Mobility wk 11

Question 1

Parathyroid hormone and Ca++ feedback loop

Answer 1

Low serum Ca++

Parathyroid gland releases PTH&raquo_space;

• Ca++ release from bone, incr
• Ca++ reabsorption from kidneys
• incr Ca++ absorption in sm intestine (with help of Vit D & calcitriol)

Incr serum Ca++

PTH release suppressed

Question 2

Calcitonin and Ca++ feedback loop

Answer 2

High serum Ca++

Thyroid gland releases calcitonin&raquo_space;

• addition of Ca++ to bone
• decr absorption of Ca++ in sm intestine

Low serum Ca++

Calcitonin release suppressed

Question 3

Lack of dietary Ca++

Answer 3

leads to bone breakdown to incr serum Ca++

Needed for muscle fx

Question 4

RANKL

Answer 4

Hormone that increases bone loss

Osteoporosis drugs target this to decr bone loss

Should be in balance w/ OPG

Question 5

OPG

Answer 5

Hormone that decrease bone loss

Should be in balance w/ RANKL

Question 6

Osteoporosis risk and gender

Answer 6

Women @ incr risk (esp. menopausal)&raquo_space; decr estrogen = incr renal excretion of Ca++

Women more likely to frac hip that get breast/ovarian cx

Men start out w/ higher bone density d/t androgens and testoterone

Question 7

General osteoporosis risk factors

Answer 7

Female, low estrogen, Depo-Provera
Small boned, thin
Hyperthyroid (Ca++ control in thyroids)
Smoking, etoh
Low impact exercise lifestyle
On chronic corticosteroids (pts w/ RA, lung dx on prednisone & at risk)
Kidney, liver dx

Question 8

Pts at risk for osteoporosis

Answer 8

Vit C, D deficiencies 
Malabsorption (ulcerative colitis) 
Hist. of excessive caffeine, etoh, nicotine
Non-wt bearing 
Thyroid disorders
Kidney dx
Estrogen deficiency

Question 9

Posture suggesting bone dx

Answer 9

Scoliosis
Kyphosis
Lordosis

Question 10

Compression fractures

Answer 10

Pts w/ osteoporosis at risk for

Doesn’t take much force

New onset of back pain w/o traumatic even may indicate

Question 11

Vitamin D

Answer 11

D2 is from dietary sources

D3 is from sunlight

• incr absorption of Ca++ from GI tract
• decr renal excretion of Ca++
• activation is determined by Ca++ avail

Blood serum levels: 18-80 ng/mL
- low levels seen in osteoporosis, malabsorption prob, CKD, liver dx

Question 12

Proteoglycans

Answer 12

Needed for production of synovial fluid

Question 13

Why are weight bearing activities important

Answer 13

Triggers the body to deposit more Ca++ in bone

Question 14

Drugs from bone disorders

Answer 14

Ca++ supplement
Vit D
Bisphosphonates (fosamax)
Selective estrogen receptor modulators
Calcitonin
HRT
PTH analog

Question 15

alendronate (Fosamax)

Answer 15

Bisphosphonate, bone metabolism regulator

MOA: Minimize loss of bone density, decr 
   #/activity of osteoclast

Route & dose: PO, 5-10 mg 1x/d
Contra: GERD, esophageal prob
Caution: renal impairment

ADR: hypocalcemia, esophageal ulceration, N/V, atypical femoral fractures (sx: ext rotation of foot will cause pain)

Nrs: assess swallow (esoph. prob)

Edu: take w/ fluids, avoid lying down for 30 mins, report persistent joint pain

Take 30 min b4 food: Ca++ and food decr
absorption

Question 16

denosumab (Prolia, Xgeval)

Answer 16

RANKL inhibitor

Question 17

Osteoporosis

Answer 17

bone resorption outpaces bone deposition

Question 18

Baclofen (Lioresal)

Answer 18

Centrally acting Muscle relaxer

Inhibit motor neuron in brain and spinal cord, decr pain, incr ROM

NO DIRECT EFFECT ON MUSCLES

Reduces spasticity assoc w/ spinal cord injury, (not stroke)

ADRs: CNS depressant - AVOID etoh, nausea, constipation

Sudden stopping > hallucinations, sz, paranoia