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Spring Pharm Exam 3 > Calcium homeostasis > Flashcards

Calcium homeostasis Flashcards

1
Q

Vitamin D stimulates intestinal abs of Ca and P

A

:)

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2
Q

PTH and Vit D effect of bone:

A

Formation via osteoblasts

Resorption via osteoclasts

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3
Q

PTH and Vit D effect on kidney:

A

Enhance resorption of Calcium
PTH: stimulates renal excretion of P
Vit D: enhances P retention

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4
Q

Fibroblast growth factor effect at kidney:

A

Stimulates excretion of P, overall decreases serum level

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5
Q

PTH stimulates Vit D activation at kidney

A

:)

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6
Q

Vit D and Ca++ inhibit PTH synthesis and release

A

negative feedback

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7
Q

Fibroblast growth factor inhibits VIt D in kidney

A

:)

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8
Q

Calcitonin (synthetic) can reduce serum Ca and P by inhibiting bone resorption

A

:)

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9
Q

Vitamin D3 (cholecalciferol)

A

Modest cost. Efficient

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10
Q

Vitamin D2 (ergocalciferol)

A

Less efficient than D3, shouldnt be 1st choice

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11
Q

25-Hydroxyvitamin D3 (calcifediol)

A

DOesnt need hepatic hydroxylation. Best for liver disease

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12
Q

1, 25-dihydroxyvitamin D3 (calcitriol)

A

Most useful in patients with decreased synthesis of calcitriol (renal disease)

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13
Q

Calicitriol synthesis stimulated by

A

PTH in the kidney (released in response to hypocalcemia)

Hypophosphatemia also directly stimulates synthesis

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14
Q

Calcitonin stimulated by, MOA

A

Hypercalcemia
inhibits bone resorption –> decreases Ca++ and PO4
Reduces absorption/increases excretion of Ca++ and PO4

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15
Q

Estrogen MOA

A

Decreases number and activity of osteoclasts

Increase osteoblast activity

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16
Q

Glucocorticoid MOA on decreasing bone density

A

Lowers serum Ca++ by inhibiting dietary absorption –> increases PTH in response, increased osteoclast activity
Activates osteoclasts –> increased bone resorption
Suppresses osetoblast activity

17
Q

RANK ligand is expressed on an osteoblast in response to

A

Vitamin D3, PTH and interleukins

18
Q

RANKL interacts with receptor (RANK) on osteoclast

A

forms mature osteoclasts

19
Q

Bisphosphonates inhibit bone resorption by osteoclasts

A

:)

20
Q

Estrogen increases production of a decoy molecule that doesnt allow activation of RANK receptor

A

:0

21
Q

Post-menopausal women predisposed to osteoporosis because loss of…

A

estrogen - which inhibits osteoclasts (normally), so they go un-leashed

22
Q

Bisphophonate MOA

A

Bind to sites of bone remodeling

Inhibit osteoclasts by (1)apoptosis and (2)inhibit protein synthesis w/i cell, necessary for function

23
Q

Bisphosphonates are 1st-line, most effective in preventing and treating osteoporosis

A

:0

24
Q

Alendronate or Risedronate dose, ADR

A

Bisphosphonates: weekly or monthly PO

Esophagitis, GI upset

25
Q

Selective Estrogen Receptor Modulator (SERM) in osteoporosis

A

Prevention and treatment only if patient can’t tolerate a bisphosphonate or is at risk of breast CA (contra of estrogen)

26
Q

Denosumab MOA

A

Antibody against RANKL - reduces osteoclast activation and improves BMD

27
Q

Denosumab use

A

For tx of patient with high fracture risk

28
Q

Teriparatide (Forteo) treats osteoporosis by stimulating bone formation. UNIQUE

A

All other treatments are anti-resorptive agents

29
Q

Teriparatide MOA

A

must be given intermittently
increases osteoblastic activity
expensive

30
Q

Calcitonin Use in Osteoporosis

A

Treats not prevents
inhibits osteoclastic resorption
Subcutaneously or intranasal
Expensive

31
Q

Thiazide diuretics in hypercalciuria

A

Reduces urinary calcium excretion

32
Q

Hypercalcemia caused by

A

hyperparathyroidism and/or cancer

Muscle weakness, lethargy

33
Q

Saline diuresis in hypercalcemia

A

Frequently dehydrated. Once rehydrated, loop diuretics can be used to increase Ca++ excretion

34
Q

Bisphosphonates in hypercalcemia

A

Mainstay of treatment. Potent inhibition of osteoclastic bone resorption

35
Q

Calcitonin in hypercalcemia

A

potentially useful - decreases calcium mobilization out of bone

36
Q

Hypocalcemia causes

A

hypoparathyroidism, Vit D deficiency, hypomagnesemia

37
Q

Hypocalcemia TX with Calcium (acute)

A

Calcium gluconate IV for treatment of severe hypocalcemic tetany

38
Q

Hypocalcemia TX with Calcium (chronic)

A

supplements recommended only if can’t be taken in from diet

39
Q

Vitamin D supplements in hypocalcemia

A

Improves intestinal Ca++ absorption

supresses bone remodelling

Spring Pharm Exam 3 (8 decks)

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