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Calcium Pharm Flashcards

1
Q

What is the role of calcium in the body?

A

Calcium is essential for normal biological function of the nervous system, musculoskeletal system, blood coagulation, enzyme activity, cellular membrane integrity, regulation of secretory activities, and bone metabolism.

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2
Q

What are the primary hormones involved in calcium regulation?

A

PTH, activated vitamin D, and calcitonin.

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3
Q

How does PTH affect serum calcium levels?

A

PTH increases serum calcium by increasing bone resorption, promoting the formation of active vitamin D, enhancing renal calcium reabsorption, and increasing renal phosphate excretion.

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4
Q

What is the effect of vitamin D on calcium levels?

A

Vitamin D facilitates intestinal absorption of calcium and provides a balance of calcium and phosphorus for bone mineralization.

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5
Q

What are the major therapeutic uses of vitamin D?

A
  • Prophylaxis and cure of nutritional rickets
  • Treatment of metabolic rickets and osteomalacia
  • Treatment of hypoparathyroidism
  • Prevention and treatment of osteoporosis
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6
Q

What condition can result from prolonged vitamin D deficiency?

A

Osteomalacia.

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7
Q

What is the pharmacological significance of calcitriol?

A

Calcitriol is the active form of vitamin D and is used for the treatment of hypocalcemia, secondary hyperparathyroidism, and metabolic bone disease.

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8
Q

What are the potential drug interactions with vitamin D preparations?

A
  • Isoniazid (INH)
  • Cholestyramine
  • Antacids
  • Calcium channel blockers
  • Anticonvulsants
  • Thiazide diuretics
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9
Q

What is hypercalcemia?

A

Hypercalcemia is defined as serum calcium concentrations above normal.

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10
Q

What are common causes of hypercalcemia?

A
  • Hyperparathyroidism
  • Cancer
  • Vitamin D excess
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11
Q

What is the first step in managing severe hypercalcemia?

A

Hydration with isotonic saline.

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12
Q

What is calcitonin’s primary mechanism of action?

A

Calcitonin inhibits osteoclastic bone resorption and increases renal excretion of calcium.

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13
Q

What are the clinical applications of bisphosphonates?

A

Used for treating hypercalcemia of malignancy.

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14
Q

What are the side effects of calcitonin?

A
  • Flushing
  • Gastrointestinal upset
  • Rash
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15
Q

Fill in the blank: Calcitriol is the primary active metabolite of _______.

A

vitamin D3

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16
Q

What is the elimination half-life of circulating vitamin D?

A

About 19 days.

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17
Q

True or False: Excessive exposure to sunlight can lead to vitamin D toxicity.

A

False.

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18
Q

What is the recommended treatment for chronic hypocalcemia?

A

Start supplemental oral calcium and vitamin D preparation.

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19
Q

What is the indication for parathyroid hormone (PTH) therapy?

A

Adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism.

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20
Q

What is the elimination half-life of calcifediol?

A

Averages 16 days.

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21
Q

What is the role of furosemide in hypercalcemia management?

A

Facilitates urinary excretion of calcium by inhibiting calcium reabsorption in the kidneys.

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22
Q

What is the effect of glucocorticoids on hypercalcemia?

A

Increases urinary calcium excretion and decreases intestinal calcium absorption.

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23
Q

What are the clinical applications of dihydrotachysterol (DHT)?

A
  • Treatment of acute, chronic, or latent postsurgical tetany
  • Idiopathic tetany
  • Hypoparathyroidism
  • Renal osteodystrophy
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24
Q

What is the indication for ergocalciferol?

A

Alternative form of vitamin D used for prevention and treatment of vitamin D deficiency.

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25
What are glucocorticoids used for in hypercalcemia?
Glucocorticoids combat hypercalcemia by increasing urinary calcium excretion and decreasing intestinal calcium absorption.
26
In which conditions does hypercalcemia respond most favorably to glucocorticoid therapy?
Hypercalcemia due to lymphomas, multiple myeloma, and granulomatous tumors.
27
What are common adverse effects associated with glucocorticosteroids?
Hyperglycemia and electrolyte disturbances such as hypokalemia.
28
What is mithramycin?
An inhibitor of RNA synthesis in osteoclasts.
29
What adverse effect is associated with mithramycin?
Nausea, which can be minimized by slow IV administration.
30
What are the contraindications for mithramycin?
Liver dysfunction, kidney dysfunction, thrombocytopenia, or any coagulopathy.
31
What is gallium nitrate's nephrotoxicity rate?
8%-15% of patients using gallium nitrate.
32
What should be done to reduce the risk of renal complications when administering gallium nitrate?
Adequately hydrate patients before administration.
33
What is denosumab?
A humanized monoclonal antibody that inhibits the binding of RANKL with its receptor RANK.
34
How does denosumab differ from bisphosphonates regarding kidney function?
Denosumab is not excreted by the kidney, thus no restriction in patients with chronic kidney disease.
35
What does secondary hyperparathyroidism refer to?
Excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia.
36
What is cinacalcet used for?
Treatment of secondary hyperparathyroidism in chronic kidney disease patients on dialysis and hypercalcemia in parathyroid carcinoma.
37
What class of drug is cinacalcet?
Calcimimetic.
38
What is the mechanism of action of calcimimetics?
Control PTH release from parathyroid glands without increasing calcium and phosphorus levels.
39
What are common side effects of calcimimetics?
Mild or moderate nausea and vomiting.
40
What is etelcalcetide's brand name?
Parsabiv.
41
What route of administration is used for etelcalcetide?
IV.
42
For which condition is etelcalcetide indicated?
Secondary hyperparathyroidism in patients with chronic kidney disease on hemodialysis.
43
What is osteoporosis?
A disease characterized by low bone mass (density) and microarchitectural abnormality, leading to fractures.
44
What are the key components of the bone remodeling cycle?
Formation, resorption, activation.
45
What are the risk factors for osteoporosis?
* Endocrine diseases (primary hyperparathyroidism, thyrotoxicosis, Cushing’s syndrome, Addison’s disease) * Rheumatologic diseases (rheumatoid arthritis, ankylosing spondylitis) * Estrogen deficiency.
46
What is the impact of glucocorticoids on bone health?
Reduction in bone formation and increase in bone resorption, leading to osteoporosis.
47
What is essential for the treatment of osteoporosis?
Calcium and vitamin D supplementation.
48
What foods can decrease calcium absorption?
* Spinach * Wheat bran * Rhubarb.
49
What is the recommended dosing for calcium carbonate?
Doses >500 mg/day should be given as divided doses.
50
Which calcium compound is well-absorbed even in a fasting state?
Calcium citrate.
51
What are the FDA approved medications for osteoporosis in women?
* Bisphosphonates * Calcitonin * Estrogens/Hormone therapy * Raloxifene * Parathyroid Hormone (teriparatide, abaloparatide) * Denosumab * Romosozumab.
52
What is the primary mechanism of action of osteoporosis treatments?
To block the bone remodeling cycle.
53
What is hormone replacement therapy (HRT) approved for?
Prevention and treatment of osteoporosis in women.
54
What are the risks associated with hormone replacement therapy?
Increased risk of breast cancer, heart disease, and dementia.
55
What are the contraindications for alendronate?
* Disorders of the esophagus * Patients who cannot sit upright for at least 30 minutes.
56
What is the dosing instruction for alendronate?
Take with 6–8 oz of plain water and do not eat, drink, or take other medications for at least 30 minutes after.
57
How does alendronate affect fracture risk?
Reduces the incidence of spine and hip fractures by about 50 percent over three years.
58
What is the active form of vitamin D discussed?
olecalciferol
59
What is a complex dosing regimen associated with?
Increase in BMD achieved on empty stomach
60
What are potential gastrointestinal adverse effects related to?
Long-term safety is unconfirmed
61
What benefits does alendronate provide?
Increases BMD and reduces fracture risk
62
What are the pros and cons of alendronate?
Pros: Increases BMD, Cons: Gastrointestinal adverse effects
63
What is Risedronate (Actonel®) approved for?
Prevention and treatment of postmenopausal osteoporosis
64
How much does Risedronate reduce the incidence of vertebral fractures?
About 41 to 49 percent
65
What is the recommended administration of Risedronate?
Take with 6–8 oz of plain water; do not eat, drink, or take other medications for at least 30 minutes
66
What is the delayed-release form of Risedronate marketed as?
Atelvia
67
What is Ibandronate (Boniva) approved for?
Treatment of postmenopausal osteoporosis
68
What percentage does Ibandronate reduce vertebral fractures?
About 50 percent
69
How is Ibandronate administered intravenously?
Once every three months
70
What is Zoledronic Acid (Reclast) indicated for?
Treatment and prevention of osteoporosis in postmenopausal women
71
By how much does Zoledronic Acid reduce the incidence of vertebral fractures?
About 70 percent
72
What are the contraindications for Zoledronic Acid?
Creatinine clearance less than 35 mL/min or evidence of acute renal impairment
73
What are common adverse reactions associated with Zoledronic Acid?
Atrial fibrillation
74
What is an acute phase reaction associated with bisphosphonates?
Flu-like symptoms occurring after administration
75
What complication has been reported in patients treated with bisphosphonates?
Osteonecrosis of the jaw (ONJ)
76
What warning did the FDA issue regarding bisphosphonates?
Increased risk of atypical femoral fractures
77
What is recommended for a drug holiday in bisphosphonate treatment?
Consider after 4-5 years if osteoporosis is mild
78
What is the dosage of calcitonin for treatment?
100 IU daily, subcutaneous or intramuscular
79
What is the primary effect of salmon calcitonin?
Suppresses osteoclast activity and reduces bone breakdown
80
What is Raloxifene (Evista®) indicated for?
Prevention and treatment of osteoporosis in postmenopausal women
81
How much does Raloxifene reduce the risk of vertebral fractures?
By about 30 percent in patients with a prior vertebral fracture
82
What is a significant adverse effect of Raloxifene?
Increased risk of venous thrombosis
83
What is Denosumab (Prolia®)?
A human IgG2 monoclonal antibody that inhibits RANK ligand
84
What is the recommended dosage for Denosumab?
60 mg administered subcutaneously once every six months
85
What does Teriparatide (Forteo®) preferentially stimulate?
Bone formation vs resorption
86
What is the indication for Teriparatide?
Treatment of osteoporosis in men and post-menopausal women at high risk for fractures
87
What is a major adverse effect associated with Teriparatide?
Increased incidence of osteosarcoma in rats
88
How is Teriparatide administered?
By subcutaneous injection once daily
89
What is a potential side effect of teriparatide therapy?
Increased incidence of osteosarcoma in rats ## Footnote Teriparatide therapy should be avoided in patients with an increased risk of osteosarcoma.
90
What is the dosage form of teriparatide?
Disposable pen device for once-daily subcutaneous injection
91
What is the recommended duration of teriparatide therapy?
Up to 24 months
92
What is the indication for abaloparatide (Tmlos)?
Treatment of postmenopausal women with osteoporosis at high risk for fracture
93
What class of drugs does abaloparatide belong to?
Parathyroid Hormone Analogs
94
What is a significant warning associated with abaloparatide?
Risk of osteosarcoma
95
What is the maximum recommended duration for abaloparatide treatment?
2 years
96
What is romosozumab (Evenity) indicated for?
Treatment of osteoporosis in postmenopausal females at high risk for fracture
97
What is the dosage for romosozumab?
210 mg subcutaneously once a month
98
What is a major warning for romosozumab?
Potential risk of myocardial infarction, stroke, and cardiovascular death
99
What should be considered if osteoporosis therapy remains warranted after romosozumab?
Transition to an anti-resorptive agent
100
What is the consequence of discontinuing denosumab?
Rebound in bone remodeling leading to potential bone loss
101
What should be done if denosumab treatment is discontinued?
Transition to an alternative anti-resorptive therapy
102
What type of approach is recommended for osteoporosis therapy?
Individualized approach to therapy
103
Which agent is indicated for postmenopausal women with osteoporosis at high risk for fracture?
Denosumab
104
What is a common compliance issue with oral bisphosphonates?
Patient compliance is often raised due to daily dosing
105
What is the cost of Denosumab (Prolia) for a year?
$1600 per year
106
What is Paget's Disease of Bone characterized by?
Regions of furious osteoclastic bone resorption followed by hectic bone formation
107
What is the drug of choice for treating hypercalcemia?
Mitramycin
108
True or False: Ibandronate tablets have been approved for once a month dosing for osteoporosis.
True
109
Which vitamin D preparation has the quickest onset of action?
Calcitriol
110
List the vitamin D preparations.
* 1,25-dihydroxyvitamin D (Calcitriol) * Calciferol * Cholecalciferol * Ergocalciferol (D2) * Calcifediol * Dihydrotachysterol
111
What are the treatments of osteoporosis?
* Calcium and Vitamin D * Estrogen * Bisphosphonates * Calcitonin * Selective estrogen receptor modulators * PTH Rank Ligand Inhibitors

Endocrinology (11 decks)

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