"Pharmacology Parathyroid Jennifer Kelly"

Question 1

What states promote the reabsorption of phosphate?

Answer 1

Phosphate depletion
Hypocalcemia
Hypoparathyroidism

Question 2

What states promote the excretion of phosphate?

Answer 2

PTH
PTHrP
Hypercalcemia
Hypokalemia
Hypomagnesemia
Calcitonin
Glucocorticoids
Diuretics

Question 3

What drugs inhibit magnesium reabsorption in the Loop of Henle?

Answer 3

Furosemide

Cisplatin

Question 4

How does vitamin D work to maintain calcium homeostasis?

Answer 4

Increases intestinal absorption of dietary calcium and stimulating bone cells to become osteoclasts

Question 5

What are the most common causes of hypercalcemia?

Answer 5

Hyperparathyroidism

Malignancy

Question 6

Why can granulomatous diseases such as sarcoidosis cause hypercalcemia?

Answer 6

These diseases increase the conversion of active vitamin D (25–>1,25) which increases osteoclast activity.

Question 7

What is the most common cause of primary hyperparathyroidism?

Answer 7

Benign, solitary adenoma

Question 8

What labwork is commonly found in primary hyperparathyroidism?

Answer 8

High or normal PTH
Elevated urine calcium
Elevated serum calcium
Low phosphorous (may see)

Question 9

Class: Cinacalcet

Answer 9

Calcimimetic

Question 10

MOA: Cinacalcet

Answer 10

Reduces PTH and serum calcium levels (alters function of calcium receptor)

Question 11

Uses: Cinacalcet

Answer 11

Secondary hyperparathyroidism from renal disease; parathyroid carcinoma;
hypercalcemia in primary hyperparathyroidism not treatable by surgery

Question 12

Side effects: Cinacalcet

Answer 12

Vision changes, palpitations, dizziness, chest pains, headache

Question 13

What is milk alkali syndrome?

Answer 13

Excessive use of OTC calcium such as Tums

Question 14

Lithium can have what effects on calcium levels?

Answer 14

Lithium can increase PTH levels and increase parathyroid gland mass

Question 15

Thiazides have what effect on calcium?

Answer 15

They increase serum calcium by lowering excretion

Question 16

Class: Pamidronate

Answer 16

Bisphosphonate

Question 17

MOA: Pamidronate

Answer 17

Reduce osteoclastic bone resorption

Question 18

Uses: Pamidronate

Answer 18

Hypercalcemia of malignancy;
Paget’s disease of bone;
prevention of fractures in osteogenesis imperfecta

Question 19

Side effects: Pamidronate

Answer 19

Fever

Flu-like symptoms

Question 20

Class: Zoledronic acid

Answer 20

Bisphosphonate

Question 21

MOA: Zoledronic acid

Answer 21

Reduce osteoclastic bone resorption

Question 22

Uses: Zoledronic acid

Answer 22

Hypercalcemia of malignancy;
Paget’s disease of bone;
prevention of fractures in osteogenesis imperfecta

Question 23

Side effects: Zoledronic acid

Answer 23

Fever

Flu-like symptoms

Question 24

How are bisphosphonates administered?

Answer 24

IV, so bypasses GI tract

Takes several days to lower serum calcium

Question 25

How do you prevent volume overload and promote calcium excretion in the treatment of hypercalcemia?

Answer 25

Give a loop diuretic such as fursemide, bumetanide, torsemide, ethacrynic acid

Question 26

How does renal disease cause secondary hyperparathyroidism?

Answer 26

Phosphate retention, and lack of 1-alpha hydroxylase activity in the failing kidney, resulting in a 1,25 deficiency. At high concentrations, phosphate directly stimulates PTH secretion

Question 27

How is parathyroidism secondary to renal disease treated?

Answer 27

Low phosphate diet Phosphate binders vitamin D supplementation Dialysis

Question 28

What is tertiary hypoparathyroidism?

Answer 28

Parathyroid glands become autonomous after prolonged secondary parathyroidism Gland ends up oversecreting, so patients resemble those with primary parathyroidism Serum calcium is high

Question 29

In what endocrinologic condition would you see a prolonged QT interval?

Answer 29

Hypocalcemia | A shortened QT interval would be seen in hypercalcemia

Question 30

Class: Calcitriol; Paracalcitol; Doxercalciferol

Answer 30

Vitamin D analogs

Question 31

MOA: Calcitriol; Paracalcitol; Doxercalciferol

Answer 31

Binds to VDR and elevates serum calcium levels

Question 32

Uses: Calcitriol; Paracalcitol; Doxercalciferol

Answer 32

Secondary hyperparathyroidism from renal disease