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Pharm Block 4 > drug affecting Ca balance > Flashcards

drug affecting Ca balance Flashcards

1
Q

bone formation

A

osteoblasts

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2
Q

bone resorption

A

osteoclasts

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3
Q

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

A

Net serum level

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4
Q

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

A

primary hyperparathyroidism

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5
Q

Plasma Ca decrease
plasma phosphate increase
Effects on bone - malformation

A

primary hypoparathyroidism

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6
Q

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

A

vit D def

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7
Q

Plasma Ca increase
plasma phosphate increase
Effects on bone - osteoporosis

A

excess vit D

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8
Q

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

A

renal failure + high plasma phosphate

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9
Q

in adequate diet and hypoparathyroidism

tx with Vit D and calcium

A

hypocalcemia

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10
Q

hyperparathyroidism and hypervitaminosis D

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

A

hypercalcemia

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11
Q

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

A

bone remodeling

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12
Q

produced by osteoblasts

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

A

fibroblast growth factor 23

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13
Q

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

A

PTH - parathyroid hormone

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14
Q

senses increase serum Ca

increase serum Ca levels inhibit PTH production and secretion

A

Ca sensing receptor on parathyroid hormone gland

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15
Q

increase Ca

absorption by TRPV6 Ca ch in duodenum and proximal jejunum

A

Vit D - calcitriol

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16
Q

obtained by dairy products or UVB radiation in sunlight

A

vit D3 cholecalciferol

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17
Q

ergocalciferol obtained by plants

A

vit D2

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18
Q

found in food

A

vit D1

19
Q

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

A

Vit D - calcitriol

20
Q

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

A

Vit D - calcitriol

21
Q

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

A

Vit D - calcitriol

22
Q

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

A

calcitonin

23
Q

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

A

teriparatide

24
Q

Tx: osteoporosis

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

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

A

teriparatide

25
Q

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

A

cinacalcet

26
Q

used to tx: hyperparathyroidism and parathyroid carconoma

ADR: hypocalcemia

A

cinacalcet

27
Q

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

Used: osteoporosis

A

denosumab

28
Q

Vit D preparations

A

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

29
Q

Ca gluconate
Ca chloride
Ca carbonate

A

calcium salts

30
Q

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

A

bisphosphonates

31
Q

inhibit farnesyl pyrophosphate synthase - attach to hydroxyapatite in bone

A

bisphosphonates

32
Q

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

A

bisphosphonates

can not use in renal failure px

33
Q

bisphosphonates 3 generations

A

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

34
Q

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

A

raloxifene

35
Q

DOC for treating hypercalcemia

A

hydration fluid + furosemide

36
Q

drugs decreasing bone mineral density

A

Glucocorticoids

medroxyprogesterone

37
Q

type 1: loss of trabecular bone - decrease estrogen

type 2: loss of cortical and trabecular bone

A

osteoporosis

38
Q

treatments for osteoporosis

A

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

39
Q

tx for pagets

A

bisphosphonates: alendronate, risedronate, zoledronate

calcitonin

40
Q

adults - osteomalacia

children - ricketts

A

vit D def

41
Q

tx for hypoparathyroidism

A

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

42
Q

kidney excretes less phosphate

high blood phosphate predicates Ca - forms Ca phosphate - blood Ca decreases - stimulates PTH

A

secondary hyperparathyroidism in renal failure

PTH >88 bone resorption is increased

43
Q

tx for hyperparathyroidism

A

1) DOC - cinacalcet

2) aluminum hydroxide, calcitriol

Pharm Block 4 (18 decks)

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