

What can an increase in osteoblasts cause?

A

Osteosarcoma

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15
Q

What are 3 patient populations that should not use PTH analogs?

A
  1. Children
  2. Adolescents
  3. Pregnancy
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16
Q

What are 3 side effects of the PTH analogs?

A
  1. Dizziness
  2. Leg cramps
  3. Kidney stones
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17
Q

What does Sclerostin normally inhibit?

A

Wnt/beta-catenin pathway

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18
Q

What is the Wnt/beta-catenin pathway involved in?

A

Bone formation

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19
Q

What are 3 approaches to inhibit osteoclasts?

A
  1. Bisphosphonates
  2. Calcitonin
  3. RANK-L inhibitor
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20
Q

What do the bisphosphonates inhibit?

A

FPP synthase

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21
Q

What is the FPP synthase enzyme involved in?

A

Cholesterol biosynthetic pathway

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22
Q

How does FPP synthase activate osteoclasts?

A

By adding farnesyl groups to small GTPases

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23
Q

Where do the small GTPases exist when they are inactivated?

A

In the cytoplasm

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24
Q

What are the 3 small GTPases?

A
  1. Rho
  2. Ras
  3. Rab
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25
Q

Where do the small GTPases go after they are activated?

A

To the membrane to activate osteoclasts

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26
Q

What are micro fractures caused by?

A

Imbalanced bone remodeling leading to atypical femur fractures

27
Q

What are the 4 main ADRs of the bisphosphonates?

A
  1. Osteonecrosis of the jaw
  2. Micro fractures
  3. Esophageal irritation/ulceration
  4. Cramping/joint pain/muscle aches
28
Q

What can bisphosphonates mimic that can lead to esophageal irritation?

A

The lipid bilayer

29
Q

What are 2 reasons why bisphosphonates can cause cramping/joint pain/muscle aches?

A
  1. Inhibition of osteoclasts lead to a decrease in calcium
  2. Decrease in cholesterol
30
Q

What is the MOA for calcitonin?

A

Inhibits osteoclasts and decreases calcium levels

31
Q

How does calcitonin inhibit osteoclasts?

A

By decreasing the ruffled border surface area

32
Q

Denosumab

A

PROLIA

33
Q

What is the MOA for Denosumab?

A

Binds to the RANKL, degrades it and prevents it from interacting with RANK on osteoclasts

34
Q

What are the 2 H+ secreting enzymes that dissolve bone and reside in the resorption pits?

A
  1. TRAP
  2. Cathepsin K
35
Q

What does phosphate reduce?

A

Free calcium levels

36
Q

What are the 4 symptoms of hypercalcemia?

A
  1. Muscle weakness
  2. CNS Depression
  3. Respiratory depression
  4. CaPO4 precipitation
37
Q

What are 3 Disease resulting in or causing hypercalcemia?

A
  1. Hyperparathyroidism
  2. Hypervitaminosis
  3. Familial benign hypercalcemia
38
Q

How would you treat hyperparathyroidism?

A

Remove the PTH glands

39
Q

What would you do to treat hypervitaminosis?

A
  1. Remove the drug
  2. Diet low in calcium
40
Q

What are 4 ways to treat familial benign hypercalcemia?

A
  1. Enhance calcium excretion (furosemide)
  2. Bisphosphonates
  3. Oral phosphates
  4. EDTA
41
Q

What are 5 symptoms of hypocalcemia?

A
  1. Tetany
  2. Muscle spasms
  3. Neuronal excitability
  4. Cramps
  5. Increase in bone resorption
42
Q

What are 4 diseases resulting in or caused by hypocalcemia?

A
  1. Hypoparathyroidism
  2. Secondary hypothyroidism
  3. Rickets
  4. Osteomalacia
43
Q

How would you treat hypoparathyroidism?

A
  1. Calcitriol
  2. Dietary calcium
44
Q

How would you treat secondary hypoparathyroidism?

A
  1. Vitamin D
  2. Calcium
  3. Calcitonin
  4. Bisphosphonates
45
Q

What is used to treat rickets?

A
  1. Vitamin D
  2. Calcium
  3. Calcitonin
  4. Bisphosphonates
46
Q

How would you treat osteomalacia if it is caused by renal failure?

A

Give Calcitriol

47
Q

How would you treat osteomalacia if it’s caused by the inability to absorb calcium?

A

IV calcium

48
Q

When is bone mass at its peak?

A

In your 30s

49
Q

What is the gold standard test for determining if a patient has osteoporosis?

A

T-score

50
Q

What T score is indicative of osteopenia?

A

-2.5 to -1

51
Q

What T-score is indicative of osteoporosis?

A

-2.5 or less

52
Q

People with osteopenia and osteoporosis will have ___ bone turnover

A

High

53
Q

What test can be helpful in determining if osteoporosis treating is working after 3 months?

A

BTM

54
Q

What are the scans called that give a T-score?

A

DXA or DEXA

55
Q

Which marker is a predictable response to treatment?

A

Bone formation marker

56
Q

What assays does the bone formation marker use?

A

P1NP

57
Q

What marker shows degradation products of type 1 collagen of bone?

A

Bone resorption marker

58
Q

What marker is generated by the activity of the enzyme cathepsin k?

A

Bone resorption marker

59
Q

What are 6 environmental factors that contribute to bone loss?

A
  1. Exercise
  2. Smoking
  3. Low calcium/vitamin D and protein
  4. Xs alcohol consumption
  5. Menopause
  6. Aging
60
Q

What type of osteoporosis occurs in post menopausal women?

A

Type 1

61
Q

What type of osteoporosis occurs in both males and females?

A

Type II

62
Q

What usually causes hyperparathyroidism?

A

A tumor resulting in hypersecretion of PTH

63
Q

Who is more affected by hyperparathyroidism?

A

Women

64
Q

How are the 2 PTH analogs given to stimulate osteoclasts?

A

Continuous

Special pops Exam 3 (4 decks)

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