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Pharm II > Bone Mineral Homeostasis-DONE > Flashcards

Bone Mineral Homeostasis-DONE Flashcards

0
Q

Bone is a dynamic reservoir and there is constant remodeling, exchanging minerals with ___ and homeostasis is disrupted by ___ dysfunction?

A

intracellular fluid

intestine and kidney

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1
Q

What 2 minerals are important in bone homeostasis?

A

Calcium and phosphate

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2
Q

What are the principal hormone regulators of bone?

A

PTH
Fibroblast growth factor 23
Vitamin D

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3
Q

___ stimulates 1, 25 (OH2) D production in the kidneys

A

PTH

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4
Q

1,25 (OH2) D and Calcium _____ the production of PTH

A

suppress

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5
Q

1,25 (OH2) D stimulates intestinal absorption of ___

A

Calcium and phosphate

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6
Q

1, 25 (OH2) D and ___ stimulate proliferation and differentiation of osteoblasts and osteoclasts

A

PTH

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7
Q

PTH and 1,25 (OH2) D enhance ___ retention of calcium

A

renal

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8
Q

___ Promotes renal phosphate excretion

A

PTH

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9
Q

___ promotes renal absorption of phosphate

A

1,25 (OH2) D

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10
Q

___ stimulates renal phosphate excretion and inhibits renal production of 1, 25 (OH2) D

A

FGF23

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11
Q

1,25 (OH2) D and phosphate stimulate the production of ____

A

FGF23

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12
Q

Effects of PTH

A

Raises calcium and reduces phosphate

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13
Q

Effects of FGF23

A

decreases phosphate

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14
Q

Effects of Vitamin D

A

raises calcium and raises phosphate

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15
Q

What is a recombinant PTH 1-34 that in excess endogenous PTH Increases bone resorption? Low intermittent doses of PTH increase bone formation without stimulating bone resorption

A

Teriparatide

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16
Q

What are the reabsorption affects of PTH in the kidneys?

A

Increases Ca and Mg

Reduces Phosphate, Amino Acids, bicarbonate, Sodium, Chloride and Sulfate

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17
Q

T/F Women and men with osteoporosis at high risk of fractures.

A

TRUE

Teriparatide is at least as effective as bisphosphonates in preventing fractures

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18
Q

What are two cautions associated with Teriparatide (Forteo)

A

Watch for high calcium levels

Only use for 2 years ( + 2 years = osteosarcoma)

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19
Q

What are the 2 types of Vitamin D?

A

Cholecalciferol (natural form)

Ergocalciferol (plant based form)

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20
Q

What is the active metabolite of vitamin D?

A

1, 25 dihydroxyvitamin D or Calcitriol (Rocaltrol)

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21
Q

Where is vitamin D cleared and where is it stored?

A

Cleared by the liver

Stored in adipose tissue

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22
Q

Name 3 Vitamin D Analogs

A

Calcipotriene (Calcipotriol)
Doxercalciferol (Hectorol)
Paricalcitol (Zemplar)

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23
Q

Read the functions of Vitamin D Metabolites/Analogs

A 
Intestinal calcium absorption
Bone Resorption
Renal Calcium and Phosphate reabsorption
Decrease PTH
Promote innate immunity
Inhibit adaptive immunity
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25
Q

When do you use Vitamin D metabolites?

A 
Osteoporosis
Osteomalacia
Renal failure
Malabsorption
Psoriasis
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26
Q

What is the MOA of calcitonin?

A

it lowers serum calcium and phosphate, inhibits osteoclastic bone resorption, and in time, reduces bone formation and absorption

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27
Q

What conditions is calcitonin useful in treating?

A
  1. Paget’s dz
  2. hypercalcemia
  3. osteoporosis
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28
Q

When prescribing a patient with osteoporosis Fortical, what are the specific directions you need to instruct the patient on how to take the med?

A

spray ONE spray in ONE nostril daily. Be sure to alternate nostrils (will need to keep a log)

29
Q

____ is useful in reversing the hypercalcemia associated with lymphomas and granulomatous diseases such as sarcoidosis.

A

glucocorticoids

30
Q

What is prolonged used of glucocorticoids a common cause of?

A

osteoporosis and stunted skeletal development

31
Q

What is used to treat or prevent postmenopausal osteoporosis in the immediate postmenopausal period?

32
Q

____ retain the beneficial effect on bone while minimizing adverse effects on breast, uterus, and CV system.

A

SERMs (selective estrogen receptor modulators)

33
Q

Which SERM interacts selectively with estrogen receptors and inhibits bone resorption W/O stimulating breast or endometrial hyperplasia?

A

Raloxifene (Evista)

34
Q

____ is used in osteoporosis AND for 5 yrs to reduce breast cancer risk

A

Raloxifene (Evista)

35
Q

Does Raloxifene (Evista) relieve menopausal symptoms?

36
Q

Raloxifene (Evista) may increase risk of….

A

VTE or stroke

37
Q

Do you need to watch triglycerides with Raloxifene (Evista)?

38
Q

Does Raloxifene (Evista) reduce vertebral fractures?

39
Q

What is required for bone mineralization?

A

calcium and phosphate

40
Q

What is Calcium and Phosphate used to treat?

A

osteoporosis, osteomalacia, calcium or phosphate deficiency

41
Q

What is the MOA of bisphosphonates?

A

they suppress the activity of osteoclasts and increase bone density

42
Q

T/F: Bisphosphonates reduce fractures over at least 5 years.

43
Q

How should bisphosphonates be taken?

A

on an empty stomach with water sitting upright or via IV

44
Q

T/F: Calcitonin is more effective than Alendronate (fosamax)

A

FALSE

According to the slides alendronate is more effective

45
Q

For what conditions do you use Bisphosphonates for?

A
  1. osteoporosis
  2. bone metastases
  3. hypercalcemia
46
Q

____ acts on the osteoblast to induce a protein called ____.

A

PTH; RANKL (RANK ligand)

47
Q

What does RANKL do?

A

it increases the number and activity of osteoclasts

48
Q

____ is an antibody that inhibits RANKL to prevent excess bone resorption in patients with osteoporosis and certain cancers.

A

Denosumab (Prolia)

49
Q

T/F: Denosumab (Prolia) inhibits osteoblastogenesis and activity

A

FALSE

Inhibits osteoCLASTogenesis

50
Q

What condition is Denosumab (Prolia) used for?

A

osteoporosis

51
Q

Denosumab (Prolia) may increase risk of ____.

A

infections

52
Q

Cinacalcet (Sensipar) = ____.

A

Calcium receptor agonist

53
Q

What is the MOA of Cinacalcet (Sensipar)?

A

it activates the calcium sensing receptor (and in doing so inhibits PTH secretion)

54
Q

Cinacalcet (Senispar) is used for _____.

A

hyperparathyroidism

55
Q

What is an adverse effect of Cinacalcet (Sensipar)?

A

may cause nausea

56
Q

T/F: ALL patients need calcium and vitamin D

A

TRUE (you can’t build bone without them!!)

57
Q

WHat are the 3 most common causes of Hypercalcemia?

A
  1. thiazides
  2. hyperparathyroid
  3. cancer
58
Q

What are the less common causes of Hypercalcemia?

A

high vitD, Sarcoidosis, thyrotoxicosis, milk-alkali syndrome, adrenal insufficiency, immobilization

59
Q

What are two things that Hypercalcemia can cause that are very serious?

A

CNS depression and coma

60
Q

What is the acute treatment of Hypercalcemia?

A

lower serum calcium by

  1. Rehydration (urine flow aids excretion)
  2. Followed by loop diuretic (decreases calcium reabsorption in kidney)
61
Q

What are the Chronic Treatments for Hypercalcemia?

A

Bisphosphonates, Calcitonin, Gallium nitrate, Plicamycin, Phosphate, Glucocorticoids

62
Q

Patient presents with neuromuscular tetany, paresthesia, laryngospasm, muscle cramps, convulsions. What are these specific signs and symptoms of?

A

Hypocalcemia

63
Q

Hypoparathyroid, Vitamin D deficiency, chronic kidney disease, malabsorption (common in neonates and often resolves w/out treatment) are all causes of what?

A

hypocalcemia

64
Q

What are the treatment options for Hypocalcemia?

A
  1. Calcium IV, IM - calcium gluconate [IV, IM], Calcium gluceptate, calcium chloride
  2. Calcium Oral - carbonate (tums), lactate, phosphate, citrate
  3. Vitamin D supplementation (calcitriol)
65
Q

What are the three most common causes of Hyperphosphatemia?

A
  1. Common complications of renal failure
  2. Hypoparathyroid
  3. Vitamin D intoxication
66
Q

What are the treatment options for Hyperphosphatemia?

A
  1. emergency treatment is rarely needed
  2. restrict dietary intake
  3. phosphate binding gels (sevelamer)
67
Q

What are the 5 causes of Hypophosphatemia?

A
  1. Primary Hyperparathyroid
  2. Vitamin D deficiency (intake or genetic rickets)
  3. Idiopathic hypocalcemia
  4. Renal phosphate wasting
  5. Overuse of phosphate binders
68
Q

How do you treat hypophosphatemia?

A

emergency treatment is rarely needed, oral supplementation

69
Q

What is the radiopharmaceutical MINERAL in the US used to suppress bone resorption and increases bone formation?

A

Strontium (pipeline)

*IN Europe its used for osteoporosis and osteomalacia

Pharm II (13 decks)

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