Calcium Homeostasis Flashcards
Effects of loop diuretic on Ca?
Thiazidees?
Loops – Increase Excretion
Thiazides – Decrease Excretion
Effects of PPIs and H2 antagonists on Ca
Decreased Absorption of CA
Effects of carbemasepine, isoniazid, theophylline, and rifampin on Ca?
Induction of catabolic p450s
Bisphosphonates inhibit ________ of osteoclasts
Farnesyl-PP synthesis
Important adverse effects of Bisphosphonates
NVD, Musculoskeletal Pain
Osteonecrosis of the Jaw
Atypical Femur Fractures
Which Bisphosphonates are approved for Paget’s, but not for Osteo
PAMIdronate
TILUdronate
ETIdronate
Name the four bisphosphonates used for Osteoporosis
Ones with long chain and N
ZOLEdronate
ALENdronate
RISEdronate
IBANdronate
What does it matter that Bisphosphonates inhibit farnesyl pyrophosphate synthase
Disrupts prenylation of proteins in osteoclasts
Names and Role of Estrogens and SERMS in Osteoporosis treatment
Estradiol and Raloxifene (lower cancer, still stroke)
Prevent post-menopausal bone loss
Increases blast activity
Names and Role of Calcitonin in treatment
Calcimar, Cibacalcin
Decreases osteoclast activity, blocks renal abs. of P and Ca
Pagets, Osteo over 5 years after meno, hypercalcemia of malignancy
Side effects of calcitonin treatment
Urticaria, Hand Swelling, Nausea
Mechanism of Teripartide? Who do you use it on?
AA 1-34 of Parathyroid Hormone
Given w/ Ca to stimulate osteoblast activity
Treat high fracture risks
Side effects of Teripartide
Orthostatic Hypertension
Hypercalcemia
Arthralgia
Allergic Rxn
Explain how PTH works in the context of RANKL and OPG
Continuous PTH increases RANKL and Decreases OPG, causing an increase in osteoclasts. Intermittent can upregulate OPG, which will bind RANKL and keep is from activating RANK and causing differentiation
What drug would you use promarily for the bone formation phase?
PTH once daily
Teripartide
Cons of teriparatide
Must be injected daily
Not recommended beyond 2 years
Risk of Bone Cancer
How does Denosumab work?
Ab against RANKL, prevents osteoclast differentiation
High fracture risk post menopausal patients that can’t toleratate BPs
Adverse effects of Denosumab?
Hypocalcemia, Musculoskeletal Pain
Osteonecrosis of the Jaw
Atypical Femur Fractures
Infections and Skin Rxns
How does Cinacalcet work? When to use it?
Binds to calcium sensing receptor to inhibit PTH release to lower PTH and serum Ca
For hyperparathyroidism
Significance of Zemplar and Hectorol
Vitamin D analogs used to treat hyperparathyroidism in CKD. They will inhibit PTH secretion with less Ca effect than normal D
Important Phosphate Binders
Lanthanum Carbonate (Ca and P) Sevelamer (Just P)
