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Pharmacology > METABOLIC PROFILE DRUGS - Agents That Affect Bone Mineral Homeostasis > Flashcards

METABOLIC PROFILE DRUGS - Agents That Affect Bone Mineral Homeostasis Flashcards

1
Q

Action of the parathyroid hormone is

A
  • Increased calcium and phosphate absorption in intestine (by increased 1,25-dihydroxyvitamin D3 production)
  • Decreased calcium excretion and increased phosphate excretion in kidneys
  • In bone, calcium and phosphate resorption increased by high doses. Low doses may increase bone formation.
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2
Q

True or False. The parathyroid hormone increases serum calcium and decreases serum phosphate.

A

TRUE

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3
Q

True or False about parathyroid hormone. The parathyroid hormone (PTH) is a single-chain peptide hormone composed of 84 amino acids

A

TRUE

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4
Q

True or False about parathyroid hormone. The parathyroid hormone increases calcium and phosphate absorption in intestine (by increased 1,25-dihydroxyvitamin D3 production)

A

TRUE

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5
Q

True or False about parathyroid hormone. The parathyroid hormone increases serum calcium and decreases serum phosphate

A

TRUE

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6
Q

True or False about parathyroid hormone. The parathyroid hormone increases calcium excretion and decreases phosphate excretion in kidneys

A

FALSE

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7
Q

True or False about calcitonin. Calcitonin secreted by parafollicular cells of the mammalian thyroid is a single-chain peptide hormone with 32 amino acids

A

TRUE

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8
Q

True or False about calcitonin. Effects of calcitonin are to lower serum calcium and phosphate by acting on bones and kidneys.

A

TRUE

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9
Q

True or False about calcitonin. Calcitonin inhibits osteoclastic bone resorption.

A

TRUE

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10
Q

Mechanism of action of calcitonin is

A

Raises intracellular cAMP in osteoclasts

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11
Q

Indications for calcitonin administration are

A
  • Hypercalcemia
  • Paget’s disease
  • Osteoporosis
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12
Q

Side effect of calcitonin is

A

Tetany

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13
Q

Side effect of calcitonin is

A

Hypotension

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14
Q

Glucocorticoid hormones alter bone mineral homeostasis

A
  • By antagonizing vitamin D-stimulated intestinal calcium transport
  • By stimulating renal calcium excretion
  • By increasing parathyroid hormone stimulated bone resorption
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15
Q

True or False. Estrogens can prevent accelerated bone loss during the immediate postmenopausal period and at least transiently increase bone in the postmenopausal subject.

A

TRUE

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16
Q

Action of vitamin D3 is

A
  • Increased calcium and phosphate absorption by 1,25 dihydroxyvitamin D3
  • Calcium and phosphate excretion may be decreased by 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3
  • Increased calcium and phosphate resorption by 1,25 dihydroxyvitamin D3; bone formation may be increased by 25,24-dihydroxyvitamin D3
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17
Q

True or False. Vitamin D3 increases serum calcium and phosphate.

A

TRUE

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18
Q

Route of administration of vitamin D3 is

A

Oral

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19
Q

Side effect of vitamin D3 is

A

Nephrolithiasis

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20
Q

Indication of vitamin D3 is

A

Hypophosphatemia

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21
Q

True or False. 25-hydroxyvitamin D3 (calcifediol) is less effective than 1,25-dihydroxyvitamin D3 (calcitriol) in stimulating intestinal calcium transport, so that hypercalcemia is less of a problem with calcifediol.

A

TRUE

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22
Q

Route of administration of 25-hydroxyvitamin D3 (calcifediol) is

A

Oral

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23
Q

Indication for 25-hydroxyvitamin D3 (calcifediol) administration is

A

Failure of vitamin D formation in skin

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24
Q

Side effect of 25-hydroxyvitamin D3 (calcifediol) is

A
  • Hypercalcemia
  • Pruritus
  • GI toxicity
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25
Q

Indications for 1,25-dihydroxyvitamin D3 (calcitriol) administration are

A
  • Hypocalcemia in chronic renal failure
  • Vitamin D-dependent rickets
  • Malabsorption of vitamin D from intestine
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26
Q

Indication for 1,25-dihydroxyvitamin D3 (calcitriol) administration is

A

Hypophosphatemia

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27
Q

True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). When rapidity of action is required, 1,25-dihydroxyvitamin D3 (calcitriol), 0.25-1 μg daily, is the vitamin D metabolite of choice, since it is capable of raising serum calcium within 24-48 hours

A

TRUE

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28
Q

True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). Calcitriol also raises serum phosphate, though this action is usually not observed early in treatment

A

TRUE

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29
Q

True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). Undergoes enterohepatic circulation

A

TRUE

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30
Q

Which statements refers to 1,25-dihydroxyvitamin D3 (calcitriol)

A

The combined effect of calcitriol and all other vitamin D metabolites and analogs on both calcium and phosphate makes careful monitoring of the level of these minerals especially important to avoid ectopic calcification

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31
Q

Route of administration of 1,25-dihydroxyvitamin D3 (calcitriol) is

A

Oral

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32
Q

Commercially available analogs of 1,25-dihydroxyvitamin D3 (calcitriol) are

A
  • Doxercalciferol (Hectoral)

- Paricalcitol (Zemplar)

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33
Q

Side effect of dihydrotachysterol is

A

Hypertension

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34
Q

Route of administration of dihydrotachysterol is

A

Oral

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35
Q

Which statements refers to cholecalciferol

A

Mechanism of action: 1. Genomic effects 2. Cytoplasmic effects

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36
Q

Indication for cholecalciferol administration is

A

Malabsorption of vitamin D from intestine

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37
Q

Route of administration of cholecalciferol is

A

Oral

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38
Q

The unwanted effect of cholecalciferol is

A

CNS toxicity

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39
Q

The unwanted effect of dihydrotachysterol is

A

CNS toxicity

40
Q

Indication for dihydrotachysterol administration is

A

Hypophosphatemia

41
Q

Conditions associated with hypophosphatemia include

A
  • Primary hyperparathyroidism
  • Vitamin D deficiency
  • Idiopathic hypercalciuria
42
Q

True or False. The long-term effects of hypophosphatemia include proximal muscle weakness and abnormal bone mineralization (osteomalacia).

43
Q

Recommended phosphorus daily allowance is

A

900-1200 mg

44
Q

Interactions with other drugs of phosphorus is

A

Calcitonin: increases renal excretion

45
Q

Indication for pamidronate administration is

A

Hypercalcemia

46
Q

Route of administration of pamidronate is

A

Intravenous

47
Q

True or False about pamidronate include. Because it causes gastric irritation, pamidronate is not available as an oral preparation

48
Q

True or False about pamidronate include. Skeletal half-life is 24 h

49
Q

True or False about pamidronate include. Fever and lymphocytopenia are reversible

50
Q

True or False about pamidronate include. Can be irritable to the esophagus if not washed promptly to the stomach

51
Q

Route of administration of alendronate is

52
Q

True or False about alendronate include. Can be irritable to the esophagus if not washed promptly to the stomach

53
Q

True or False about alendronate include. 1st generation biphosphonate

54
Q

True or False about alendronate include. Reduces osteoclast activity without significantly affecting osteoblasts; useful in the treatment of Paget’s disease

55
Q

True or False about alendronate include. More potent than EHDP; has a wider therapeutic window

56
Q

Indications of alendronate are

A
  • Glucocorticoid-induced osteoporosis
  • Paget’s disease
  • Syndromes of ectopic calcification
57
Q

Indication for etidronate administration is

A

Paget’s disease

58
Q

Indications for etidronate administration are

A
  • Paget’s disease
  • Osteoporosis
  • Hypercalcemia
59
Q

True or False about etidronate. Bioavailability increases with the administered dose

60
Q

True or False about etidronate include. Skeletal half-life is hundreds of days

61
Q

True or False about etidronate include. Bioavailability increases with the administered dose

62
Q

True or False about etidronate include. 2nd generation biphosphonate (amino-biphosphonate)

63
Q

True or False about etidronate include. 1st generation biphosphonate.

64
Q

Unwanted effect of etidronate is:

A

Defective bone mineralization

65
Q

The major causes of hypocalcemia in the adult are

A
  • Hypoparathyroidism
  • Vitamin D deficiency
  • Renal failure and malabsorption
66
Q

The major causes of hypercalcemia in the adult are

A
  • Hyperparathyroidism
  • Cancer with or without bone metastases
  • Hypervitaminosis D
67
Q

True or False about calcium. Recommended Ca daily allowance for males: 1. 1-10 years: 800 mg 2. 11-18 years: 1200 mg 3. 19-50 years: 1000 mg 4. > 51 years: 1000 mg

68
Q

True or False about calcium. Ca chloride is very irritating and can cause necrosis if extravasated

69
Q

True or False about calcium. In achlorhydric patients calcium carbonate should be given with meals to increase absorption or patient switched to calcium citrate, which is somewhat better absorbed

70
Q

Indication for calcium administration is

A

Vitamin D deficiency

71
Q

Which of the calcium preparations is the most preferable for IV injection

A

Calcium gluconate (0.45 meq calcium/mL)

72
Q

Which of the oral calcium preparations is often the preparation of choice

A

Calcium carbonate (40% calcium)

73
Q

Interactions with other drugs of calcium is

A
  • Ethanol: decreases absorption
  • Loop diuretics: increase renal excretion
  • Glucocorticoids: stimulate renal excretion
74
Q

True or False about magnesium include. Magnesium is mainly an intracellular cation, and is the fourth most abundant cation in the body

75
Q

True or False about magnesium include. The recommended dietary amounts of magnesium have been set at 6 mg/kg day (350-400 mg)

76
Q

True or False about magnesium include. The most common specific causes encountered in clinical practice are: diet, alcoholism (drinking), diarrhea and malabsorption, diabetes mellitus, diuretics, and drugs such as aminoglycosides and amphotericin

77
Q

True or False about magnesium include. It is a physiological calcium agonist

78
Q

Recommended magnesium daily allowance is

A

350-400 mg

79
Q

The major causes of hypomagnesaemia are

A
  • Insufficient dietary intake, e.g. malnutrition
  • Abnormal gastrointestinal loss, e.g. severe diarrhea or chronic alcoholism
  • Abnormal renal loss, e.g. diabetes mellitus or during therapy with some kind of drugs such as amphotericin B, gentamicin, cisplatin, cardiac glycosides, distal and loop diuretics
80
Q

Which of the magnesium preparation is the most preferable for I.V. injection

A

Magnesium chloride

81
Q

Which of the oral magnesium preparations is often the preparation of choice

A

MagneB6 (Mg pidolate / Mg lactate + pyridoxine hydrochloride)

82
Q

True or False about fluoride include. Fluoride is effective for the prophylaxis of dental caries

83
Q

True or False about fluoride include. Fluoride is accumulated by bone and teeth, where it may stabilize the hydroxyapatite crystal

84
Q

True or False about fluoride include. Subjects living in areas with naturally fluoridated water (1-2 ppm) had more dental caries and fewer vertebral compression fractures than subjects living in nonfluoridated water areas

85
Q

True or False about fluoride include. Chronic exposure to very high level of fluoride dust in the inspired air results in crippling fluorosis, characterized by thickening of the cortex of long bones and bony exostoses.

86
Q

Recommended fluoride daily allowance is

87
Q

True or False about gallium nitrate. It is approved by the FDA for the management of hypercalcemia of malignancy

88
Q

True or False about gallium nitrate. This drug acts by inhibiting bone resorption

89
Q

True or False about gallium nitrate. Because of potential nephrotoxicity, patients should be well-hydrated and have good renal output before starting the infusion

90
Q

True or False about plicamycin (formerly mithramycin). Duration of action is usually several days

91
Q

True or False about plicamycin (formerly mithramycin). Mechanism of cytotoxic action appears to involve its binding to DNA, possibly through an antibiotic-Mg2+ complex.

92
Q

True or False about plicamycin (formerly mithramycin). The drug causes plasma calcium levels to decrease, apparently through an action on osteoclasts that is independent of its action on tumor cells and useful in hypercalcemia.

93
Q

Unwanted effects of plicamycin (formerly mithramycin) are

94
Q

Unwanted effect of plicamycin (formerly mithramycin) is

A

Myelosuppression

95
Q

Indication for plicamycin (formerly mithramycin) administration is

A
  • Testicular cancers refractory to standard treatment
  • Paget’s disease
  • Hypercalcemia of malignancy
96
Q

Route of administration of plicamycin is

A

Intravenous

Pharmacology (41 decks)

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