Parathyroid Disease Flashcards
what is the function of PTH in the bone?
inc. osteoclast activity
what is the function of PTH in the kidney?
holds onto Ca
wastes phosphorus and bicarb
stimulated synthesis of vitamin D (increasing absorption of Ca in the gut)
what is the pathway of vitamin D/
- dietary D2, D3 or D3 from sunlight
- liver turns D3 into 25 OH vitamin D
- kidney covnerts 25 OH to 1, 25 OH vitamin D (active form)
which vitamin D level do we test for?
25 hydroxyvitamin D
what is the daily recommended dose of Ca (including dietary)?
1000-1200mg
what is the daily recommended dose of vitamin d?
2000IU
what are common side effects of bisphosphonates?
GI upset esophagitis/cancer gastric ulcer atypical chalk-stick femoral fractures BRONJ (necrosis of the jaw) hypercalcemia
how do bisphosphonates need to be taken?
first thing in the morning with a full glass of water and don’t eat for an hour
what are contraindications of bisphosphonates?
esophageal dz
inability to sit to stand upright
hypocalcemia
what are bisphosphonate agents?
risedronate (actonel) qweek or qmonth
alendronate (fosamax) qday or qweek
ibandronate (boniva) qmonth or q3months (not as much fx reduction data)
what is zolendronic acid (reclast) used for?
osteoporosis
q12 months
$$$$
what are contraindications of reclast?
CrCl ,35
BRONJ
over what time frame would forteo be given?
2 yr course
what are contraindications of forteo?
paget’s dz
bone mets
hypercalcemia
what type of pt should receive forteo?
young pt
hypogonadal osteoporosis in male
what type of fractures do SERMS reduce more than others?
vert (40%) over non vert
which osteoporosis drug reduces risk of breast cancer?
evista (raloxifene)
what risk does evista increase?
DVT and hot flashes
what are the major side effects of prolia?
BRONJ
hypocalcemia
serious infections
dermatologic rxns
when is ERT/HRT therapy recommended?
prevention of postmenopausal osteoporosis (use conservatively and get a good breast ca hx)
how does estrogen impact bone?
inhibits osteoclasts
when would you give a pt calcitriol?
vitamin D deficiency with kidney or renal dz
what is the most common cause of hypoparathyroidism?
post thyroid or parathyroid surgery
what does Mg do to PTH levels?
lowers them by preventing PTH secretion
what is pseudohypoparathyroidism?
disorders caused by renal resistance to PTh
