drug affecting Ca balance Flashcards by bailey craig

bone formation

osteoblasts

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bone resorption

osteoclasts

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PTH Ca increase and P decrease
Vit D Ca increase and P increase
Calcitonin Ca decrease
FGF23 P decrease

Net serum level

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Plasma Ca increase
plasma phosphate decrease
Effects on bone - demineralization and osteopenia

primary hyperparathyroidism

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Plasma Ca decrease
plasma phosphate increase
Effects on bone - malformation

primary hypoparathyroidism

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Plasma Ca decrease
plasma phosphate decrease
Effects on bone - osteomalacia and Ricketts

vit D def

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Plasma Ca increase
plasma phosphate increase
Effects on bone - osteoporosis

excess vit D

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Plasma Ca decrease
plasma phosphate increase
Effects on bone - osteomalacia and osteosclerosis

renal failure + high plasma phosphate

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in adequate diet and hypoparathyroidism

tx with Vit D and calcium

hypocalcemia

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hyperparathyroidism and hypervitaminosis D

Tx: 1) loop diuretics + IV fluids, bisphosphonates, calcitonin, glucocorticoids, low calcium diet

hypercalcemia

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pagets dz of the bone and osteoporosis

tx for pagets: bisphosphonates and calcitonin

tx for osteoporosis: bisphosphonates, calcitonin, estrogen, SERMs supplemented with calcium and Vit D

bone remodeling

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produced by osteoblasts

fxn: promotes urinary phosphate excretion - PCT; suppression of activated Vit D produced by kidney

fibroblast growth factor 23

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1) Ca sensing receptor on parathyroid gland
2) stimulates osteoblasts to release receptor activator of nuclear factor RANKL - activates osteoclasts; RANKL binds to RANK on the osteoclast surface - increasing differentiation and activity - increasing bone resorption
3) increase Ca resorption by the kidney and increase phosphate excretion
4) intestine: indirectly increase Ca and P absorption by enhancing formation of Vit D3 in kidney

PTH - parathyroid hormone

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senses increase serum Ca

increase serum Ca levels inhibit PTH production and secretion

Ca sensing receptor on parathyroid hormone gland

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increase Ca

absorption by TRPV6 Ca ch in duodenum and proximal jejunum

Vit D - calcitriol

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obtained by dairy products or UVB radiation in sunlight

vit D3 cholecalciferol

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ergocalciferol obtained by plants

vit D2

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found in food

vit D1

stimulates intestinal absorption of Ca and P
stimulates osteoblasts to release RANKL - activates osteoclasts
inhibits PTH production by parathyroid gland

Vit D - calcitriol

increase bone turn over (increase bone formation)
increase bone density
inhibit epidermal proliferation
increase Ca absorption in distal tubules

Vit D - calcitriol

used to tx: osteoporosis, prevent hypocalcemia in chronic kidney dz, psoriasis

Vit D - calcitriol

produced in thyroid - thyroid parafollicular C cells
potent inhibitor of osteoclast mediated bine resorption (decrease)
promotes Ca excretion by the kidney

Used: hypercalcemia, Pagets dz
CI: hypocalcemia

calcitonin

synthetic PTH
increase Ca resorption by the kidney and increase phosphate excretion
increase activity of 1 alpha hydroxyls in kidney - increase production Vit D

teriparatide

Tx: osteoporosis

continuous use: bone demineralization, osteopenia
intermittent use: bone growth <2 yrs duration

ADR: increase risk osteosarcoma, nephrolithiasis, increase S uric acid levels

teriparatide

MOA: increase sensitivity of CaCr to extracellular Ca; activates the Ca sensing receptor on the parathyroid gland - decrease production of PTH

cinacalcet

used to tx: hyperparathyroidism and parathyroid carconoma ADR: hypocalcemia

cinacalcet

monoclonal antibody blocks osteoclast formation and activation increase bone mineral density mimics OPG Used: osteoporosis

denosumab

Vit D preparations

1) cholecalciferol - D3 2) calciferol 3) alfacacidol: 1 OH Vit D3 - useful in kidney dysfunction 4) paricalcitol D2

Ca gluconate Ca chloride Ca carbonate

calcium salts

chelates Ca bind to osteoclasts, inhibiting their adherence to the bony surface decrease the development and recruitment of osteoclast precursors induce osteoclasts apoptosis

bisphosphonates

inhibit farnesyl pyrophosphate synthase - attach to hydroxyapatite in bone

bisphosphonates

uses: pagets, osteoporosis, acute hypercalcemia SE: GIT (upper), sit upright 30 min and drink water can cause osteonecrosis of jaw hypoglycemia, bone pain and subtrochanteric fracture

bisphosphonates can not use in renal failure px

bisphosphonates 3 generations

1) etidronate - less potent 2) alendronate, pamidronate 3) risedronate, zoledronate

SERM used to tx and prevent of postmenopausal osteoporosis increase bone mineral density estrogen agonist on bone estrogen antagonist on breast and uterus

raloxifene

DOC for treating hypercalcemia

hydration fluid + furosemide

drugs decreasing bone mineral density

Glucocorticoids | medroxyprogesterone

type 1: loss of trabecular bone - decrease estrogen | type 2: loss of cortical and trabecular bone

osteoporosis

treatments for osteoporosis

1) DOC bisphosphonates 2) raloxifene - women 3) teriparatide - male/women - for sever case; used in fracture healing

tx for pagets

bisphosphonates: alendronate, risedronate, zoledronate | calcitonin

adults - osteomalacia | children - ricketts

vit D def

tx for hypoparathyroidism

1) vit D - DOC with calcium 2) dihydrotachysterol 3) calcitriol

kidney excretes less phosphate | high blood phosphate predicates Ca - forms Ca phosphate - blood Ca decreases - stimulates PTH

secondary hyperparathyroidism in renal failure PTH >88 bone resorption is increased

tx for hyperparathyroidism

1) DOC - cinacalcet | 2) aluminum hydroxide, calcitriol