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PHARM 3 > Bone mineral homeostasis > Flashcards

Bone mineral homeostasis Flashcards

1
Q

Magnesium levels effect on PTH secretion

A

moderate decrease in MG = inc in PTH

SEVERE decline in Mg = drop in PTH secretion

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2
Q

common causes of hypomagnesia

A

diarrhea
diuretics
alcohol abuse
chronic PPI and aminoglycoside use

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3
Q

PTH on intestine effect

A

indirect increase on calcium and phosphate absorption = via increase of vitamin D metabolite

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4
Q

PTH on kidney

A

decreased calcium excretion

increased phosphate excretion

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5
Q

Vit D on kidney

A

increased reabsorption of calcium and phosphate

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6
Q

net effect of PTH

A

increased serum calcium

decreased serum phosphate

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7
Q

net effect of vitamin D

A

increased serum calcium and phosphate

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8
Q

fibroblast growth factor 23

A

made by osteoblasts and osteoclasts = inhibits calcitrol production

dec calcium and phosphate reabsorption in kidney

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9
Q

Teriparatide

A

PTH analog

causes net increase in bone formation/mineralization

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10
Q

teriparatide use

A

osteoporosis

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11
Q

teriparatide kinetics

A

low intermit levels = anabolic effects

chronic admin = can cause primary hyperparathyroidism – catabolic effects –> osteitis fibrosa cystica

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12
Q

teriparatide AE

A

hypercalcemia - hypercalciuria

osteosarcoma

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13
Q

cholecalciferol

A

vit D analog

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14
Q

ergocalciferol

A

vit D analog

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15
Q

cholecalciferol/ergocalciferol use

A

added to calcium supplements and dairy products

regulates gene transcription via vitamin D receptor

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16
Q

cholecalciferol/ergocalciferol use

A

vit D deficiency
Rickets
osteomalacia

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17
Q

Vit D deficient type I

A

defective 1alpha hydroxylase enzyme

dec calcitriol = dec calcium, dec PO4

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18
Q

Vit D deficient type II

A

defective receptor

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19
Q

cholecalciferol/ergocalciferol AE

A

hypercalcemia, hyperphosphatemia, hypercalciuria

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20
Q

calcitriol

A

1,23-dihydroxyvitamin D3

  • management of secondary hyperparathyroidism
  • chronic kidney dz
  • management of hypocalcemia in pt with hypoparathyroidism
    (active form - doesn’t require metabolism)
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21
Q

doxercalciferol

A

1alpha-hydroxyvitamin D2

  • management of secondary hyperparathyroidism in pt with chronic kidney disease
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22
Q

19-nor-1,25-dihydroxyvitamin D2

A

paricalcitol

-calcitrol analog used for management of secondary hyperparathyroidism in pt with chronic kidney disease

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23
Q

calcipotriene

A

calcipotriol

used for topical tx of psoriasis

calcitriol analog

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24
Q

calcitonin

A

peptide hormone - inhibtis bone resportion

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25
Q

calcitonin use

A

Paget disease

osteoporosis

26
Q

calcitonin kinetics

A

salmon calcitonin = nasal spray or parenteral

27
Q

calcitonin AE

A

rhinitis with nasal spray

28
Q

alendronate

A

bisphosphonate

suppresses osteoclasts and inhibits bone resorption - inhibits osteoclastic activity via dec farnesyl pryophosphate synthesis via disruption of mevalonate pathway decreases osteoclast H+ ATPase

29
Q

alendronate use

A

osteoporosis

paget’s disease

30
Q

alendronate AE

A

esophageal irrigiation = reduced by drinking ater and remaining upright

osteonecrosis of jaw

adynamic bone

31
Q

risedronate

A

bisphosphonate

32
Q

ibandronate

A

bisphosphonate

33
Q

pamidronate

A

bisphosphonate

34
Q

zoledronate

A

bisphosphonate

35
Q

ethinyl estradiol

A

activate estrogen receptors - changes in transcription of estrogen regulated genes

36
Q

ethinyl estradiol use

A

prevent osteoporosis

HRT

OCP

37
Q

ethinyl estradiol AE

A

moderate tox - breakthrough bleeding

serious tox - thromboembolism, gall bladder dz, hyperTG, migraine, HA, HTN, depression

postmenopausal women - breast CA, endometrial hyperplasia

if in combo with P450 inducer – breakthrough bleeding, dec contraceptive efficacy

38
Q

raloxifene

A

SERM = estrogen agonist in bone, antag in breast and endometrium

39
Q

raloxifene use

A

osteoporosis in postmenopasual women

40
Q

raloxifene AE

A

hot flush

thromboembolism

41
Q

Denosumab

A

RANKL inhibitor

42
Q

denosumab MOA

A

bind RANK-L - prevents osteoclast differentiation

43
Q

denosumab use

A

osteoporosis

44
Q

denosumab AE

A

inc risk of infections

45
Q

cinacalcet

A

calcimimetic

stimulates calcium sensing receptor = decreaes PTH release/suppression

46
Q

cinacalcet use

A

hyperparathyroidism - primary and secondary

47
Q

cinacalcet AE

A

nausea, hypocalcemia, adynamic bone

48
Q

calcium preps

A

calcium carbonate
calcium citrate
calcium lactate

49
Q

calcium prep use

A

hypocalcemic tetany

magnesium sulfate overdose used in eclampsia

50
Q

calcium prep AE

A

necrosis and abscess formation

thrombophlebitis

51
Q

prednisone AE

A

glucocorticoid
**note that the duration is longer than the half life

AE: OSTEOPOROSIS, adrenal suppression, muscle wasting, salt retention

52
Q

fluoride

A

chronic exposure – dense but brittle bone

53
Q

gallium nitrate

A

inhibits bone resorption

nephrotoxic

54
Q

plicamycin

A

(mithracin)

used in cancer related hypercalcemia

55
Q

plicamycin AE

A

thrombocytopenia

hepatic/renal insufficiency

56
Q

drugs causing osteoporosis

A 
corticosteroids
heparin
lithium
anastrozole
alcohol
57
Q

drugs causing osteomalacia

A

phenytoin

etidronate

58
Q

sevelamer

A

phosphate binding drug - prevents absorption in GI

tx for hyperphosphatemia

59
Q

osteoporosis tx method

A

stop smoking, alcohol abuse, corticosteroid use

perimenopausal women == HRT

calcium Vit D supplement

bisphosphonates

SERMs

teriparatide

60
Q

thiazides

A

decreases excretion of calcium - increased reabsorption

prevents renal stone formation

tx HTN in osteoporosis pt

PHARM 3 (21 decks)

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