Exam 2- Drugs Affecting Calcium Homeostasis Flashcards
1
Q
Primary hyperparathyroidism (PHPT)
A
- Autonomous overproduction of parathryoid hormone
- Most patients have hypercalcemia
2
Q
Treatment of primary hyperparathyroidism
A
- Estrogen-progestin combination
- Bisphosphonates
- Calcimimetics
- Lifestyle modifications
3
Q
Estrogen replacement
A
- Stabilizes bone mineral density in post-menopausal women
- Decreases osteoclastic activity
- Increased risk of breast cancer, stroke, and heart attack
4
Q
Bisphosphonates
A
- End in “dronate”
- Etidronate, pamidronate, alendronate, risedronate, tiludronate, ibandronate, and zoledronate
- Uses: osteoporosis, hypercalcemia, and hyperparathyroidism
- Inhibits bone reabsorption by suppressing osteoclast activity
5
Q
Calcimimetics
A
- Cinacalcet
- Uses: hypercalcemia and hyperparathyroidism
- Allosterically increases the sensitivity of the calcium sensing receptor (CaSR) in the parathyroid gland to calcium
- AE: N/V
6
Q
Secondary hyperparathyroidism
A
- Usually caused by chronic renal failure
- PTH and decreased GFR increase proximal tubular reabsorption of phosphate
- Formation of insoluble calcium phosphate
- Reduces circulating free calcium, rather as insoluble calcium phosphate
7
Q
Treatment of secondary hyperparathyroidism
A
- Dietary phosphate restriction
- Calcimimetics
- Phosphate binders
- Vitamin D analogues
8
Q
Calcium containing phosphate binders
A
- Calcium carbonate and calcium acetate
- Bind to dietary phosphate, form insoluble complex, carry through bowel unabsorbed
- AE: Hypercalcemia (calcium load plus unbinding of circulating Ca-Phosphate complexes), constipation, gas, bloating, and pruritis
9
Q
Non-calcium containing phosphate binders
A
- Sevelamer carbonate, sevelamer hydrochloride, and lanthanum carbonate
- Bind phosphate and carry through bowel
- AE: hypertension, hypotension, N/V/D, and abdominal pain
10
Q
Inactive vitamin D
A
- Cholecalciferol (D3) and ergocalciferol (D2)
- Ergocalciferol is less potent
11
Q
Active vitamin D
A
- Calcitriol (D3), Doxercalciferol (D2), and Paricalcitol (D3)
- Calcitriol is most potent
- Stimulate intestinal calcium and phosphate transport and bone reabsorption
12
Q
Hypoparathyroidism
A
- Blood calcium levels fall and phosphorus levels rise
- Absence of PTH
- Abnormal target tissue response to PTH
13
Q
Hypoparathyroidism treatments
A
- Vitamin D (calcitriol)
- Dietary calcium supplement
- Teriparatide (off label)
14
Q
Calcium supplementation
A
- Calcium carbonate (better absorption in acidic environment)
- Calcium citrate (better for patients taking acid reducing medications)
15
Q
Teriparatide
A
- Recombinant PTH 1-34
- Stimulates bone turnover
- Use: osteoporosis
- AE: orthostatic hypotension, hypercalcemia, and hypercalciuria
