Lecture 10 Calcium and drugs

Question 1

PTH:
increases bone _____;
increases reabasorption of Ca in the ____ tubule, decreases reabsorption of PO4 in the ____ tubule
increased calcitriol production by stimulating _____ in the ____

Answer 1

resorption of Ca and PO4;
distal convoluted;
proximal convoluted;
1 alpha hydroxylase, PCT

Question 2

Vitamin D3 is converted to 25-OH in the ____. 1 alpha hydroxylase converts it to its ___ form 1,25-D3. 24 hydroxylase converts it to in its ___ form 24,25-D3. Both enzymes are in the ____

Answer 2

liver;
active, inactive;
kidney

Question 3

Vit D:
increases ____ reabsorption from the small intestine. increases bone ______;
indirectly increases Ca reabsorption via increased

Answer 3

Ca and PO4 (directly, via TrpV6)
resorption;
calbindin and Ca-ATPase

Question 4

calcitonin directly inhibits _____

Answer 4

bone resorption

stimulated by high calcium

Question 5

osteoporosis: loss of ___ and ____ bone

Answer 5

cortical, trabecular

Question 6

hyperparathyroidism causes ___calcemia;

osteomalacia and rickets are due to low ___ levels

Answer 6

hyper;

Vit D

Question 7

symptoms of VIT D overdose:
___calcemia, loss of ___, stupor;
coma and death

Answer 7

hyper, appetite

Question 8

____ is characterized by bone resorption followed by unorganized secondary bone formation.
can cause ____ loss, bone deformities

Answer 8

paget disease;

hearing

Question 9

drugs and calcium:
loop diuretics cause a ____ in excretion. thiazide diuretics cause a ____ in excretion;
PPIs cause decreased acidity of the stomach and ____ absorption

Answer 9

increase;
decrease;

inhibit

Question 10

bisphosphonates:
_____ analogs that bind ____ in bone, inhibiting osteoclast activity. also induce ____ in osteoclasts and reduce osteoclast development

Answer 10

pyrophosphate, hydroxyapatite;

apoptosis

Question 11

bisphosphonates all end in ______

Answer 11

dronate

ie alen, iban, rise, zoledronate

Question 12

side effects of bisphosphonates:

_____; osteonecrosis of ____, atypical _____

Answer 12

esophagitis, jaw;

fractures

Question 13

bisphosphonates inhibit farnesyl pyrophosphate synthase, which disrupts ___ of proteins in osteoclasts

Answer 13

prenylation

Question 14

_____ is a SERM used as second line treatment for osteoporosis. side effects include increased risk of _____

Answer 14

raloxifen;

thromboembolic events

Question 15

calcitonin can be used in hypercalcemia associated with ____ disease or ____. side effects include ____, ____ swelling and nausea

Answer 15

pagets, malignancy;

uticaria, hand

Question 16

____ is a recombinant PTH analog. it increases ____ activity

Answer 16

teriparatide;

OSTEOBLAST

Question 17

side effects of teriparatide:
most important is increased risk of _____.
____ hypotension.

it is usually given in ___ doses

Answer 17

osteosarcoma;
orthostatic;

intermittent

Question 18

teriparatide and PTH (in intermittent doses) cause an increase in _____ from osteoblasts and an an increase in _____, a pro building substance

Answer 18

RANKL;

OPG (osteoprotegerin)

Question 19

_____ is a monoclonal antibody against RANKL. it binds and prevents activation on _______

Answer 19

denosumab;

osteoclast precursors

Question 20

denosumab (taken daily):

can cause osteonecrosis of ____, severe ____, skin reactions

Answer 20

jaw, infection;

given to postmenopausal women who are intolerant to bisphosphonates

Question 21

_____ sensitizes the Ca2+ sensing receptor (CaSR) in the parathyroid gland to circulating Ca2+, ____ PTH

Answer 21

cinaclet, decreasing

Question 22

cinaclet is used to treat primary _____ or secondary _____ as seen in _____ disease

Answer 22

hyperparathyroidism, hyper PTH;

chronic kidney

Question 23

Zemplar and Hectorol are what?

Answer 23

vitamin D analogs

Question 24

vitamin D analogs are used to treat….

Answer 24

Chronic kidney disease with dialysis

Question 25

_____ binders can also be used to treat CKD with dialysis

Answer 25

phosphate

ie lanthanum carbonate