Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 343 > Bone disease > Flashcards

Bone disease Flashcards

1
Q

Consequences of CKD-MDB

A

-Calcification of soft tissues (BV, heart valves)
-Calciphylaxis, mineralized skin that makes unhealing ulcers
-metabolic acidosis from bicarb loss decreasing Vit D production causing low Ca uptake and worsening MBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Calcium location

A

99% in bone and 1% in blood, 50% bound to albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

phosphate location

A

85% in bone and the rest in soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Calcitriol production

A

inactive from from diet or UV light, then activated in liver and last step in kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Vit D3 effects

A
  • Increases GI absorption of Ca and PO4
  • Promotes resorption of bone (increase serum conc)
  • Directly inhibits PTH production
  • Indirectly inhibits PTH secretion via increases Ca
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PTH effects

A

Stimulated by: Low Ca (main driver), increased PO4, low D3
- increases Ca reabsorption and PO4 excretion
- increased Ca stimulates D3 production
- Promotes bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FGF-23

A

Fibroblast growth factor 23
- stimulated by D3 and PO4
- increases PO4 excretion and decreases D3
- Lower PO4 decreases PTH production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathophysiology of CKD-MBD

A

Decreased kidney function reduces PO4 elimination, increased PO4 suppresses D3 and stimulates FGF-23 further reducing D3 and Ca, Very low D3 lowers GI Ca absorption, High PO4, Low D3, Low Ca all stimulate PTH which causes bone reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hyperparathyroid related bone disease (HPT)

A

mild-moderate-high turnover and normal mineralization
- reduce hyperphosphatemia to remove mechanism for turnover
- normalize calcium levels
- Suppress PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Adynamic bone disease

A

Low turnover and normal mineralization
-Can be from over correction from HPT Tx
- or aluminum deposition from phosphate binders
- Reduce D3 analogs or calcimimetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

phosphate binders

A

For HPT treatment, needs to be taken with meals when the phosphates are entering the GI tract. Calcium salts are first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Calcium salts

A

Phosphate binders
Tums regular TID with meals
——-
hypercalcemia
constipation
no iron or flouroquinolones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sevelamer

A

Second line phosphate binder
hydrogel that binds phosphate
TID
can also decrease LDL and cholesterol
———
GI side effects
metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lanthanum carbonate

A

Phosphate binder
can be used alongside other binders
TID
very expensive and unknown long term safety
——–
nausea and diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aluminum salts

A

most potent phosphate binder
only used in severe acute hyperphosphatemia for max of 4 weeks
TID
——–
aluminum toxicity (CNS issues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Magnesium salts

A

phosphate binder
less effective than calcium salts but decent alternative
——–
diarrhea
hypermagnesemia

17
Q

Sucroferric oxyhydroxides

A

Irion based binder via ligand exchange for phosphate
TID
——
diarrhea and nausea
black stools

18
Q

Calcitriol analogs

A

Used when phosphate binders are not lowering PTH
-increases Ca and PO4 absorption which inhibits PTH, also direct PTH suppression
-Need to have normal PO4 and Ca levels to start as they will increase
——–
- PO4 >2mmol/L
- Ca > 2.6mmol/L
it is contraindicated

19
Q

Rocaltrol (calcitriol)

A

\
Calcitriol analog, slow titration up
——-
-hypercalcemia, phosphatemia and magnesia
-Elevated liver enzymes
-Bone pain

20
Q

Alfacalcidol

A

Synthetic calcitriol analog
Less affinity for GI receptors decreasing chance of hyper Ca, Mg or PO4

21
Q

Calcimimetics

A

Final option when PTH is high even when using D3 analogs and phosphate binders
- suppresses PTH by increasing Ca receptor sensitivity on parathyroid), this prevents PTH release

22
Q

Cinacalcet (Sensipar)

A

/
calcimimetic
——–
-hypocalcemia
-QT prolongation

23
Q

Parathyroidectomy

A

last resort to reduce PTH

24
Q

How does PTH cause high Ca+

A

PTH adenoma that causes VIT D release (increasing Ca GI absorption), Decreases kidney excretion and causes bone reabsorption. All leading to high calcium

25
Q

Hypercalcemia treatment

A

Forced diuresis (Fluids + furosemide), needs Potassium chloride to maintain other electrolytes.
Calcitonin in Renal inpaired patients to reverse PTH effects and reduce Ca absorption and bone resorption
Bisphosponates (reduce bone resorption)
Hemodialysis

Pharm 343 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions