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D&T test 6 - endocrine, dermatology, MSK > Drugs Affecting Bone Mineralization (online) > Flashcards

Drugs Affecting Bone Mineralization (online) Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the key molecule that causes formation, activation and maintenance of osteoclasts and is highly regulated by multiple systems in the body

A

NF-kB ligand RANKL is

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2
Q

what is the purpose of RANK ligand would inhibition of RANK ligand would do to overall bone balance?

A

since RANK ligand stimulates bone resorption, inhibition of RANK ligand would favor overall bone building as osteoclast activity would be less than osteoblast activity.

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3
Q

What are the three MAJOR regulators of calcium homeostasis?

A

PTH, vitamin D and FGF-23.

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4
Q

What effects does PTH have on the kidneys?

A

increase calcium reabsorption and decreases phosphorous reabsorption

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5
Q

What effect does PTH have in the gut?

A

increases BOTH calcium and phosphorous to reabsorption.

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6
Q

Net effect of PTH on serum calcium and Phosphorus levels

A

increase Calcium, decrease phosphorus

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7
Q

what is Teriparatide (Forteo)?

A

a subunit of amino acids 1-34 of human PTH

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8
Q

What is the MOA of Teriparatide?

A

stimulator of bone formation

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9
Q

What does intermittent PTH treatment do to bones?

A

stimulates osteoblastic bone formation with

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10
Q

Side effects of teriparatide include (6)

A

nausea, dizziness, headache, joint pain, mild hypercalcaemia, and orthostatic hypotension.

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11
Q

Teriparatide currently a drug of choice for treating? Why? .

A

osteoporosis and this is because it is currently the only drug with a primary mechanism of action of increasing bone formation.

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12
Q

Teriparatide is also used in the prevention and treatment of ?

A

pathological fractures

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13
Q

Where is Vitamin D first hydroxylated? to form? (aka)

A

in the liver to form 25-hydroxyvitamin D which is also called calcifediol calcidiol

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14
Q

After the liver, what organ converts vitamin D metabolites to what? (aka)

A

in kidney, 25-hydroxyvitamin D is further converted to 1,25-hydroxyvitamin D (aka calcitrol) = the activated form of vitamin D

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15
Q

PTH has what effect on Vit D mtb

A

PTH stimulates the production of 1,25-hydroxyvitamin D = calcitrol

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16
Q

what enzyme in the kidney converts 25-hydroxyvitamin D into 1,25-hydroxyvitamin D?

A

1-a hydroxylase

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17
Q

Three activities of vitamin D and their locations ***

A
  1. bone mineralization (via increased Ca and P)
  2. facilitates calcium absorption in the small intestine.
  3. helps to decrease calcium excretion in the kidneys.
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18
Q

viramin D is used to treat what 4 diseases

A

rickets and osteomalacia, hypocalcemia. and hypoparathyroidism

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19
Q

How does Vitamin D increase serum Ca levels? what is the implication for it’s administration?

A

stimulates intestinal calcium absorption–> so it is often given with calcium supplements

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20
Q

analogues of Vitamin D that are nonhypercalcemic are used in what case?

A

used in secondary hyperparathyroidism

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21
Q

What is the MOA of the (2) vitamin D analogues and what are they called?

A

Both paricalcitol and doxercalciferol may lower plasma PTH levels without significantly raising plasma calcium levels

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22
Q

What is the side effect condition of vitamin D toxicity and it’s sx? (7)

A

hypercalcemia

constipation, depression, weakness, fatigue, kidney stones, or even renal failure

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23
Q

What is the main role of FGF-23? (acting where?)

A

The main role of FGF-23 is to inhibit 1,25 hydroxy vitamin D formation in the kidney.

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24
Q

What is another function of FGF-23

A

also inhibits phosphate reabsorption in the kidney.

25
Q

What is a common hereditary form of FGF-23/phosphatonin excess in humans?

A

X-linked hypophosphatemic rickets (XLH)

26
Q

What is X-linked hypophosphatemic rickets (XLH) caused by?

A

caused by mutations in the endopeptidase PHEX.

27
Q

What metabolic influence increases serum calcium and phosphate?

Vit D
PTH
Calcitonin
Cortisol

A

Vitamin D

28
Q

how does intermittent vs continuous PTH affect bone modeling?

A

Intermittent - PTH stimulates bone formation

Continuous - PTH stimulates bone resorption

29
Q

What is the primary mechanism of action of Teriparatide?

A

stimulates osteblastic bone formation

30
Q

Calcitonin effects on kidney (1) and bone (2)

A

kidney- prevents reabsorption of calcium
Bone-
1. stimulates osteoblasts
2. inhibits osteoclast

31
Q

Net effect of calcitonin

A

decrease serum calcium.

32
Q

What are the two forms of clacitonin and which is stronger?

A

salmon calcitonin (salcatonin)
human recombinant calcitonin.
Salmon calcitonin is 50 to 100 times more potent than human calcitonin

33
Q

what does “calcitonin escape” refer to, and what is the implication********

A

It limits the use of calcitonin to lower plasma calcium and phosphorous concentrations in patients with hypercalcemia due to decreased bone resorption. It refers to downregulation of receptors

34
Q

Calcitonin is also effective in what 2 disorders of increased skeletal remodeling

A

Paget’s disease and osteoporosis.

35
Q

Salmon calcitonin available in what form to treat what? ************

A

as nasal spray is indicated for postmenopausal osteoporosis.

36
Q

the nasal form of calcitonin is ineffective for what? why?

A

ineffective for the indication of hypercalcemia due to its limited bioavailability.

37
Q

What is the most common ADE to calcitonin?

A

is local inflammation at injection site

38
Q

What is GH effect on minerals and where? (2 locations)

A

GH increases intestinal calcium absorption and renal phosphate resorption.

39
Q

Patients who are GH deficient are prone to what as kids and what as adults?

A

decreased bone mineral density in childhood and osteoporosis as adults

40
Q

What is thyroid hormone function in bone?

A

It has direct effects on osteoblasts to stimulate bone formation.

41
Q

Hypothyroidism, or an underactive thyroid, leads to ?

A

decreased bone growth

42
Q

hyperthyroidism can lead to? (4)

A

increased bone loss, suppression of PTH, decreased vitamin D metabolism, and decreased calcium absorption leading to osteoporosis

43
Q

What is the treatment goal of hyperthyroidism?

A

to normalize thyroid hormone levels to prevent decreased bone mineral density

44
Q

What effect do excess glucocorticoid levels have? (3)

A

decrease renal calcium reabsorption
decrease intestinal calcium absorption
stimulate PTH secretion.

45
Q

glucocorticoid excess effect on GH

A

lowers GH

46
Q

net result of excessive glucocorticoids?

A

bone loss and osteoporosis.

47
Q

In what 5 ways does estrogen reduce bone resorption?

A
  1. inhibits production of bone cell cytokines
  2. inhibits secretion of osteoclast-stimulating factors by osteoblasts
  3. inhibits PTH
  4. increases calcitonin levels
  5. 1,25(OH)2D which is calcitriol, increases in the blood
48
Q

What is net effect of estrogen on bone? why?

A

The net effect of this action is bone formation is favored since osteoclast activity is inhibited by calcitonin

49
Q

Why do postmenopausal women suffer from osteoporosis?

A

they have less estrogen

50
Q

What is The principal therapeutic application for estrogen?

A

is in the treatment and/or prevention of postmenopausal osteoporosis.

51
Q

what type of drug is Raloxifene?

A

SERM

52
Q

What effect does Raloxifene have? (4)

A

stimulates bone estrogen receptors
inhibits breast and uterine estrogen receptors.
Raloxifene also increases bone mineral density by inhibiting bone resorption.

53
Q

The primary indication for raloxifene?

A

is in the treatment of postmenopausal osteoporosis

54
Q

most important ADEs of raloxifene (3)*********

A

raloxifene increases the risk of stroke, pulmonary emboli, and deep vein thrombosis

55
Q

What effect does thyroxine have on bone?***********

A

stimulates osteoclast function

56
Q

which is only homo that inhibits osteoblasts********

A

Glucocorticoids

57
Q

which 2 homos inhibit osteoclast activity***********

A

estrogen

calcitonin

58
Q

How does raloxifiene cause hot flashes******

A

antagonistic action on some tissues sometimes intensifies hot flashes

59
Q

What do homos Est, Androgens, and GH have in common with regard to bone mineralization?*****

A

They all stimulate osteoblast activity

D&T test 6 - endocrine, dermatology, MSK (22 decks)

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