Bone Mineral Homeostasis Drugs

Question 1

cholecalciferol

Answer 1

vit D3

Question 2

ergocalciferol

Answer 2

Vit D2

Question 3

raloxifene

Answer 3

selective estrogen-receptor modulator

Question 4

alendronate

Answer 4

bisphosphanate

Question 5

denosumab

Answer 5

prolia

Question 6

RANKL

Answer 6

binds RANK - induces osteoclast formation

Question 7

Ca and P balance

Answer 7

renal excretion balances intestinal absorption

Question 8

PTH

Answer 8

increased serum Ca
decreased serum PO4

acts on osteoblasts to produce RANKL
-increased osteoclast activity - bone remodeling

Question 9

PTH in kidney

Answer 9

increased Ca absorption

decreased PO4 absorption

Question 10

teriparatide

Answer 10

synthetic parathyroid hormone

Question 11

teriparatide

Answer 11

intermittent - once daily subQ - promotes bone grwoth

Question 12

teriparatide CI

Answer 12

patient at risk for osteosarcoma

Question 13

calcitriol

Answer 13

1,25 Vit D

Question 14

calcitriol on kidney

Answer 14

increased absorption of Ca and PO4

Question 15

tx of rickets

Answer 15

Vit D analogs

Question 16

patient with liver disease

Answer 16

should use 25 Vit D

Question 17

patient with kieny disease

Answer 17

should use 1,25 Vit D

Question 18

calcitriol risk

Answer 18

hypercalcemia

Question 19

adverse drug effects of vit D analogs

Answer 19

arrhythmia and pancreatitis

Question 20

FGF23

Answer 20

inhibits 1,25 Vit D production

inhibits PO4 reabsorption in kidney

Question 21

Vit D and Ca and PO4

Answer 21

increases both levels in serum

Question 22

PTH and Ca and PO4

Answer 22

serum calcium increased

serum phosphate decreased

Question 23

calcitonin

Answer 23

from C cells of thyroid

decrease serum Ca and PO4

inhibits osteoclast activity
decreases Ca and PO4 reabsorption

Question 24

tx of pagets

Answer 24

calcitonin

Question 25

glucocorticoids

Answer 25

decrease total body calcium stores

Question 26

raloxifene

Answer 26

selective serotonin receptor modulator (SERM)

tx for post-menopausal osteoporosis

partial agonist at bone but does not stimulate endometrial proliferation

Question 27

estrogens

Answer 27

reduce bone resorbing actions of PTH

Question 28

ADRs of estrogens

Answer 28

hot flashes, leg cramps, thromboembolism

Question 29

bisphosphonate MOA

Answer 29

analog of pyrophosphate in which P-O-P bond replaced with non-hydrolyzable P-C-P bond
-cheoate Ca

concentrate at sites of active bone remodeling - incorporated into bone

decreased osteoclast activity

Question 30

when to take bisphosphonates

Answer 30

on empty stomach

Question 31

ADR bisphosphonate

Answer 31

erosive esophagitis

osteonecrosis of jaw

Question 32

denosumab MOA

Answer 32

monoclonal Ab - binds and prevents action of RANKL

blocks osteoclast activation

Question 33

denosumab use

Answer 33

tx of post-menopausal osteoporosis and cancers (prostate and breast)

Question 34

ADRs denosumab

Answer 34

increased risk of infection

osteonecrosis of jaw

transient hpocalcemia

Question 35

thiazide therapy

Answer 35

can cause hyperCa

Question 36

tx of hypercalcemia

Answer 36

saline diuresis with or without furosemide

bisphosphonates

calcitonin

phosphate (to decrease serum Ca)

glucocorticoids

Question 37

tx of hypocalcemia

Answer 37

calcium IV, IM, or PO

Question 38

thyrotoxicosis

Answer 38

osteoporosis

Question 39

first line for pagets

Answer 39

calcitonin

bisphosphonates

Question 40

post menopausal osteoporosis estrogen use

Answer 40

concern for increased risk of breast cancer and fails to reduce heart disease

Question 41

IV calcium

Answer 41

calcium gluconate

-less irritating to veins

Question 42

oral calcium

Answer 42

calcium carbonate preferred

high % of calcium