parathyroid Flashcards
1
Q
Tx of hypercalcemia
A
- fluids: IV saline and loop diuretic
- bisphosphonates
- calcitonin
- corticosteroids
- dialysis if renal failure or refractory to other tx
- ambulation
2
Q
pamidronate
A
- bisphosphonate
- inhibits bone resorption
- tx: hypercalcemia of malignancy (high PTHrP)
- IV (poorly absorbed from GI tract) –> given as 2-4 hr infusion
- takes up to 6 days to work so don’t immediately repeat dose
- SE: fever and flu-like symptoms, elevation of Cr
3
Q
zoledronic acid
A
- bisphosphonate- inhibits bone resorption
- tx: hypercalcemia of malignancy (high PTHrP)
- most potent bisphosphonate
- shorter infusion time (15 mins)
- SE: fever and flu like symptoms, elevated Cr
4
Q
calcitonin (in setting of hypercalcemia)
A
- tx: hypercalcemia (adjunct tx in acute setting)
- SQ or IM
- increases urinary Ca excretion and inhibits bone resorption
- continous exposure leads to downregulators of Calcitonin receptors on osteoclasts –> develop tachyphylaxis in 2-3 days
5
Q
corticosteroids
A
- tx hypercalcemia in setting of Vit D intoxication, granulomatous diseases and hematologic malignancies
- decreases production of 1,25 dihydroxy Vit D and inhibits growth of neoplastic lymphoid tissue
- IV hydrocortisone or oral prednisone
6
Q
secondary hyperparathyroidism from renal disease
A
- renal failure –> limited excretion of phosphate and diminished production of activated Vit D –> hypocalcemia –> PTH secretion –> renal osteodystrophy
- tx with calcitriol or other Vit D analog
- tx with phosphate binders
- tx with calcimimetics
7
Q
hypoparathyroidism
A
- low PTH, low Ca, high phosphate
- tx: Ca and Vit D supplements
- major concern is to avoid hypercalcuria –> Ca goal = low end of normal
8
Q
cholecalciferol
A
- 25-hydroxyvit D
- tx: Vit D deficiency, hypocalcemia, hypoparathyroidism
- avoid precipitating hypercalcemia or hypercalcuria
- more efficacious than ergocalciferol
9
Q
ergocalciferol
A
- 25-hydroxyvitamin D
- tx Vit D or PTH deficiency
- careful to not precipitate hypercalcemia or hypercalcuria
*
10
Q
tx of acute hypocalcemia
A
- IV infusion of calcium gluconate
- may need Vit D or Calcium supplements orally if hypocalcemia persists
11
Q
osteoporosis
A
- BMD T score between -1 and -2.5 = osteopenia and less -2.5 = osteoporosis (normal >-1)
tx:
- bisphosphonates
- SERMS
- Calcitonin
- Teriparatide
- Denosumab
12
Q
alendronate (Fosamax)
A
- oral bisphosphonate to tx osteopenia and osteoporosis
- inhibits bone resorption
- 2 doses = 35mg/week for osteopenia
- 2 doses = 70mg/week for osteoporosis
- need to be taken fasting with full glass of water, PT must remain upright for 30 mins after ingestion and not eat or take any other meds during that time
- SE: esophageal irritation
13
Q
risedronate (Actonel)
A
- oral bisphosphonate – tx osteoporosis
- 1 dose 35 mg/week
- SE: esophageal irritation
- take with full glass of water, fasting, remain upright and cant eat or take any other meds for 30 mins
14
Q
ibandronate (Boniva)
A
- oral bisphosphate for osteoporisis
- 1 dose of 150mg/month
- SE: esophageal irritation
- take when fasting with full glass of water, can’t eat or take any other meds or lay down for 30 mins after
15
Q
SERM
A
- Selective Estrogen Receptor Modulator
- approved to tx osteoporosis in postmenopausal women (don’t use as sole tx because of SE)
- estrogen-like effect on bone –> decreased bone resorption
- SE: hot flashes and increased risk of DVT
