PTH

Question 1

Actions of PTH (4)

Answer 1

Release Ca form bone, Reabsorb Ca in kidneys, Absorb C and P in small intestine, synthesize Vit D

Question 2

Phosphate excretion increased by..

Answer 2

PTH, PTHrP, hypercalcemia, hypokalemia, hypoagnesemia, calcitonin, glucocorticoids, diuretics

Question 3

Actions of Vitamin D

Answer 3

Increases intestinal absorption of calcium and stimulates osteoclasts

Question 4

Labs for PTH (Ca, PTH, P, urine Ca)

Answer 4

High Ca, elevated or normal PTH, low phosphorus, elevated urine Ca

Question 5

Tx of primary hyperPTH

Answer 5

hydration, ambulation, moderate Ca intake, bisphosphonates, calcimimetics (alters calcium sensing receptor)

Question 6

Tx of hypercalcemia

Answer 6

increase fluid intake, moderate Ca diet, bisphosphonates, calcitonin, corticosteroids

Question 7

Mechanism of action: Bisphosphonates

Answer 7

inhibit osteoclastic bone resorption

Question 8

Types of bisphosphonates (5)

Answer 8

Pamidronate, zoledronic acid, alendronate, risedronate, ibandronate

Question 9

Mechanism of action: Calcitonin

Answer 9

Increases urinary calcium excretion, inhibits bones resorption; normally secreted by C cells of thyroid

Question 10

SE’s of Calcitonin

Answer 10

Tachphylaxis

Question 11

Labs for secondary hyperPTH

Answer 11

low Ca, high Ph, high PTH, low VitD

Question 12

Tx of secondary hyperPTH

Answer 12

Low Ph diet, Ph binders, VitD replacement

Question 13

Labs in renal failure induced hypocalcemia

Answer 13

Low Ca, high Ph, PTH and Cr

Question 14

Phosphate binders (3)

Answer 14

calcium carbonate, calcium acetate, sevelamer

Question 15

VitD replacements (3)

Answer 15

calcitriol, paracalcitol, doxercalciferol

Question 16

Labs in hypoPTHism

Answer 16

low calcium, low PTH, high Ph

Question 17

Tx goals of hypoPTHism

Answer 17

normalize Ca and Ph, avoid hyperCa

Question 18

Tx for osteoporosis

Answer 18

Bisphosphonates (Alendronate, risedronate, ibandronate), Selective estrogen receptor modulates (Raloxifene), Calcitonin (not used anymore), Teriparatide, Denosumab

Question 19

Raloxifene

Answer 19

SERM used to tx osteoporosis

Question 20

SE’s of bisphosphonates

Answer 20

GI irritation, administration restrictions

Question 21

Teriparatide

Answer 21

PTH analog. Exposure of short daily bursts stimulates bone resorption and formation; Used to tx osteoporosis. SEs: dizziness, palpitations, transient hypercalcemia

Question 22

Denosumab

Answer 22

RANKL inhibitor

Question 23

Does OPG increase or decrease bone resorption?

Answer 23

Decrease

Question 24

Which decreases Ca bound to albumin (and therefore increases free ionized Ca): Alkalosis or Acidosis

Answer 24

Acidosis

Question 25

MC sites of Ca reabsorption in kidneys

Answer 25

PT and loop of Henle

Question 26

Resorption of renal Ca is enhanced by…

Answer 26

PTH, phosphate, metabolic alkalosis, thiazide diuretics, increased Na resorption

Question 27

Excretion of renal Ca is enhanced by…

Answer 27

metabolic acidosis, loop diuretics, saline diuresis and PTH deficiency

Question 28

Renal reabsorption of Ph is enhanced by…

Answer 28

phosphate depletion, hyPOparathyroidism, hyPOcalcemia

Question 29

Renal excretion of Ph is enhanced by…

Answer 29

PTH, PTHrP, hypercalcemia, hypokalemia, hypomagnesemia, glucocorticoids, calcitonin and diuretics

Question 30

Triad of Multiple Myeloma

Answer 30

Hypercalcemia, anemia, renal insufficiency

Question 31

Causes if secondary hyperparathyroidism

Answer 31

phosphate retention and lack of 1-a-hydroxylase activity in failing kidneys