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Pharm3: Mod1: Endocrine > Mod 1 lecture 2: calcium homeostasis > Flashcards

Mod 1 lecture 2: calcium homeostasis Flashcards

1
Q

what is the presentation of hypercalcemia

A

stones, moans, bones and psychiatric overtones
ECG = shortened QT, ST depression, AV block

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2
Q

what are the common causes of hypercalcemia

A

hyperparathyroidism, malignancy, granulomatous disease, thiazide, lithium, pancreatitis

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3
Q

what are the interventions for hypercalcemia

A

IV hydration, calcitonin, bisophosphonates, loop diuretics, glucocorticoids, denosumab, dialysis

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4
Q

what build bone by secreting collagen and catalyzing mineralization

A

osteoblasts

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5
Q

what dissolve bone by secreting acid and collagenases

A

osteoclasts

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6
Q

what at low intermittent levels, have an anabolic effect on osteoblasts (build bone)

A

parathyroid hormone (PTH)

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7
Q

what inhibits apoptosis in osteoblasts and induces apoptosis in osteoblasts

A

estrogen

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8
Q

what does estrogen deficiency lead to

A

excess cycles of remodeling and bone resorption resulting in osteoporosis

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9
Q

what stimulates calcium deposition in bones, decrease calcium uptake in kidneys

A

calcitionin

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10
Q

what increases intestinal and renal uptake of Calcium and phosphate and stimulates calcium release from bones - promotes bone mineralization

A

vitamin D

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11
Q

what are regulators of bone mineral and calcium homeostasis

A

osteoblasts
osteoclasts
PTH
estrogen
calcitonin
vitamin D

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12
Q

what is the MAO for bisphosphonates

A

inhibits osteoclast activity, reducing bone resorption and turnover

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13
Q

what are the indications for alendronate

A

osteoporosis, paget disease of bone, osteopenia (in non-ambulatory patients)

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14
Q

what are the indications for risedronate

A

osteoporosis, paget disease of bone

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15
Q

what are the indications for ibandronate

A

osteoporosis

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16
Q

what are the indications for zoledronic acid

A

osteoporosis, malignant hypercalcemia, bone metastasis, multiple myeloma

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17
Q

what are the bisphosphonates

A

aldendronate
risedronate
ibrandronate
zoledronic acid

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18
Q

what are the side effects of bisphosphonates

A

bone, joint and muscle pain
N, abd pain, heartburn, diarrhea, constipation
irritation to upper GI mucosa (risedronate < alendronate)
HA
atypical femur fractures, osteonecrosis of the jaw
flu-like symptoms with IV bisphosphonates
hypocalemia - Ca and Vit. D supplementation recommended

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19
Q

what are the contraindications for bisphosophonates

A

esophageal disorders (achalasia, esophageal strictures, osophageal varices, Barrett’s esophagus)
renal insufficiency (CrCl < 35)
hypocalcemia
food interferes with absorption - take with water on empty stomach and wait 30-60 minutes before eating

20
Q

what is the MOA of Calcitonin

A

antagonizes the effect of PTH, inhibits osteoclast activity and promotes renal excretion of Ca2+

21
Q

what are the indications of calcitonin

A

hypercalcemia, paget disease of bone, postmenopausal osteoporosis, pain from osteoporotic fracture

22
Q

what are the AE of calcitonin

A

rhinitis, epistaxis, back pain, N/V, bronchospasms, hypocalcemia, anaphylaxis (rare)

23
Q

what is the MOA for vitamin D

A

cholecalciferol (vit D3) is a provitamin. active metabolite 1,25-dihydroxyvitamin D stimulates calcium absorption from small intestine and promotes bone mineralization

24
Q

what are the indicatiosn for vitamin D

A

vitamin D deficiency, osteopososis, hypoparathyroidism

25
Q

what are the contraindications of vitamin D

A

hypercalcemia, primary hyperparathyroidism, sarcoidosis

26
Q

what is the MOA for Calcitrol

A

vitamin D analog - stimulates calcium and phosphorus absorption, decrease PTH synthesis, stimulates bone mineralization

27
Q

what are the indications for calcitriol

A

renal failure, hypoparathyroidism, rickets, hypophosphatemia

28
Q

what are the AE of calcitriol

A

hypercalcemia, hyperphoephatemia, N/V

29
Q

what are the contraindications of Calcitriol

A

pancreatitis, soft tissue calcification, arrhythmias

30
Q

What is the MOA for denosumab

A

recombinant antibody that inhibits RANK-ligand to bind to RANK (antiresorptive)

31
Q

what are the indications for denosumab

A

osteoporosis, cannot tolerate or unresponsive to bisphosphonates, renal impairment

32
Q

what are the SE of denosumab

A

osteonecrosis of the jaw, atypical subtrochanteric fracture, bone pain

33
Q

what are the contraindications of denosumab

A

hypocalcemia

34
Q

What is the MOA of teriparatide (forteo)

A

recombinant PTH
anabolic effect on bone metabolism by stimulating bone formation and activating bone remodeling
treatment duration < 2 years in lifetime

35
Q

what are the indications for teriparatide

A

osteoporosis (but not used often)

36
Q

what are the AE of teriparatide

A

generally well tolerated. hypercalcemia and hypercalciuria. orthostatic hypotension
US boxed warning: risk of Osteosarcoma

37
Q

what are the contraindications of teriparatide

A

hypercalcemia, severe renal impairment

38
Q

What is the MOA for Raloxifene

A

selective estrogen receptor modifier (SERM)
acts like estrogen agonist in bone thereby decreasing bone resorption and overall bone turnover
bone density is increased

39
Q

what are the indications for Raloxifene

A

osteoporosis in postmenopausal women

40
Q

what are the AE of Raloxifene

A

hot flashes, leg cramps, peripheral edema, DVT/PE

41
Q

what are the contraindications of Raloxifene

A

history of DVT/PE, pregnancy

42
Q

what are the effects of thiazides (HCTZ) on calcium levels

A

decrease urinary Ca2+ excretion
inhibits secretion of Calcium sometimes leading to elevated calcium levels in the blood

43
Q

what are the effects of loops diuretics (furosemide) on calcium levels

A

increase urinary calcium concentration
useful in treatment of hypercalcemia because it stimulates tubular calcium excretion

44
Q

what are the toxicity symtpoms of fluoride

A

GI effects such as N/V/D, severe cases renal or cardiac dysfunction

45
Q

where is the total body fluoride contained

A

in bones and teeth

Pharm3: Mod1: Endocrine (5 decks)

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