PHARMA calcium and bone homeostasis Flashcards
0
Q
amt of calcium in averagediet
A
600-1000 mg
1
Q
functions of bone
A
mineral reservoir
structural support
hematopoiesis
2
Q
principal regulatoes
A
PTH
FGF 23
Steroid vitamin d
3
Q
secondary regulators
A
calcitonin prolactin gh insulin
thyroid hormone, glucocorticoids, sex strroids
4
Q
function of fgf 23
A
stimulates RENAL PO4 EXCRETION
5
Q
what increases serum calcium and decrease serum phosphate
acts on bone and kidney
A
PTH
6
Q
action of pth on bone
A
inc osteoclast activity by inducing RANK ligand (for bone REMODELING)
7
Q
effect of low and intermittent PTH on bine
A
increase bone FORMATION
8
Q
recombinant PTH 1-34
A
TERIPARATIDE
9
Q
effect of pth on kidney
A
reabsorb calcium and magnesium
stimulate vit d production
10
Q
forms of vit d
A
vit d3 cholecalciferol NATURAL
vit d2 ergocalciferol PLANT DERIVED
11
Q
forms of vit d in liverr and kidney
A
liver 25OHD
kidney 1,25OH2D
kidney 24,24 OH 2D
12
Q
calcifediol
calcitriol
secalcifediol
A
25 OH d3
1,25 oh 2D3
24,25 oh 2D3
13
Q
give 3 vitamin d analogs
A
calcipotriene
doxercalciferol
paricalcitol
14
Q
tx for psoriasis
A
CALCIPOTRIENE vit d analog
15
Q
tx for 2ndary hyperparathyroidism
A
DOXERCALCIFEROL and PARACALCITOL vit d analogs
16
Q
what inhibits and stimulates vit d metabolism
A
fgf23 inhibits
pth stimulates
17
Q
which vit d is most potent and has low affinity
A
CALCITRIOL
18
Q
calcifediol vs calcitriol
A
calcifediol more potent in stimulating renal reabsorption of ca and po4
19
Q
pth regulated by feedback loops through?
A
calcium sensing receptors
20
Q
directly inhibits PTH secretion
A
1,25(OH)2D
21
Q
stimulates production of FGF23
A
1,25(OH)2D
22
Q
inhibits 1,25(OH)2D production
A
FGF23
23
Q
inhibit PTH secretion
A
Calcitriol analogs
24
mgmt of secondary hyperparathyroidism of CKD
Calcitriol analogs
25
Parafollicular cells of mammalian thyroid
Calcitonin
26
calcitonin half life
10mins
27
longer halflife, reduced metabolic clearance
salmon calcitonin
28
lowers Ca and PO4 reabsorption, dec GASTRIN secretion
calcitonin
29
potent stimulus for calcitonin secretion
Pentagastrin
30
block bone resorption and lower serum calcium
calcitonin
31
physiologic use of calcitonin
Paget's disease, Hypercalcemia, Osteoporosis
32
Glucocorticoid use
stimulates renal calcium excretion
antagonizes vit D transport
blocks bone formation
33
hypercalcemia associated with inc production of 1,25(OH)2D
Granulomatous diseases - Sarcoidosis
34
Estrogen
prevent accelerated bone loss in post menopausal women
reduce bone resorption
inc 1,25(OH)2D
35
Selective estrogen receptor modulators
breast, uterus, cardiovascular system
36
newer therapies for osteoporosis
| no risk of breast and endometrial ca
raloxifene
37
Bisphosphonates
osteoclast apoptosis
| inhibition of cholesterol pathway
38
amino bisphosphonates
Alendronate and risedronate
39
block farnesyl pyrophosphate synthase
amino bisphosphonates
40
First generation bisphosphonates
MEDronate
ETIdronate
CLODronate
41
second generation bisphosphonates
ALEdronate
| PAMidronate
42
3rd generation bisphosphonates
RISEdronate
ZolEDdronate
10,000x more potent than 1st gen
43
All current available bisphosphonate hav this complication
Gastric irritation (possible exception of ETIdronate)
44
main contraindication of bisphosphonates
dec renal dunction
esophageal motility disorders
peptic ulcer disease
45
physiologic use of bisphosphonates
hypercalcemia
paget's disease
osteoporosis
bone metastasis
46
mineralization defect SE
ETIdronate
47
gastric and esophageal irritation SE
PAMidronate
| high doses of ALEdronate
48
high doses of IV ZolEDronate SE
ONJ osteonecrosis of the jaw
49
Recombinant form of PTH stim bone formation
TERIparatide -
50
activates CaSR and blocks PTH secretion
Cinacalcet
51
Cinacalcet Tx
Secondary hyperPTH of CKD
| Parathyroid carcinoma
52
cytotoxic antibody
| binds to DNA and interrupts RNA synthesis
PLICAmycin
53
Thiazide use
reduces renal calcium excretion
block sodium reabsorption
inc Ca-Na exchange
54
reduces stone formation
decrease urine oxalate
increase urine Mg and Zinc
Thiazides
55
fluoride without adequate calcium produces
Osteomalacia
56
Blocks osteoclast differentiation while promoting their apoptosis
Strontium Ranelate
57
bone formation markers
inc bone density
dec fractures
Strontium Ranelate
58
for mgmt of hypercalcemia of malignancy
inhibits bone formation
potential nephrotoxic
Gallium Nitrate
59
major causes of hypercalcemia
thiazide therapy
hyperPTH
Cancer
60
less common cause of hypercalcemia
hypervitaminosis D
61
for syptomatic hypercalcemia
Saline Diuresis with furosemide
62
Tx for hypercalcemia of malignancy
| has self-limited flu-like symptoms
PAMidronate
| ZolEDronate
63
parentral and nasal administration of Salmon Calcitonin
| ANCILLARY Tx
Calcimar
64
most dangerous SE of sudden thrombocytopenia followed by hemorrhage
PLICAmycin
65
"when all else fail"
PLICAmycin
66
fastest and surest way for hypercalcemia
IV phosphate
67
for chronic hypercalcemia of sarcoidosis, vit D intoxication etc
Glucocorticoids
68
Major causes of hypocalcemia in adult
hypoparathyroidism
vit D deficiency
CKD
Malabsoprtion
69
mainstay Tx for hypocalcemia
calcium and vitamin D
70
Calcium forms
Calcium gluceptate
Calcium GLUCOnate (preferred)
Calcium chloride
71
Oral preparation of Calcium
```
Ca carbonate (40%)
Ca phosphate (25%)
Ca citrate (21%)
Ca lactate (13%)
```
72
Ca carbonate should be given with meals
| or Ca citrate alternative
Achlorydic patients
73
Tx for severe symtomatic hypocalcemia
5-20ml 10% calcium gluconate (slow infusion)
74
Vit D metabolite of choice
| raises serum PO4
Calcitriol
75
Hyperphosphatemia symptoms
common complication of renal failure
vit D intoxication
hypoPTH
rare Tumoral calcinosis
76
phosphate-binding gel
SEVELAMER
77
hypophosphatemia related diseases
Vit D Deficiency
hypophosphatemic rickets
FANCONIs SYNDROME (renal wasting)
78
Reduced ATP
Decreased 2,3DPG
rhabdomyolysis
acute hypophosphatemia effects
79
For hypercalcemia
```
Saline + furosemide
bisphosphonate
calcitonin
plicamycin
phosphate IV - fastest
glucocorticoid - cancer
```
80
for hypocalcemia
Calcium gloconate IV
Calcium CO3PO
Calcitriol - RAPID
81
for hyperphosphatemia
```
PO4 restriction
SEVELAMER
Calcium
Aluminum antacid*
Dialysis
```
82
for hypophosphatemia
oral phosphate suppplment
83
Best Tx for HyperPTH
Surgery
84
Causes of HypoPTH
absence of PTH
| abnormal target tissue response (pseudohoPTH)
85
nor mal or high PTH acting on the bone not kidneys
pseudohypoPTH
86
pseudohypoPTH causes
osteitis fibrosa
87
optimum level of 25(OH)D
30ng/mL
88
daily intake of Vit D
800-1200 units of vit D
89
effect of CKD in bone
Osteomalacia and Osteitis fibrosa
90
Tx for adynamic bone disease in CKD
DEFEROXAMINE
91
Analongs of calcitriol
DOXercalciferol
| PARIcalcitriol
92
advantage of calcitriol analogs
less likely to induce HYPERGLYCEMIA
93
characterized by malabsorption of ca and vit d
| and combined osteoporosis and osteomalacia
intestinal osteodystrophy
94
intestinal vs renal osteodystrophy
no osteitis fibrosa in intestinal dystrophy
95
tx for mild and severe int. osteodystrophy
mild vit d
| severe calcitriol
96
causes of osteoporosis in men
```
chronic glucocorticoids
thyrotoxicosis and hyperparathyroidism
malabsorption
alcohol abuse
cigarette smoking
isionpathic
```
97
osteoporosis tx in postmenopausal women, may be accompanied by lower calcitriol?
estrogen cycled with progestin
98
serm for osteoporosis, preventing risk of breast and uterine cancer
RALOXIFENE
99
Raloxifene adverse effect
inc risk of thrombophlebitis
100
raloxifene clinical actions
protects against spine BUT NOT hip fractures
| cant prevent HOT FLUSHES
101
recombinant pth
| approved for use for ONLY 2 YEARS in sequential therapy
TERIPARATIDE
102
bisphosphonate for osteoporosis action
reduce risk of HIP SPINE AND OTHER fractures
| for MEN AND WOMEN
103
toxicities of adjuvant endocrine tx
loss of BMD
bone fracture
osteoporosis
musculoskeletal / arthralgia
104
used for bmd assessment, from lumbar spine of one or both total hip sites
DXA scan
105
tx for high risk group of BMD (baseline score of <-2)
BISPHOSPHONATE therapy
106
calcitonin action on osteoporisis
affects only the SPINE
107
antibody to RANKL, for osteoporosis
DENOSUMAB
108
denosumab adverse effects
possible inc risk for infection
risk of OSTEONECROSIS OF JAW
subtrochanteric fractures
109
slow release, low dose tx for osteoporosisl
fluoride
110
loss of vit d binding protein, some develop bone disease
nephrotic syndrome
111
vit d dependent rickets type i and ii
type i - pseudovit d deficiency rickets, dec PRODUCTION, give vit d and calcitriol
type ii - hereditary vit d RESISTANT rickets, problems with receptor, give LARGE DOSES of calcitriol and calcium and po4 infusions
112
normal serum calcium and pth BUT
| hypercalciuria and nephrolithiaisis
idiopathic hypercalciuria
113
idiopathoc hypercalciuria tx
hydrochlorothiazide or ALLOPURINOL
114
short bowel syndrome with fat malabsorption, with ca and oxalate renal stones
enteric oxaluria
115
enteric oxaluria etiology
calcium bound to fat fails to bind to oxalate
116
poorly organized bone, elevated ALK PHOSPHATASE and urinary HYDROXYPROLINE
pagets disease of the bone
117
pagets dse of the bone tx
first line CALCITONIN and BISPHOSPHONATES, requiring weeks to months
treatment failures PLICAMYCIN
118
etidronate adverse effects
osteomalacia
| inc risk of fractures
119
alendronate adverse effects
gastric irritation, but reversible
