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Special pops Exam 3 > Bone > Flashcards

Bone Flashcards

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1
Q

What does the release of PTH increase?

A

Calcium in the body

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2
Q

What are the 3 places where PTH acts to enhance the concentration of calcium?

A
  1. Kidneys
  2. Bone
  3. Intestine
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3
Q

What would a decrease in calcium trigger in regards to the PTH glands?

A

PTH release from the PTH glands

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4
Q

What is the role of calcitriol?

A

To increase calcium absorption in the intestine

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5
Q

What does PTH activate?

A

Osteoclasts

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6
Q

What does PTH stimulate the production of?

A

cAMP production in osteoblasts

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7
Q

How does PTH indirectly regulate the absorption of calcium through the intestine?

A

Via the formation of calcitriol in the kidney

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8
Q

What does PTH promote in the kidneys? Where at in the kidneys?

A

Calcium reabsorption; distal convoluted tubules (DCT)

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9
Q

What does PTH prevent reabsorption if in the proximal convoluted tubule?

A

Phosphate

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10
Q

What is calciferol used to treat?

A
  1. Rickets
  2. Osteomalacia
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11
Q

What are 2 other disease states that vitamin D can be used to treat?

A
  1. Hypoparathyroidism
  2. Osteoporosis
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12
Q

What are the two drugs of choice to stimulate the osteoblasts?

A
  1. PTH analogs
  2. Sclerostin inhibitors
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13
Q

How are the two PTH analogs given to stimulate osteoblasts?

A

Pulsatile

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14
Q

What can an increase in osteoblasts cause?

A

Osteosarcoma

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15
Q

What are 3 patient populations that should not use PTH analogs?

A
  1. Children
  2. Adolescents
  3. Pregnancy
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16
Q

What are 3 side effects of the PTH analogs?

A
  1. Dizziness
  2. Leg cramps
  3. Kidney stones
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17
Q

What does Sclerostin normally inhibit?

A

Wnt/beta-catenin pathway

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18
Q

What is the Wnt/beta-catenin pathway involved in?

A

Bone formation

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19
Q

What are 3 approaches to inhibit osteoclasts?

A
  1. Bisphosphonates
  2. Calcitonin
  3. RANK-L inhibitor
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20
Q

What do the bisphosphonates inhibit?

A

FPP synthase

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21
Q

What is the FPP synthase enzyme involved in?

A

Cholesterol biosynthetic pathway

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22
Q

How does FPP synthase activate osteoclasts?

A

By adding farnesyl groups to small GTPases

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23
Q

Where do the small GTPases exist when they are inactivated?

A

In the cytoplasm

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24
Q

What are the 3 small GTPases?

A
  1. Rho
  2. Ras
  3. Rab
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25
Where do the small GTPases go after they are activated?
To the membrane to activate osteoclasts
26
What are micro fractures caused by?
Imbalanced bone remodeling leading to atypical femur fractures
27
What are the 4 main ADRs of the bisphosphonates?
1. Osteonecrosis of the jaw 2. Micro fractures 3. Esophageal irritation/ulceration 4. Cramping/joint pain/muscle aches
28
What can bisphosphonates mimic that can lead to esophageal irritation?
The lipid bilayer
29
What are 2 reasons why bisphosphonates can cause cramping/joint pain/muscle aches?
1. Inhibition of osteoclasts lead to a decrease in calcium 2. Decrease in cholesterol
30
What is the MOA for calcitonin?
Inhibits osteoclasts and decreases calcium levels
31
How does calcitonin inhibit osteoclasts?
By decreasing the ruffled border surface area
32
Denosumab
PROLIA
33
What is the MOA for Denosumab?
Binds to the RANKL, degrades it and prevents it from interacting with RANK on osteoclasts
34
What are the 2 H+ secreting enzymes that dissolve bone and reside in the resorption pits?
1. TRAP 2. Cathepsin K
35
What does phosphate reduce?
Free calcium levels
36
What are the 4 symptoms of hypercalcemia?
1. Muscle weakness 2. CNS Depression 3. Respiratory depression 4. CaPO4 precipitation
37
What are 3 Disease resulting in or causing hypercalcemia?
1. Hyperparathyroidism 2. Hypervitaminosis 3. Familial benign hypercalcemia
38
How would you treat hyperparathyroidism?
Remove the PTH glands
39
What would you do to treat hypervitaminosis?
1. Remove the drug 2. Diet low in calcium
40
What are 4 ways to treat familial benign hypercalcemia?
1. Enhance calcium excretion (furosemide) 2. Bisphosphonates 3. Oral phosphates 4. EDTA
41
What are 5 symptoms of hypocalcemia?
1. Tetany 2. Muscle spasms 3. Neuronal excitability 4. Cramps 5. Increase in bone resorption
42
What are 4 diseases resulting in or caused by hypocalcemia?
1. Hypoparathyroidism 2. Secondary hypothyroidism 3. Rickets 4. Osteomalacia
43
How would you treat hypoparathyroidism?
1. Calcitriol 2. Dietary calcium
44
How would you treat secondary hypoparathyroidism?
1. Vitamin D 2. Calcium 3. Calcitonin 4. Bisphosphonates
45
What is used to treat rickets?
1. Vitamin D 2. Calcium 3. Calcitonin 4. Bisphosphonates
46
How would you treat osteomalacia if it is caused by renal failure?
Give Calcitriol
47
How would you treat osteomalacia if it’s caused by the inability to absorb calcium?
IV calcium
48
When is bone mass at its peak?
In your 30s
49
What is the gold standard test for determining if a patient has osteoporosis?
T-score
50
What T score is indicative of osteopenia?
-2.5 to -1
51
What T-score is indicative of osteoporosis?
-2.5 or less
52
People with osteopenia and osteoporosis will have ___ bone turnover
High
53
What test can be helpful in determining if osteoporosis treating is working after 3 months?
BTM
54
What are the scans called that give a T-score?
DXA or DEXA
55
Which marker is a predictable response to treatment?
Bone formation marker
56
What assays does the bone formation marker use?
P1NP
57
What marker shows degradation products of type 1 collagen of bone?
Bone resorption marker
58
What marker is generated by the activity of the enzyme cathepsin k?
Bone resorption marker
59
What are 6 environmental factors that contribute to bone loss?
1. Exercise 2. Smoking 3. Low calcium/vitamin D and protein 4. Xs alcohol consumption 5. Menopause 6. Aging
60
What type of osteoporosis occurs in post menopausal women?
Type 1
61
What type of osteoporosis occurs in both males and females?
Type II
62
What usually causes hyperparathyroidism?
A tumor resulting in hypersecretion of PTH
63
Who is more affected by hyperparathyroidism?
Women
64
How are the 2 PTH analogs given to stimulate **osteoclasts**?
Continuous

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