Calcium/Osteoporosis Flashcards

1
Q

Vitamin D

A

PRIMARY FUNCTION: cofactor with PTH to increase GI absorption of Calcium

  • essential for bone health
  • prevention/treatment of postmenopausal osteoporosis and renal osteodystrophy
  • decreased Vit D will increase risk for diseases (cancers, infections, asthma, heart disease, dementia, diabetes, chronic pain syndromes, and autoimmune disorders)
  • two forms = D2 and D3 (active form)
  • Increases PTH mediated osteoCLAST maturation

-High risk deficiency in:
Children, breast fed infants in mothers, older adults, people with limited sun exposure, dark skinned, fat malabsorption syndromes, obese, gastric bypass patients (quick emptying of stomach = decrease of vit D)

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2
Q

Vit D primary food sources

A
sunlight
fatty fish (salmon, swordfish, tuna, mackerel, cod liver oil)
milk (fortified)
infant formula
breakfast cereals
orange juice
yogurts
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3
Q

Vit D dosage

A

400-800 mg/day (more if deficient)

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4
Q

Calcium needed for the functioning of?

A
  • bones
  • neuro-muscular system
  • cardiac system
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5
Q

Dietary sources of Calcium

A
  • milk
  • broccoli
  • spinach
  • fortified foods – orange juice and cereals
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6
Q

Calcium intake

A

> 70 y/o need more vitamin D & Calcium

- children need more calcium for bone growth/development

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7
Q

Calcium salts

A
  • Calcium acetate/PhosLo (least absorbed)
  • Calcium carbonate/Tums, Rolaids (well absorbed)
  • Calcium citrate/Citracal (highest absorption)

Calcium salts for Cardiac Conduction:

  • Ca gluconate/Cal-G (used most often) (IV)
  • Ca Lactate/ Cal-Lac
  • Ca Chloride (Given IV)
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8
Q

Low calcium contributes to

A

osteoporosis

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9
Q

Low vitamin D contributes to

A

increase risk for disease

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10
Q

Calcitonin

A
  • produced by Thyroid gland = REDUCE calcium levels
  • rarely given
  • a hormone that can be given as a medication
  • 8.5 - 10.5 normal ca levels
  • does NOT affect calcium absorption in gut
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11
Q

Calcitonin-Salmon (Miacalcin, Fortical)

A

-form of calcitonin derived from salmon similar to human calcitonin

MOA:

  1. decrease bone resorption by inhibiting activity of osteoCLASTS
  2. increase calcium excretion by inhibiting renal tubule resorption

INDICATIONS:

  • treatment of postmenopausal osteoporosis
  • NOT prevention
  • Paget’s disease

ROUTE: nasal spray or injection; 1 nostril/day (alternate - don’t forget which nostril was sprayed last)

ADR:

  • VERY SAFE
  • Nausea diminshes overtime
  • flushing of face and hands
  • may not work after a year due to antibody development
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12
Q

Biphosphonate prototype Drug

A

Alendronate (Fosamax)

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13
Q

Alendronate (Fosamax)

A

MOA:
- suppress bone resorption by decreasing number AND activity of osteoCLASTS

INDICATIONS:

  • osteoporosis in POSTmenopausal women and in men.
  • glucoccorticoid-induced osteoporosis
  • Paget’s disease

ADR:

  • esophagitis
  • atypical femur fraction
  • occular inflammation
  • osteonecrosis of jaw

ROUTE: PO

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14
Q

Alendronate (Fosamax) administration

A
  • full glass of water in AM
  • before eating food/fluids to maximize bioavailability
  • wait 30-60 mins to consume food/fluid
  • given daily, weekly, or monthly formulations
  • Must increase WB exercises*
  • drink plenty of water to prevent cancer*
  • ** if they can’t sit up they CAN’T take medicine***
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15
Q

ADR of Alendronate that can lead to?

A

Barret’s esophagitis (from esophagitis)

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16
Q

Bone loss but not same degree as osteoporosis

A

osteopenia

17
Q

Osteoporosis and osteopenia have different _____ _____?

A

Standard deviations

18
Q

Selective Estrogen Receptor Modulators (SERMS) drug

A

Raloxifene (Evista)

19
Q

Raloxifene (Evista)

A

MOA:

  • similar to estrogen and binds to estrogen receptors
  • acts as agonist AND antagonists in others
  • mimics estrogen in bone, lipid, and blood clotting (agonist)
  • BLOCKS estrogen in BREAST ad ENDOMETRIUM (antagonist)

INDICATIONS
- prevent and treatment of postmenopausal osteoporosis, estrogen receptor breast cancer

ADR

  • hot flashes (main SE)
  • risk for thromboembolism, fetal harm (cat X)

Take adequate intake of calcium and vitamin D