Bone Pharmacology

Question 1

Loop diuretics vs. Thiazides diuretics effect on plasma Ca++

Answer 1

Loop diuretics: decrease

Thiazide: increase

Question 2

Calcitonin actions on Bones

Answer 2

1. inhibit osteoclastic bone resorption

Question 3

Glucocorticoid actions on Bones

Answer 3

Decrease Bone Density:
1. Antagonize vit D effect on gut --> decrease serum Ca++ --> increase PTH 
2. Increase RANK-L
=> increase osteoclast OC activity
3. Decrease osteoblast OB activity

Question 4

Teriparatide

Answer 4

1. Synthetic PTH

2. Tx Osteoporesis

Question 5

Teriparatide vs. other Tx Osteoporesis

Answer 5

1. Teriparatide: only agent stimulate bone formation

2. Others: anti-resorptive

Question 6

Teriparatide continuous vs. intermittent administration

Answer 6

1. Continuous: bone demineralization

2. Intermittent: bone formation (OB activity)

Question 7

Cholecalciferol

Answer 7

1. Vit D3 (skin & animal diet)

2. Preferred: modest cost and efficacy

Question 8

Ergocalciferol

Answer 8

Vit D2 (plant diet)

Question 9

When to use Calcitriol?

Answer 9

1,25(OH)2 vit D3

1. Vit D dependent Ricket’s Type I
2. Chronic renal failure

Question 10

When to use Calcifediol?

Answer 10

25(OH) vit D3

1. Liver disease

Question 11

Dihydrotachysterol

Answer 11

Alternative for Calcitriol

Question 12

Paracalcitol

Answer 12

1. Calcitriol analog
2. Use: 2nd hyper-parathyroidism
   => decrease PTH
   => NO hyper-calcemia

Question 13

Major causes of HYPO-Ca++

Answer 13

1. Hypo-parathyroidism

2. Hypo-Mg++

Question 14

Acute severe HYPO-Ca++ Tx

Answer 14

1. Calcium gluconate - 1st line
2. Calcium chloride
3. Calcium gluceptate
4. Oral Calcium salts

Question 15

Chronic Ca++ Supplement

Answer 15

1. Ca-Carbonate

2. Ca-Citrate

Question 16

When to use Ca-Citrate for chronic Ca++ Tx?

Answer 16

Pt on PPIs or H2 antagonist

Question 17

Adverse effect of Ca salts?

Answer 17

GI upset