Pharmacology of Parathyroid & Metabolic Bone Disorders

Question 1

Cholecalciferol is the ____________ form of vitamin D.

Answer 1

precursor (i.e., without either hydroxyl group)

Question 2

Vitamin D ___________ the release and production of PTH.

Answer 2

decreases

Question 3

The major effect of estrogen on bone is ________________, though they also increase the number of osteocytes.

Answer 3

decreased number and activity of osteoclasts

Question 4

Estrogens increase osteoblast production of ___________.

Answer 4

osteoprotegerin

Question 5

In addition to antagonizing vitamin D, glucocorticoids also decrease bone density by _____________.

Answer 5

stimulating the overproduction of RANK and underproduction of osteoprotegerin

Question 6

Non-pharmacologic therapy of osteoporosis should include _______________.

Answer 6

dietary intake of 1,500 mg of calcium and 1,000 IU of vitamin D; weight-bearing exercise; and smoking cessation

Question 7

Denosumab is a _____________.

Answer 7

monoclonal antibody to the RANK-L

Question 8

______________ bind to sites on bone and prevent bone resorption.

Answer 8

Bisphosphonates

Question 9

Bisphosphonates are not recommended in those with _________________.

Answer 9

renal deficiency

Question 10

When would you use SERMs (instead of bisphosphonates or estrogens)?

Answer 10

In a patient who can’t tolerate bisphosphonates or is at risk of breast cancer (which estrogen can cause)

Question 11

After a few days of treatment, “escape” can occur from use of ______________.

Answer 11

calcitonin

Question 12

In which part of the nephron does PTH act to increase calcium resorption?

Answer 12

DCT

Question 13

How does cinacalcet work?

Answer 13

It increases the sensitivity of the PTH CaSR, thus decreasing the release of PTH.

Question 14

Calcitonin excess or deficiency is usually _____________.

Answer 14

asymptomatic

Question 15

Teriparatide is a ____________ analog.

Answer 15

PTH (because PTH in intermittent doses actually promotes bone growth)

Question 16

The main side effect of bisphosphonates is _______________.

Answer 16

esophagitis; because of this, instruct patients to take it with a lot of water and while standing upright

Question 17

Bisphosphonates have a ________ half-life and are ___________ absorbed.

Answer 17

long; poorly

Question 18

Sclerostin inhibits the ___________ pathway.

Answer 18

Wnt (thus antibodies to it promote bone growth)