Bone mineral homeostasis Flashcards Preview

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Flashcards in Bone mineral homeostasis Deck (60)
1

Magnesium levels effect on PTH secretion

moderate decrease in MG = inc in PTH

SEVERE decline in Mg = drop in PTH secretion

2

common causes of hypomagnesia

diarrhea
diuretics
alcohol abuse
chronic PPI and aminoglycoside use

3

PTH on intestine effect

indirect increase on calcium and phosphate absorption = via increase of vitamin D metabolite

4

PTH on kidney

decreased calcium excretion
increased phosphate excretion

5

Vit D on kidney

increased reabsorption of calcium and phosphate

6

net effect of PTH

increased serum calcium
decreased serum phosphate

7

net effect of vitamin D

increased serum calcium and phosphate

8

fibroblast growth factor 23

made by osteoblasts and osteoclasts = inhibits calcitrol production

dec calcium and phosphate reabsorption in kidney

9

Teriparatide

PTH analog
causes net increase in bone formation/mineralization

10

teriparatide use

osteoporosis

11

teriparatide kinetics

low intermit levels = anabolic effects

chronic admin = can cause primary hyperparathyroidism -- catabolic effects --> osteitis fibrosa cystica

12

teriparatide AE

hypercalcemia - hypercalciuria
osteosarcoma

13

cholecalciferol

vit D analog

14

ergocalciferol

vit D analog

15

cholecalciferol/ergocalciferol use

added to calcium supplements and dairy products

regulates gene transcription via vitamin D receptor

16

cholecalciferol/ergocalciferol use

vit D deficiency
Rickets
osteomalacia

17

Vit D deficient type I

defective 1alpha hydroxylase enzyme

dec calcitriol = dec calcium, dec PO4

18

Vit D deficient type II

defective receptor

19

cholecalciferol/ergocalciferol AE

hypercalcemia, hyperphosphatemia, hypercalciuria

20

calcitriol

1,23-dihydroxyvitamin D3

- management of secondary hyperparathyroidism
- chronic kidney dz
- management of hypocalcemia in pt with hypoparathyroidism
(active form - doesn't require metabolism)

21

doxercalciferol

1alpha-hydroxyvitamin D2

- management of secondary hyperparathyroidism in pt with chronic kidney disease

22

19-nor-1,25-dihydroxyvitamin D2

paricalcitol

-calcitrol analog used for management of secondary hyperparathyroidism in pt with chronic kidney disease

23

calcipotriene

calcipotriol

used for topical tx of psoriasis

calcitriol analog

24

calcitonin

peptide hormone - inhibtis bone resportion

25

calcitonin use

Paget disease
osteoporosis

26

calcitonin kinetics

salmon calcitonin = nasal spray or parenteral

27

calcitonin AE

rhinitis with nasal spray

28

alendronate

bisphosphonate

suppresses osteoclasts and inhibits bone resorption - inhibits osteoclastic activity via dec farnesyl pryophosphate synthesis via disruption of mevalonate pathway decreases osteoclast H+ ATPase

29

alendronate use

osteoporosis
paget's disease

30

alendronate AE

esophageal irrigiation = reduced by drinking ater and remaining upright

osteonecrosis of jaw

adynamic bone

31

risedronate

bisphosphonate

32

ibandronate

bisphosphonate

33

pamidronate

bisphosphonate

34

zoledronate

bisphosphonate

35

ethinyl estradiol

activate estrogen receptors - changes in transcription of estrogen regulated genes

36

ethinyl estradiol use

prevent osteoporosis

HRT

OCP

37

ethinyl estradiol AE

moderate tox - breakthrough bleeding

serious tox - thromboembolism, gall bladder dz, hyperTG, migraine, HA, HTN, depression

postmenopausal women - breast CA, endometrial hyperplasia

if in combo with P450 inducer -- breakthrough bleeding, dec contraceptive efficacy

38

raloxifene

SERM = estrogen agonist in bone, antag in breast and endometrium

39

raloxifene use

osteoporosis in postmenopasual women

40

raloxifene AE

hot flush
thromboembolism

41

Denosumab

RANKL inhibitor

42

denosumab MOA

bind RANK-L - prevents osteoclast differentiation

43

denosumab use

osteoporosis

44

denosumab AE

inc risk of infections

45

cinacalcet

calcimimetic

stimulates calcium sensing receptor = decreaes PTH release/suppression

46

cinacalcet use

hyperparathyroidism - primary and secondary

47

cinacalcet AE

nausea, hypocalcemia, adynamic bone

48

calcium preps

calcium carbonate
calcium citrate
calcium lactate

49

calcium prep use

hypocalcemic tetany

magnesium sulfate overdose used in eclampsia

50

calcium prep AE

necrosis and abscess formation

thrombophlebitis

51

prednisone AE

glucocorticoid
**note that the duration is longer than the half life

AE: OSTEOPOROSIS, adrenal suppression, muscle wasting, salt retention

52

fluoride

chronic exposure -- dense but brittle bone

53

gallium nitrate

inhibits bone resorption
nephrotoxic

54

plicamycin

(mithracin)

used in cancer related hypercalcemia

55

plicamycin AE

thrombocytopenia
hepatic/renal insufficiency

56

drugs causing osteoporosis

corticosteroids
heparin
lithium
anastrozole
alcohol

57

drugs causing osteomalacia

phenytoin
etidronate

58

sevelamer

phosphate binding drug - prevents absorption in GI

tx for hyperphosphatemia

59

osteoporosis tx method

stop smoking, alcohol abuse, corticosteroid use

perimenopausal women == HRT

calcium Vit D supplement

bisphosphonates

SERMs

teriparatide

60

thiazides

decreases excretion of calcium - increased reabsorption

prevents renal stone formation

tx HTN in osteoporosis pt