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Pharm: Endocrine and Derm > Bone Mineral Homeostasis > Flashcards

Bone Mineral Homeostasis Flashcards

1
Q

Vitamin D analogs and what do they treat

A

Calcipotriene – used to treat psoriasis

Paricalcitol – used to treat secondary hyperparathyroidism in patients with chronic kidney disease

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2
Q

Fibroblast growth factor 23 (FGF23)

A

Long polypeptide chain
Inhibits 1,25(OH)D3 production and phosphate reabsorption in the kidney
Produced in osteoblasts and osteocytes

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3
Q

Calcitonin naturally in the body does what?

A

Lowers serum calcium and phosphate levels
Acts on bone and kidney
Inhibits osteoclasts (blocks bone resorption)
Reduces calcium and phosphate reabsorption

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4
Q

What stimulates calcitonin secretion

A

Pentagastrin

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5
Q

Calcitonin is used to treat what?

A

Paget’s Dz
Hypercalcemia
Postmenopausal osteoporosis (sometimes)
Used off label for bone pain (cancer) and vertebral fracture

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6
Q

Calcitonin med MOA

A

Reduces the number of osteoclast and prevents resorptive activity of the bone: reduced bone turnover rate; temporary increase in osteoblastic activity.

*derived from salmon

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7
Q

Calcitonin Administration and Bio availability

A

Nasal spray or IV

BA of nasal = 3%

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8
Q

Calcitonin general recommendation for use

A

Recommended to use for short term (under 6 mos) or for use in bone pain (vertebral fracture/bone ca)

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9
Q

FDA warning for Calcitonin

A

Advisory Panel for FDA “benefit of calcitonin salmon products in treating…osteoporosis is outweighed by a potential increase in the risk of cancer.” (0.7% oral to 2.4% nasal)

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10
Q

Estrogens MOA and use

A

Prevent accelerated bone loss (postmenopausal)

Use for osteoporosis prophylaxis (increased vit D)

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11
Q

Estrogens ADE

A

endometrial/breast hyperplasia/cancer, MI, stroke, cancer, dementia, DVT

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12
Q

Glucocorticoids MOA

A

Antagonize vitamin D-stimulated intestinal calcium transport, stimulate renal calcium excretion, block bone formation.

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13
Q

Bisphosphonates Drugs

A

Alendronate (Fosamax)
Risedronate (Actonel),
Zoledronate (Zometa, Reclast)
Ibandronate (Boniva)

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14
Q

Bisphosphonates MOA

A

Osteoclast Inhibitors/osteoclast apoptosis

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15
Q

Bisphosphonates ADE

A

Esophagitis (oral) Do not use in Barrett’s esophagus

Risk of osteonecrosis of the jaw and subtrochanteric fractures- both are rare

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16
Q

Bisphosphonates drug admin instructions

A

Administer first thing in the morning on empty stomach with nothing but plain water, remain upright for 30 min.

Note: Food delays absorption (BA under 10% t ½ 10yrs)

May consider “drug holiday” after 5 years

17
Q

Calcimimetics Name, MOA, and Use

A

Cinacalcet (Sensipar) – blocks PTH secretion in parathyroid gland – lowers serum Ca levels

Use for txt of secondary hyperparathyroidism (chronic kidney dz, cx), Hypercalcemia- parathyroid cx

18
Q

Thiazides use

A

reduce renal calcium excretion

19
Q

Fluoride

A

stabilizes hydroxyappatite crystal

20
Q

Hypercalcemia Tx

A

Avoid aggravating factors: thiazide diuretics, lithium, volume depletion, inactivty, dietary Ca

Volume expansion- NS @ 200-300ml/hr

Bisphosphonates
(Pamidronate, zoledronate)

Calcitonin

Cinacalcet (Sensiar)

Plicamycin (Mithramycin)- Drug of last resort due to toxicity

21
Q

Hypocalcemia causes

A

Caused by vit D def, CKD, malabsorption hypoparathyroidism. (neuromuscular sxs)

22
Q

How to calculate corrected calcium

A

CC=0.8(4-albumin)+ serum Ca

23
Q

Hyperphophatemia Preferred Drug and MOA

A

Sevelamer (Renagel, Renvela) titrate based on levels
800mg-1600mg TIDcc (BA=0%)
Inhibits intestinal absorption, lowers LDL and TC

24
Q

What is a risk of using calcium supplements?

A

risk ectopic calcification

25
Q

What are other drug choices for Hyperphophatemia?

A

Calcium supplements

Lanthanum (Fosrenol) 1500-3000mg/day divided doses. (forms lanthanum phostphate complexs with dietary phosphate)

26
Q

Osteoporosis Tx

A

Estrogen supplementation

Raloxifene (Evista)-60mg po qday

Bisphosphonates (alendronate, risedronate, zoledronate, etc)- 1st line

All patients should get Ca/Vit D if dietary intake inadequate

27
Q

Tx for Primary Hyperparathyroidism

A

Surgical treatment

Bisphosphonates

28
Q

Tx for Secondary Hyperparathyroidism

A

Cinacalcet (Sensipar)

29
Q

Tx for Hypoparathyroidism

30
Q

Tx for Nutritional Vitamin D Deficiency

A

Vitamin D3 daily or weekly

Check 25-OHD3 levels

31
Q

Tx for CKD w/ bone mineral problem

A

May need parathyroidectomy

32
Q

Tx for Paget’s Dz

A

Uncontrolled osteoclast activity – may be due to virus. Bone pain
Bisphosphonates or calcitonin

33
Q

Tx for Vitamin D- Dependent Rickets

A

Calcitriol

34
Q

Glucocorticoids Use and What pathology could it potentially cause?

A

Treats hypercalcemia, sarcoidosis, vit D intoxication

Causes osteoporosis,

Pharm: Endocrine and Derm (6 decks)

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