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endoII exam2 > Kinder, bone mineral homeostasis part I > Flashcards

Kinder, bone mineral homeostasis part I Flashcards

1
Q

what minerals are used for bone homeostasis

A

Ca

phosphate

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2
Q

what hormones are used for bone homeostasis

A

teriparatide (forteo)

calcintonin (fortical)

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3
Q

what are the drugs we have that are vit D, metabolites and analogs

A

cholecalciferol (Vit D3)
ergocalciferol (Vit D2)
calcitriol

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4
Q

drug that is selective estrogen R modulator

A

raloxifene (Evista)

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5
Q

what bisphosphonate do we use

A

alendronate (fosamax)

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6
Q

where is most cortical bone

A

appendicular or peripheral bone

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7
Q

where is trabecular bone

A

acial or central (spine and pelvis)

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8
Q

what regulate osteoclast production

A

osteoblast derived cyrokines

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9
Q

What is RANK

A

R for NK-kbeta that is an osteoclast protein required for osteoclastic bone resorption

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10
Q

osteopblasts produce what to keep osteoclast under regulation

A

osteoprotegerin which acts as a decoy ligand for RANKL

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11
Q

when is OPG suppressed

A

increased bone resorption

e.g. estrogen deprivation

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12
Q

how long does remodeling of one take

A

6 mo

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13
Q

where is Ca absorbed

A

duodenum and upper jejunum

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14
Q

what is absorbed more, Ca or PO4

A

PO4

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15
Q

where is filtered Ca resorbed

A

kidney

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16
Q

extracell Ca and PO4 levels

A

Ca 8.5-10.4

PO4 2.5-4.5

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17
Q

how does PTH change Ca and PO4 levels

A

increased serum Ca and decreased serum PO4

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18
Q

how does PTH increase osteoclasts

A

induces osteoblasts to secrete RANKL

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19
Q

PTH inhibits production of what from osteocytes

A

sclerostin which blocks osteoblast proliferation

20
Q

PTH affect on kidney

A

PTH increases tubular reabsorption of Ca and inhibits reabsorption of PO4

21
Q

PTH increases excretion of what

A

amino acids, bicarb, Na, Cl, and sulfate

22
Q

Ca changes PTH how

A

decrease PTH production

23
Q

what is teriparatide

A

synthetic recombinant human PTH

24
Q

MOA teriparatide

A

continuous administration of PTH caues bone demineralization and osteopenia
intermittent PTH promotes bone growth

25
therapeutic use teriparatide
women with Hx osteoporosis who have multiple risk factors for fracture, or who have failed other therapy men with primary hypogonadal osteoporosis
26
adverse effects teriparatide
orthostatic HTN, hyper Ca, dizziness, nausea, hyperuricemia, angina
27
CI teriparatide
those at increased risk osteosarcoma, like Pagets or elevated alkaline phosphatase levels, open epiphyses or prior radiation therapy of skeleton
28
How is Vit D3 formed to active 1,25 dihydroxy vit D3
ultraviolet light on skin | then hydrozylation in liver and then in kidney
29
how does calicitriol increase bone turnover
promotes recruitment of soteoclast precursor cells to resorption sites promotes development of mature osteoclasts induce synthesis of several proteins that regulate bone mineralization process such as RANK ligand and osteocalcin
30
how do Vit D analogs work
increase intestinal absorption of Ca and PO4 as well as bone turnover
31
therapeutic use of vit D analogs
prophylaxis and cure of nutrional rickets Tx metabolic ricketts and osteomalacia Tx hypoPTH prevention and Tx osteoporosis
32
what do ergocalcigerol or cholecalciferol require
metaboilc conversion in liver and kidney
33
what to give patient with liver disease and rickets or osteomalacia
25, hydroxyvit D because does not require hepatic hydroxylation
34
why is calcitriol used in patients with kidney disease
most rapid onset
35
what to watch when patient is on calcitriol
hypercalcemia
36
adverse effects to Vit D analogs
hyperCa, sometimes hyperPO4, nausea, vomiting, constipation | arrhythmias and pancreatitis
37
how does FGF-23 affect Ca and PO4 regulation
inhibits 1,25 OHvit D production and PO4 reabsorption in kidney
38
how does PTH change intestinal Ca and PO4
increased Ca and PO4 absorption | increased 1,25 OH production
39
how does PTH affect kidney excretion of minerals
dec Ca excretion | increased PO4
40
Vit D affects on intestine
increased Ca and PO4 absorption
41
Vit D affects on kidney
Ca and PO4 excretion
42
FGF23 affects on intestine
dec Ca and PO4 absorption
43
FGF23 affects on kidney
increased PO4 excretion
44
PTH affects on bone
Ca and PO4 resorption increased by high doses, low doses may increase bone formation
45
Vit D affects on bone
increased Ca and PO4 resorption by 1,25 OH Vit D,
46
FGF23 affects on bone
dec mineralization from hypoPO4
47
serum levels from: - PTH - Vit D - FGF23
PTH: increased serum Ca decreased serum PO4 VitD: increased serum Ca and PO4 FGF23: decreased serum PO4

endoII exam2 (18 decks)

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