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PHARMA calcium and bone homeostasis Flashcards

0
Q

amt of calcium in averagediet

A

600-1000 mg

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1
Q

functions of bone

A

mineral reservoir
structural support
hematopoiesis

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2
Q

principal regulatoes

A

PTH
FGF 23
Steroid vitamin d

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3
Q

secondary regulators

A

calcitonin prolactin gh insulin

thyroid hormone, glucocorticoids, sex strroids

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4
Q

function of fgf 23

A

stimulates RENAL PO4 EXCRETION

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5
Q

what increases serum calcium and decrease serum phosphate

acts on bone and kidney

A

PTH

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6
Q

action of pth on bone

A

inc osteoclast activity by inducing RANK ligand (for bone REMODELING)

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7
Q

effect of low and intermittent PTH on bine

A

increase bone FORMATION

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8
Q

recombinant PTH 1-34

A

TERIPARATIDE

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9
Q

effect of pth on kidney

A

reabsorb calcium and magnesium

stimulate vit d production

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10
Q

forms of vit d

A

vit d3 cholecalciferol NATURAL

vit d2 ergocalciferol PLANT DERIVED

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11
Q

forms of vit d in liverr and kidney

A

liver 25OHD
kidney 1,25OH2D
kidney 24,24 OH 2D

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12
Q

calcifediol
calcitriol
secalcifediol

A

25 OH d3
1,25 oh 2D3
24,25 oh 2D3

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13
Q

give 3 vitamin d analogs

A

calcipotriene
doxercalciferol
paricalcitol

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14
Q

tx for psoriasis

A

CALCIPOTRIENE vit d analog

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15
Q

tx for 2ndary hyperparathyroidism

A

DOXERCALCIFEROL and PARACALCITOL vit d analogs

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16
Q

what inhibits and stimulates vit d metabolism

A

fgf23 inhibits

pth stimulates

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17
Q

which vit d is most potent and has low affinity

A

CALCITRIOL

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18
Q

calcifediol vs calcitriol

A

calcifediol more potent in stimulating renal reabsorption of ca and po4

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19
Q

pth regulated by feedback loops through?

A

calcium sensing receptors

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20
Q

directly inhibits PTH secretion

A

1,25(OH)2D

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21
Q

stimulates production of FGF23

A

1,25(OH)2D

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22
Q

inhibits 1,25(OH)2D production

A

FGF23

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23
Q

inhibit PTH secretion

A

Calcitriol analogs

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24
Q

mgmt of secondary hyperparathyroidism of CKD

A

Calcitriol analogs

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25
Q

Parafollicular cells of mammalian thyroid

A

Calcitonin

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26
Q

calcitonin half life

A

10mins

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27
Q

longer halflife, reduced metabolic clearance

A

salmon calcitonin

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28
Q

lowers Ca and PO4 reabsorption, dec GASTRIN secretion

A

calcitonin

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29
Q

potent stimulus for calcitonin secretion

A

Pentagastrin

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30
Q

block bone resorption and lower serum calcium

A

calcitonin

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31
Q

physiologic use of calcitonin

A

Paget’s disease, Hypercalcemia, Osteoporosis

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32
Q

Glucocorticoid use

A

stimulates renal calcium excretion
antagonizes vit D transport
blocks bone formation

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33
Q

hypercalcemia associated with inc production of 1,25(OH)2D

A

Granulomatous diseases - Sarcoidosis

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34
Q

Estrogen

A

prevent accelerated bone loss in post menopausal women
reduce bone resorption
inc 1,25(OH)2D

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35
Q

Selective estrogen receptor modulators

A

breast, uterus, cardiovascular system

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36
Q

newer therapies for osteoporosis

no risk of breast and endometrial ca

A

raloxifene

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37
Q

Bisphosphonates

A

osteoclast apoptosis

inhibition of cholesterol pathway

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38
Q

amino bisphosphonates

A

Alendronate and risedronate

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39
Q

block farnesyl pyrophosphate synthase

A

amino bisphosphonates

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40
Q

First generation bisphosphonates

A

MEDronate
ETIdronate
CLODronate

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41
Q

second generation bisphosphonates

A

ALEdronate

PAMidronate

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42
Q

3rd generation bisphosphonates

A

RISEdronate
ZolEDdronate

10,000x more potent than 1st gen

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43
Q

All current available bisphosphonate hav this complication

A

Gastric irritation (possible exception of ETIdronate)

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44
Q

main contraindication of bisphosphonates

A

dec renal dunction
esophageal motility disorders
peptic ulcer disease

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45
Q

physiologic use of bisphosphonates

A

hypercalcemia
paget’s disease
osteoporosis
bone metastasis

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46
Q

mineralization defect SE

A

ETIdronate

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47
Q

gastric and esophageal irritation SE

A

PAMidronate

high doses of ALEdronate

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48
Q

high doses of IV ZolEDronate SE

A

ONJ osteonecrosis of the jaw

49
Q

Recombinant form of PTH stim bone formation

A

TERIparatide -

50
Q

activates CaSR and blocks PTH secretion

A

Cinacalcet

51
Q

Cinacalcet Tx

A

Secondary hyperPTH of CKD

Parathyroid carcinoma

52
Q

cytotoxic antibody

binds to DNA and interrupts RNA synthesis

A

PLICAmycin

53
Q

Thiazide use

A

reduces renal calcium excretion
block sodium reabsorption
inc Ca-Na exchange

54
Q

reduces stone formation
decrease urine oxalate
increase urine Mg and Zinc

55
Q

fluoride without adequate calcium produces

A

Osteomalacia

56
Q

Blocks osteoclast differentiation while promoting their apoptosis

A

Strontium Ranelate

57
Q

bone formation markers
inc bone density
dec fractures

A

Strontium Ranelate

58
Q

for mgmt of hypercalcemia of malignancy
inhibits bone formation
potential nephrotoxic

A

Gallium Nitrate

59
Q

major causes of hypercalcemia

A

thiazide therapy
hyperPTH
Cancer

60
Q

less common cause of hypercalcemia

A

hypervitaminosis D

61
Q

for syptomatic hypercalcemia

A

Saline Diuresis with furosemide

62
Q

Tx for hypercalcemia of malignancy

has self-limited flu-like symptoms

A

PAMidronate

ZolEDronate

63
Q

parentral and nasal administration of Salmon Calcitonin

ANCILLARY Tx

64
Q

most dangerous SE of sudden thrombocytopenia followed by hemorrhage

A

PLICAmycin

65
Q

“when all else fail”

A

PLICAmycin

66
Q

fastest and surest way for hypercalcemia

A

IV phosphate

67
Q

for chronic hypercalcemia of sarcoidosis, vit D intoxication etc

A

Glucocorticoids

68
Q

Major causes of hypocalcemia in adult

A

hypoparathyroidism
vit D deficiency
CKD
Malabsoprtion

69
Q

mainstay Tx for hypocalcemia

A

calcium and vitamin D

70
Q

Calcium forms

A

Calcium gluceptate
Calcium GLUCOnate (preferred)
Calcium chloride

71
Q

Oral preparation of Calcium

A 
Ca carbonate (40%)
Ca phosphate (25%)
Ca citrate (21%)
Ca lactate (13%)
72
Q

Ca carbonate should be given with meals

or Ca citrate alternative

A

Achlorydic patients

73
Q

Tx for severe symtomatic hypocalcemia

A

5-20ml 10% calcium gluconate (slow infusion)

74
Q

Vit D metabolite of choice

raises serum PO4

A

Calcitriol

75
Q

Hyperphosphatemia symptoms

A

common complication of renal failure
vit D intoxication
hypoPTH
rare Tumoral calcinosis

76
Q

phosphate-binding gel

77
Q

hypophosphatemia related diseases

A

Vit D Deficiency
hypophosphatemic rickets
FANCONIs SYNDROME (renal wasting)

78
Q

Reduced ATP
Decreased 2,3DPG
rhabdomyolysis

A

acute hypophosphatemia effects

79
Q

For hypercalcemia

A 
Saline + furosemide
bisphosphonate
calcitonin
plicamycin
phosphate IV - fastest
glucocorticoid - cancer
80
Q

for hypocalcemia

A

Calcium gloconate IV
Calcium CO3PO
Calcitriol - RAPID

81
Q

for hyperphosphatemia

A 
PO4 restriction
SEVELAMER
Calcium
Aluminum antacid*
Dialysis
82
Q

for hypophosphatemia

A

oral phosphate suppplment

83
Q

Best Tx for HyperPTH

84
Q

Causes of HypoPTH

A

absence of PTH

abnormal target tissue response (pseudohoPTH)

85
Q

nor mal or high PTH acting on the bone not kidneys

A

pseudohypoPTH

86
Q

pseudohypoPTH causes

A

osteitis fibrosa

87
Q

optimum level of 25(OH)D

88
Q

daily intake of Vit D

A

800-1200 units of vit D

89
Q

effect of CKD in bone

A

Osteomalacia and Osteitis fibrosa

90
Q

Tx for adynamic bone disease in CKD

A

DEFEROXAMINE

91
Q

Analongs of calcitriol

A

DOXercalciferol

PARIcalcitriol

92
Q

advantage of calcitriol analogs

A

less likely to induce HYPERGLYCEMIA

93
Q

characterized by malabsorption of ca and vit d

and combined osteoporosis and osteomalacia

A

intestinal osteodystrophy

94
Q

intestinal vs renal osteodystrophy

A

no osteitis fibrosa in intestinal dystrophy

95
Q

tx for mild and severe int. osteodystrophy

A

mild vit d

severe calcitriol

96
Q

causes of osteoporosis in men

A 
chronic glucocorticoids
thyrotoxicosis and hyperparathyroidism
malabsorption
alcohol abuse
cigarette smoking
isionpathic
97
Q

osteoporosis tx in postmenopausal women, may be accompanied by lower calcitriol?

A

estrogen cycled with progestin

98
Q

serm for osteoporosis, preventing risk of breast and uterine cancer

A

RALOXIFENE

99
Q

Raloxifene adverse effect

A

inc risk of thrombophlebitis

100
Q

raloxifene clinical actions

A

protects against spine BUT NOT hip fractures

cant prevent HOT FLUSHES

101
Q

recombinant pth

approved for use for ONLY 2 YEARS in sequential therapy

A

TERIPARATIDE

102
Q

bisphosphonate for osteoporosis action

A

reduce risk of HIP SPINE AND OTHER fractures

for MEN AND WOMEN

103
Q

toxicities of adjuvant endocrine tx

A

loss of BMD
bone fracture
osteoporosis
musculoskeletal / arthralgia

104
Q

used for bmd assessment, from lumbar spine of one or both total hip sites

105
Q

tx for high risk group of BMD (baseline score of <-2)

A

BISPHOSPHONATE therapy

106
Q

calcitonin action on osteoporisis

A

affects only the SPINE

107
Q

antibody to RANKL, for osteoporosis

108
Q

denosumab adverse effects

A

possible inc risk for infection
risk of OSTEONECROSIS OF JAW
subtrochanteric fractures

109
Q

slow release, low dose tx for osteoporosisl

110
Q

loss of vit d binding protein, some develop bone disease

A

nephrotic syndrome

111
Q

vit d dependent rickets type i and ii

A

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
Q

normal serum calcium and pth BUT

hypercalciuria and nephrolithiaisis

A

idiopathic hypercalciuria

113
Q

idiopathoc hypercalciuria tx

A

hydrochlorothiazide or ALLOPURINOL

114
Q

short bowel syndrome with fat malabsorption, with ca and oxalate renal stones

A

enteric oxaluria

115
Q

enteric oxaluria etiology

A

calcium bound to fat fails to bind to oxalate

116
Q

poorly organized bone, elevated ALK PHOSPHATASE and urinary HYDROXYPROLINE

A

pagets disease of the bone

117
Q

pagets dse of the bone tx

A

first line CALCITONIN and BISPHOSPHONATES, requiring weeks to months
treatment failures PLICAMYCIN

118
Q

etidronate adverse effects

A

osteomalacia

inc risk of fractures

119
Q

alendronate adverse effects

A

gastric irritation, but reversible

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