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MQW U5 > Pharm - Parathyroid/Calcium > Flashcards

Pharm - Parathyroid/Calcium Flashcards

1
Q

What are the 2 types of bone and where are they located?

A

Cortical = 80% of skeleton, shafts of long bone

Trabecular = vertebral bodies, ribs, pelvis, ends of long bones

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2
Q

In bone, what is the major noncellular component that is:

  • -Organic?
  • -Inorganic?
A 
Organic = Type 1 collagen
Inorganic = Hydroxyapatite
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3
Q

Low serum ionized calcium causes [stimulates/suppresses] PTH secretion

A

Stimulates

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4
Q

Where do the 2 modifications of vitamin D occur?

A

1st hydroxylation = liver

2nd hydroxylation = kidney –> 1,25 (OH)2 Vitamin D

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5
Q

What is the normal serum concentration of Calcium?

A

8.6-10.2 mg/dL

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6
Q

What are the 2 most common causes of Hypercalcemia?

A

Hyperparathyroidism

Malignancy

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7
Q

Pertinent lab abnormalities in Primary Hyperparathyroidism

A

High Ca
High or normal PTH
Low PO4
High Urine Ca

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8
Q

2 Most common causes of hyperparathyroidism?

A

Parathyroid Adenoma – benign, solitary, 80% of cases

Hyperplasia – of all 4 glands

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9
Q

Mnemonic for primary hyperparathyroidism symptoms?

A

Stones = hypercalciuria–> renal stones
Bones = Osteitis fribrosa cystica
Groans = weakness and constipation
Psych overtones = depression

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10
Q

Calcimimetics:

  • -Mechanism of action?
  • -When are they used?
A
  • -Alters Functino of calcium sensing receptor
  • -Reduce PTH and serum Ca
  • -Used in Primary hyperparathyroidism
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11
Q

What does excessive OTC Calcium use cause?

A

Milk Alkali Syndrome

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12
Q 
Autosomal Dominant trait
Normal to slightly high PTH
Low urine calcium
Mechanism: defective Ca sensing receptor --> need more Ca to suppress PTH --> excessive renal Ca reuptake
What disease?
A

Familial Hypocalciuric hypercalcemia = mild hypercalcemia, hypocalciuria, normal to high PTH

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13
Q

What diuretic class can cause

  • -hypercalcemia?
  • -hypocalcemia?
A

Hypercalcemia = Thiazides – increase Ca reabsorption in distal tubule

Hypocalcemia = Loop – decrease positive lumen voltate –> less Ca and Mg reabsorption at TAL

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14
Q

Granulomatous Diseases can cause [Hyper/Hypo] calcemia

A

HypERcalcemia – increaseD 1,25(OH)2D

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15
Q

Important points about calcitonin use in hypercalcemia:

A
  • -Increases urinary Ca secretion, inhibit bone resorption
  • -Rapid effect = good for acute setting
  • -Tachyphylaxis in 2-3 days = tolerance
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16
Q

Pertinent lab abnormalities in secondary hyperparathyroidism

A

Low Ca = decreased absorption (main cause)
High PO4 = Renal failure –> can’t excrete PO4
or Low PO4 = in other causes
Low 1,25(OH)2D = lack of 1-a-hydoxylase activity –> decreased Ca absorption

17
Q

Pertinent lab abnormalities in tertiary hyperparathyroidism

A

Parathyroid gland becoming autonomous(Refractory) after prolonged 2ndary hyperparthyroidism (renal disease):
High Ca
Very High PTH

18
Q

What is the most common cause of hypocalcemia?

A

Chronic Renal Failure
High PO4
High PTH
High Cr

19
Q

What are the D3 and D2 forms of vitamin D called?

A 
D2 = Ergocalciferol 
D3 = Cholecalciferol --more efficacious
20
Q

Bone mineral density in normal, osteopenia, and osteoporosis

A 
Normal = greater than -1
Osteopenia = -1 to -2.5
Osteoporosis = less than -2.5
21
Q

What drug class is approved for osteoporosis only in postmenopausal women?

A

Selective Estrogen Receptor Modulators – Raloxifene, Tamoxifen, Basedoxifene, Lasofoxifene

  • -protective against breast cancer
  • -risk of DVT
22
Q

What hormone inhibits osteoclast resorption of bone and where is it produced?

A

Calcitonin – C-cells of the thyroid

23
Q

What osteoporosis drug is a PTH analog?

Side effects?

A

Teriparatide – anabolic agent
Side effects: dizziness, palpitations, transient hypercalcemia

*Black box warning = osteosarcoma in rats

24
Q

Denosumab mechanism of action:

A

RANK Ligand inhibitor –> antiresoprtive for osteoporosis

25
Q

Aledronate, Ibandronate, Risedronate, and Zoledronate are of this drug class

A

Bisphosphonates – pyrophosphate analogs, bind hydroxyapatite, inhibit osteoclast activity

26
Q

[FA]

How does pH affect Calcium?

A

high pH –> high affinity of albumin ((-) charge) to Ca –> hypocalcemia –> cramps, pain, paresthesias, carpopedal spasm

27
Q

[FA]

When is PTH-related peptide abnormal?

A

Increased in malignancies (eg. SCC of lung, RCC)

28
Q

[FA]

How does low and very low Mg levels affect PTH?

A

Low serum Mg –> increased PTH secretion (b/c feedback inhibition)

Very low serum Mg –> decreased PTH secretion (no feedback = ion independent suppression)

MQW U5 (8 decks)

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