Bone Mineral Homeostasis Flashcards
concept: what does hypomagnesium do to PTH
decreases –> leads to hypocalcemia
concept: what are common causes of hypomagnesium
chornic diarrhoea, diuretics, alcohol abuse, chronic PPI and aminoglycoside use
MOA Teriparatide
recombinant PTH that stimulates bone formation if you give it PULSATILE
@ high does - resorption
MOA Denosumab
RANK L inhibitior
prevents stimulation of osteoclast
A/se Denosumab
increased infection risk
Type I Vitamin D dependent Rickets
defective 1alpha hydroxylase
Type II vitamin D dependent RIckets
defective receptor
Treat Psoriasis
calcipotriol
What is cholecalciferol
vitamin D3
What is ergocalciferol
vitamin D2
MOA Sevelamer
phosphate binding drug –> no absoprtion of dietary phosphate in teh Gi
uses of Sevelamer
phosphate binding drug - used to prevent hyperphosphatemia in chronic renal dailure patients
Treat overdose of magnesium sulfate in eclampsia please
calcium gluconate IV style
A/se estrogen
thromboembolism
migraine
increased risk of breast and endometrial cancer
What’s a SERM?
Selectie Estrogen Receptor Modulator
Name some SERMs
Tamoxifen, Raloxifene
Describe Tamoxifen
antag @ breat
agonistic @ bone
agonistic @ bone
A/se tamoxifen
increasedk endometrial ca and thrmoboembolism and hot flushes
Uses of tamoxifen
breast cancer and beneficial effect on bone
Describe Raloxifene
antag at breast
agonist at bone
no estrogenic effect on endometrium
Name the bisphosphnates
etriDRONATE
alenDRONATE
pamiDRONATE
riseDRONATE
MOA of bisphosphonates
inhibit osteoclasitc activity via decreasing farnesyl pyrophosphate synthesis = disrupts mevlonate pahtway decreased osteoclast HATPase = reduced resorption
Which bisphoshonate should not be used long term and why please
Etidronate - dont use it when its late –> bone malformation due to decreased osteoblastic activity
What do you use etidronate, alendronate, pamidronate and risedronate for?
osteoporsis
malignancy associated with hypercalceim
Paget disease
a/se of bisphosphates DRONATEs
erosive esophagitis
a/se of etidronate
osteomalacia
osteonercorsis of jaw and fracures
MOA cinacalcet
activates calcium sensing receptors –> leads to decreased PTH
uses of cinacalcet
secondary hyperparathyroidism
parathyroid carcinoma
Treat parathyroid carcinoma
cinacalcet - stimulates CaSR
Flouride it up
chronic exposure - new bone synthesis that is denser but brittle
describe gallium nitrate
inhibits bone resoprtion
nephrotoxic
used at cancer-related hypercalcemia
Plicamycin/mithracin
cytotoxic acnticancer drug
used at cancer-related hypercalceim (wiht gallim nitrate)
cancer related hypercalcemia
plicamycin and gallium nitrate
Name the drugs that cause osteoporsis
AACHL alcohol Anastrozole chorticosteroids heparin lithium
name drugs that cause osteomalacia
phenytoin
etridronate if used for more than 12 months
Treat the hypercalcemia
furosemide - diuretic
biophosphonates (DRONATES) inhibit osteoclast activity
calcitonin
parathyroidectomy
Treat osteoporosis
stop smoking stop OH abuse stop corticosteroids (otehr drugs that can cause - anastrozole, Li and heparin) calcium and vit B supplementation bisphosphonates DRONATES SERMs terparatide
