DLA18- Bone Homeostasis

Question 1

(1) is most common cause of hypercalcemia

(2) is choice treatment for hypercalcemia

Answer 1

1- hyperparathyroidism

2:
IV saline
loop diuretic (furosemide)

Question 2

Hypocalcemia:

• (1) most common cause
• (2) signs, symptoms
• (3) Tx

Answer 2

1- iatrogenic (parathyroidectomy w/ thyroidectomy)

2- tetany, carpo-pedal spasm, Chvostek’s sign

3- IV Calcium gluconate (preferred as CaCl would => venous sclerosis)

Question 3

list Bisphosphonates by generation

Answer 3

(for osteoporosis)
1st- Etidronate

2nd- Alendronate, Pamidronate (10-100x potent)

3rd- Risedronate, Zoledronate (10000x potent)

Question 4

Bisphosphonates are analogs of (1).

-(2) and (3) are main MOAs

Answer 4

1- pyrophosphate

2- induce osteoclast apoptosis
3- inhibits cholesterol biosynthetic pathway

Question 5

besides osteoporosis, bisphosphonates are also used for ______, explain

Answer 5

malignancy-associated hypercalcemia: Ca chelator

Question 6

______ is RANKL inhibitor, describe dosing and route of administratoin

Answer 6

Denosumab:

• post-menopausal osteoporosis
• SQ every 6 mos

Question 7

______ is the PTH analog for male and female osteoporosis

Answer 7

Teriparatide:
-only anabolic / bone building agent –> inc osteoblast activity

• alternate for previously failed Tx
• SQ injection

Question 8

______ are the anti-breast cancer agents that can be used to treat osteoporosis

Answer 8

SERMs: selective estrogen receptor modulator
Raloxifene:
-bone, liver agonist
-inactive in uterus
-breast antagonist

Tamoxifen-

• bone, liver, uterus agonist
• breast antagonist

Question 9

______ is a hormone Tx for osteoporosis that is not currently recommended

Answer 9

Calcitonin – PTH antagonist

Question 10

Paget’s Disease:

1st line, 2nd line, 3rd line Tx

Answer 10

1st- bisphosphonates

2nd- calcitonin

3rd- plicamycin: lethal antineoplastic antibiotic that inhibits RNA synthesis

Question 11

Sevelamer:

• (1) formulation
• (2) MOA
• treats (3)

Answer 11

1- sevelamer carbonate (not hydrochloride => metabolic acidosis)

2- chelated Phosphate

3- hemodialysis Pts

Question 12

______ is phosphate binder

Answer 12

sevelamer

Question 13

______ is selective vitD receptor agonists, include its use

Answer 13

Paricalcitol- secondary hyperparathyroidism

Question 14

______ is Ca receptor agonist, indicate specific receptor and use

Answer 14

Cinacalcet:

• enhances sensitivity of parathyroid calcium sensing receptor –> dec PTH
• for CKD Pts with secondary hyperparathyroidism //// hemodialysis Pts

Question 15

______ is synthetic vitD3, describe use

Answer 15

Calcipotriol:

• apply topically (cream, ointment, foam) to Psoriatic plaques (or occasional Dermatitis)
• regulates keratinocyte development –> inhibits proliferation and enhances differentiation

Question 16

list the agents used for CKD with secondary mineral / bone disorders

Answer 16

• Sevelamer (PO4- chelator)
• VitD: doxercalciferol (prohormone), paricalcitol (agonist)
• Cinacalcet (Ca receptor antagonist)
• Fluoride
• Gallium Nitrate
• Thaiazides
• Ca supplements