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Pharmacology > Bone Homeostasis > Flashcards

Bone Homeostasis Flashcards

(130 cards)

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0
Q

PTH on bone

A

⬆️activity and number of osteoclasts ➡️release of calcium and phosphate

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1
Q

what stimulates PTH secretion

A

fall in plasma ionized calcium level

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2
Q

PTH on kidney

A

⬆️tubular resorption of calcium and magnesium
⬇️absorption of phosphate, amino acid, bicarbonate, sodium chloride and sulfate
stimulation of 1,25 DH vit D

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3
Q

metabolic active form of vit D

A

1,25 OH2D

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4
Q

enzyme that catalyzes formation of 1,25 OH2D from 25 OHD

A

1 hydroxylase

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5
Q

PT gland contains

A

ca sensitive protease
ca sensing receptor
vit D receptor and CYP27B1

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6
Q

ca sensitive protease

A

cleaves PTH

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7
Q

ca sensing receptor

A

reduces PTH production when stimulated by Ca

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8
Q

vit D receptor and CYP27B1

A

produces active metabolite of vit D, ⬇️PTH

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9
Q

1,25 DH vit D on bone

A

release of calcium and phosphate

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10
Q

1,25 DH vit D on intestine

A

⬆️Ca absorption

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11
Q

1,25 DH vit D on kidneys

A

reabsorption of calcium and phosphate

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12
Q

phosphaturic hormone

A

FGF 23

fibroblast growth factor 23

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13
Q

FGF 23 on kidney

A

inhibits phosphate reabsorption

inhibits 1,25 DH vit D production

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14
Q

FGF 23 on phosphate level

A

hypophosphatemia

➡️inhibition or defective mineralization of bone

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15
Q

primary site of production of FGF 23

A

osteoblasts

osteoclasts

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16
Q

low 1,25 DH vit D level impact by FGF 23

A

absorption of calcium thus there will be lower levels of calcium

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17
Q

phospate on PTH

A

regulates PTH secretion : form complexes with ca➡️ ⬇️Ca stimulates PTH secretion

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18
Q

high phosphate levels stimulate

A

FGF 23 production➡️

phosphate excretion

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19
Q

recombinant human PTH

only FDA approved bone forming drug

A

TERIPARATIDE

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20
Q

TERIPARATIDE on bone

A

stimulates the osteoblasts to induce RANK ligand that acts on osteoclasts and precursors to increase their number and activity

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21
Q

TERIPARATIDE on kidneys

A

increases reabsorption of calcium and magnesium

decreasing the reabsorption of phosphate, aa, HCO3,
➡️stimulates 1,25 DH vit D formation

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22
Q

effects of PTH- TERIPARATIDE

A

elevates serum calcium level

lowers serum phosphate level

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23
Q

TERIPARATIDE form of admin

A

multiple doses of pre filled pen

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24
moa of TERIPARATIDE
receptor binding increases cAMP
25
physiologic effect of PTH
bone resorption
26
pharmacologic effect of PTH: low intermittent dose
bone formation by stimulation of osteoblasts and inc collagen synthesis inc skeletal mass and bone strength
27
uses of TERIPARATIDE
postmenopausal osteoporosis glucocorticoid induced osteoporosis primary hypogonadism in men
28
TERIPARATIDE duration of use
2 years only | to prevent risk of osteosarcoma
29
AE of TERIPARATIDE
``` nausea vomiting constipation lethargy muscle weakness hypercalcemia hypercalciuria ```
30
TERIPARATIDE CI
Paget's dse of bone cancer metastasis to bone open epiphysis- children, young adults
31
absorption of vit d
intestines
32
first conversion of vit D by
25 hydroxylase
33
conversion by 1 hydroxylation
1,25 DH Vit D
34
conversion by 24 hydroxylation
24,25 DH vit d
35
storage of vit D
adipose tissue | liver
36
vit D clearance
liver
37
moa of vit d
receptor binding @➡️ gene transcription or repression
38
increase transcription by vit d
vit d receptor gene calbindin gene 24 hydroxylase enzyme
39
vit D on the intestine
induction of new protein synthesis - calcium binding CHON - intestinal calcium channel result: enhanced calcium absorption
40
vit D on bone
stimulates bone resorption - needs PTH mineralization of newly formed osteoid induces osteocalcin synth in osteoblasts
41
marker for osteoblastic bone formation
osteocalcin
42
vit D on kidney
increase calcium pumps ➡️ decrease calcium excretion
43
vit D on keratinocytes
calcitriol stimulates differentiation inhibits proliferation formation of cornified layer of epidermis ➡️psoriasis
44
vit D on PTH
decrease levels
45
vit D on immunity
promote innate immunity inhibit adaptive immunity
46
vit D prohormones
cholecalciferol - vit D3 | ergocalciferol - vit D2
47
vit d metabolite
calcitriol- 1,25 DH vit D
48
vit D analogs
paricalcitol | doxecalciferol
49
dihyrdrocalciferol
can increase calcium in 24-48 hours
50
vit d nutritional deficiency
rickets | osteomalacia
51
defective mineralization in growing bone
rickets
52
softening and weakening of bone
osteomalacia
53
hypocalcemia tx
vit D or calcitriol with calcium
54
hypoparathyroidism cause
idiopathic or surgical | leads to 1,25 DH vit D decrease
55
secondary hypoparathyroidism of chronic renal disease tx
calcitriol doxecalciferol paricalcitol
56
malabsorption of vit d and calcium
intestinal osteodystrophy
57
nephrotic syndrome causes
loss of vitamin D binding protein
58
vit D AE
hypercalcemia hypercalciuria renal calculi- calcium phosphate deposits hyperphosphatemia
59
calcitonin source
parafollicular cells of the thyroid gland
60
moa of calcitonin
receptor binding➡️ increase cAMP
61
calcitonin on bone
inhibits osteoclastic bone resorption
62
calcitonin on kidney
decrease calcium and phosphate reabsorption
63
calcitonin on GI
⬇️gastrin secretion and gastric acid output ⬆️secretion of Na, K, Cl and water in gutw
64
overall effect of calcitonin
decrease serum calcium and serum phosphate
65
calcitonin prep
salmon calcitonin
66
Properties of salmon calcitonin
greater potency per miligram | longer duration of action
67
salmon calcitonin routes of admin
nasal spray | injection
68
tachyphylaxis by calcitonin in 48-72 hours is due to
receptor downregulation
69
uses of Calcitonin
Paget's dse of bone (osteitis deformans) osteoporosis hypercalcemic emergency due to CA, multiple myeloma, primary hyperparathyroidism
70
AE of calcitonin
``` hypersensitivity athralgia rhinitis, epistaxis, sinusitis rash and facial flushing malaise transient marked increase in sodium and water excretion ```
71
glucocorticoids on GI
inhibit intestinal absorption of calcium
72
GC on kidney
promote renal excretion of calcium
73
GC on bone
loss of calcium
74
GC indications
hypercalcemia of malignancy, sarcoidosis, hypervitaminosis
75
GC on malignancy
decrease tumor mass and activity- lymphoma, mM inhibit cytokines that stimulate osteoclasts
76
GC on sarcoidosis
decrease sarcoid tissue mass that produces high levels of 1,25 DHD
77
GC on hypervitaminosis
decrease intestinal calcium absorption mediated by vit D
78
AE of gc
stunted growth | osteoporosis
79
effect of estrogen on bone
inhibits bone resorption of PTH | preserve bone after menopause
80
estrogen on breast and endometrium
stimulation
81
estrogen use
not first line drug prevent or treat postmenopausal osteoporosis
82
estrogen concerns
carcinoma | thromboembolism
83
estrogen on serum calcium and phosphate levels
decreases
84
estrogen on calcitriol
increased
85
synthetic steroid derived from 19 nortestosterone
TIBOLONE
86
estrogen effects of TIBOLONE
relieves urogenital and vasomotor symptoms prevents bone loss
87
anti estrogen effect of TIBOLONE
prevents uterine and breast stimulation
88
advantage of TIBOLONE
no need to add progestin
89
TIBOLONE indications
relieve menopausal symptoms prevent postmenopausal osteoporosis
90
AE of TIBOLONE
``` vaginal bleeding, spotting, discharge breast pain nausea, vomiting headache weight gain ```
91
RALOXIFENE Action on bone
preVents bone resorption
92
RALOXIFENE on breast and endometrium
prevents stimulation
93
raloxifene effects
increases bone density
94
RALOXIFENE classification
selective estrogen receptor modulator
95
RALOXIFENE on lipid
decrease LDL c and total cholesterol
96
RALOXIFENE indications
prevent or treat postmenopausal osteoporosis decrease risk of invasive breast ca in postmenopausal osteoporotic women
97
RALOXIFENE AE
hot flushes leg cramps peripheral edema deep vein thrombosis
98
moa of bisphosphonates
bind to hydroxyapatite in bone, preferential localization to bone resorption sites
99
BISPHOSPHONATES on bone
suppress osteoclast activity, inhibiting bone formation retard formation and dissolution of hydroxyapatite, gradually released from bone
100
RALOXIFENE indications
Paget's dse of bone hypercalcemia of malignancy osteoporosis
101
bisphosphonates for hypercalcemia of malignancy
PAMIDRONATE | ZOLEDRONIC ACID
102
less potent first gen bisphosphonate
ETIDRONATE
103
2nd gen bisphosphonate
ALENDRONATE
104
3rd gen bisphosPhonate
ZOLEDRONATE
105
AE of bisphosphonates
``` adynamic bone osteonecrosis of jaw possible renal failure metallic taste hyperphosphatemia inhibition of bone mineralization ```
106
CI bisphosphonates
esophageal motility disorders PUD decrease renal fxn
107
IV prep
IBANDRONATE- bolus, q3 months ZOLEDRONIC ACID- reclast 5 mg, yearly infusion
108
oral bisphosphonates should be taken
on an empty stomach with 6-8 oz of water no food or drink for 30-60 minutes upright position
109
levels checked before IV dose of bisphosphonates
creatine | calcium
110
calcimimetic
CINACALCET
111
action of CINACALCET
activate calcium sensing receptors to block the release of PTH
112
uses of CINACALCET
secondary hyperparathyroidism in chronic renal dse parathyroid ca primary hyperparathyroidism who are unable to undergo parathyroidectomy
113
naturally occuring mineral deposited in bone
STRONTIUM RANELATE
114
STRONTIUM RANELATE actions
suppresses bone resorption by inhibiting osteoclast differentiation
115
PHOSPHATE AE
GI | hypocalcemia, hypotension, shock, acute MI, tetany, ectopic calcification
116
PHOSPHATE actions
promote calcium deposition in the bone and soft tissue | reduce calcium absorption
117
PHOSPHATE CI
impaired renal flow hyperphosphatemia alkaline urine secondary to UTI
118
PHOSPHATE drug interactions
antacids
119
phosphate prep
Potassium phosphate injection sodium phosphate injection sodium phosphate tablet or oral solution
120
PHOSPHATE indications
hypercalcemic crisis- slowly phosphate deficiency - x linked hypophosphatemia - autosommal dominant hypophosphatemia
121
indication for IV calcium
severe hypocalcemia | -tetany, laryngospasm
122
IV calcium prep
calcium cl 27% calcium gluceptate 8% calcium gluconate 9%
123
preferred IV because less irritating to veins
calcium gluconate
124
risks of iv calcium
arrhythmias local vein irritation, abscess formation precipitation, calcification ectopic calcification
125
oral calcium indications
mild hypocalcemia | osteroporosis
126
oral calcium prep
ca carbonate 40% ca citrate 21% ca lactate 13% ca gluconate 9%
127
more readily available oral calcium with high content | requires food
calcium carbonate 40%
128
better absorbed oral calcium
calcium citrate
129
ADR of calcium
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Pharmacology (8 decks)

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