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Pharm II > Bone Mineral Homeostasis-DONE > Flashcards

Bone Mineral Homeostasis-DONE Flashcards

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0
Q

Bone is a dynamic reservoir and there is constant remodeling, exchanging minerals with ___ and homeostasis is disrupted by ___ dysfunction?

A

intracellular fluid

intestine and kidney

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1
Q

What 2 minerals are important in bone homeostasis?

A

Calcium and phosphate

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2
Q

What are the principal hormone regulators of bone?

A

PTH
Fibroblast growth factor 23
Vitamin D

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3
Q

___ stimulates 1, 25 (OH2) D production in the kidneys

A

PTH

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4
Q

1,25 (OH2) D and Calcium _____ the production of PTH

A

suppress

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5
Q

1,25 (OH2) D stimulates intestinal absorption of ___

A

Calcium and phosphate

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6
Q

1, 25 (OH2) D and ___ stimulate proliferation and differentiation of osteoblasts and osteoclasts

A

PTH

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7
Q

PTH and 1,25 (OH2) D enhance ___ retention of calcium

A

renal

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8
Q

___ Promotes renal phosphate excretion

A

PTH

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9
Q

___ promotes renal absorption of phosphate

A

1,25 (OH2) D

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10
Q

___ stimulates renal phosphate excretion and inhibits renal production of 1, 25 (OH2) D

A

FGF23

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11
Q

1,25 (OH2) D and phosphate stimulate the production of ____

A

FGF23

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12
Q

Effects of PTH

A

Raises calcium and reduces phosphate

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13
Q

Effects of FGF23

A

decreases phosphate

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14
Q

Effects of Vitamin D

A

raises calcium and raises phosphate

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15
Q

What is a recombinant PTH 1-34 that in excess endogenous PTH Increases bone resorption? Low intermittent doses of PTH increase bone formation without stimulating bone resorption

A

Teriparatide

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16
Q

What are the reabsorption affects of PTH in the kidneys?

A

Increases Ca and Mg

Reduces Phosphate, Amino Acids, bicarbonate, Sodium, Chloride and Sulfate

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17
Q

T/F Women and men with osteoporosis at high risk of fractures.

A

TRUE

Teriparatide is at least as effective as bisphosphonates in preventing fractures

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18
Q

What are two cautions associated with Teriparatide (Forteo)

A

Watch for high calcium levels

Only use for 2 years ( + 2 years = osteosarcoma)

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19
Q

What are the 2 types of Vitamin D?

A

Cholecalciferol (natural form)

Ergocalciferol (plant based form)

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20
Q

What is the active metabolite of vitamin D?

A

1, 25 dihydroxyvitamin D or Calcitriol (Rocaltrol)

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21
Q

Where is vitamin D cleared and where is it stored?

A

Cleared by the liver

Stored in adipose tissue

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22
Q

Name 3 Vitamin D Analogs

A

Calcipotriene (Calcipotriol)
Doxercalciferol (Hectorol)
Paricalcitol (Zemplar)

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23
Q

Read the functions of Vitamin D Metabolites/Analogs

A 
Intestinal calcium absorption
Bone Resorption
Renal Calcium and Phosphate reabsorption
Decrease PTH
Promote innate immunity
Inhibit adaptive immunity
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25
When do you use Vitamin D metabolites?
``` Osteoporosis Osteomalacia Renal failure Malabsorption Psoriasis ```
26
What is the MOA of calcitonin?
it lowers serum calcium and phosphate, inhibits osteoclastic bone resorption, and in time, reduces bone formation and absorption
27
What conditions is calcitonin useful in treating?
1. Paget's dz 2. hypercalcemia 3. osteoporosis
28
When prescribing a patient with osteoporosis Fortical, what are the specific directions you need to instruct the patient on how to take the med?
spray ONE spray in ONE nostril daily. Be sure to alternate nostrils (will need to keep a log)
29
____ is useful in reversing the hypercalcemia associated with lymphomas and granulomatous diseases such as sarcoidosis.
glucocorticoids
30
What is prolonged used of glucocorticoids a common cause of?
osteoporosis and stunted skeletal development
31
What is used to treat or prevent postmenopausal osteoporosis in the immediate postmenopausal period?
estrogen
32
____ retain the beneficial effect on bone while minimizing adverse effects on breast, uterus, and CV system.
SERMs (selective estrogen receptor modulators)
33
Which SERM interacts selectively with estrogen receptors and inhibits bone resorption W/O stimulating breast or endometrial hyperplasia?
Raloxifene (Evista)
34
____ is used in osteoporosis AND for 5 yrs to reduce breast cancer risk
Raloxifene (Evista)
35
Does Raloxifene (Evista) relieve menopausal symptoms?
NO
36
Raloxifene (Evista) may increase risk of....
VTE or stroke
37
Do you need to watch triglycerides with Raloxifene (Evista)?
YES
38
Does Raloxifene (Evista) reduce vertebral fractures?
YES
39
What is required for bone mineralization?
calcium and phosphate
40
What is Calcium and Phosphate used to treat?
osteoporosis, osteomalacia, calcium or phosphate deficiency
41
What is the MOA of bisphosphonates?
they suppress the activity of osteoclasts and increase bone density
42
T/F: Bisphosphonates reduce fractures over at least 5 years.
TRUE
43
How should bisphosphonates be taken?
on an empty stomach with water sitting upright or via IV
44
T/F: Calcitonin is more effective than Alendronate (fosamax)
FALSE According to the slides alendronate is more effective
45
For what conditions do you use Bisphosphonates for?
1. osteoporosis 2. bone metastases 3. hypercalcemia
46
____ acts on the osteoblast to induce a protein called ____.
PTH; RANKL (RANK ligand)
47
What does RANKL do?
it increases the number and activity of osteoclasts
48
____ is an antibody that inhibits RANKL to prevent excess bone resorption in patients with osteoporosis and certain cancers.
Denosumab (Prolia)
49
T/F: Denosumab (Prolia) inhibits osteoblastogenesis and activity
FALSE Inhibits osteoCLASTogenesis
50
What condition is Denosumab (Prolia) used for?
osteoporosis
51
Denosumab (Prolia) may increase risk of ____.
infections
52
Cinacalcet (Sensipar) = ____.
Calcium receptor agonist
53
What is the MOA of Cinacalcet (Sensipar)?
it activates the calcium sensing receptor (and in doing so inhibits PTH secretion)
54
Cinacalcet (Senispar) is used for _____.
hyperparathyroidism
55
What is an adverse effect of Cinacalcet (Sensipar)?
may cause nausea
56
T/F: ALL patients need calcium and vitamin D
TRUE (you can't build bone without them!!)
57
WHat are the 3 most common causes of Hypercalcemia?
1. thiazides 2. hyperparathyroid 3. cancer
58
What are the less common causes of Hypercalcemia?
high vitD, Sarcoidosis, thyrotoxicosis, milk-alkali syndrome, adrenal insufficiency, immobilization
59
What are two things that Hypercalcemia can cause that are very serious?
CNS depression and coma
60
What is the acute treatment of Hypercalcemia?
lower serum calcium by 1. Rehydration (urine flow aids excretion) 2. Followed by loop diuretic (decreases calcium reabsorption in kidney)
61
What are the Chronic Treatments for Hypercalcemia?
Bisphosphonates, Calcitonin, Gallium nitrate, Plicamycin, Phosphate, Glucocorticoids
62
Patient presents with neuromuscular tetany, paresthesia, laryngospasm, muscle cramps, convulsions. What are these specific signs and symptoms of?
Hypocalcemia
63
Hypoparathyroid, Vitamin D deficiency, chronic kidney disease, malabsorption (common in neonates and often resolves w/out treatment) are all causes of what?
hypocalcemia
64
What are the treatment options for Hypocalcemia?
1. Calcium IV, IM - calcium gluconate [IV, IM], Calcium gluceptate, calcium chloride 2. Calcium Oral - carbonate (tums), lactate, phosphate, citrate 3. Vitamin D supplementation (calcitriol)
65
What are the three most common causes of Hyperphosphatemia?
1. Common complications of renal failure 2. Hypoparathyroid 3. Vitamin D intoxication
66
What are the treatment options for Hyperphosphatemia?
1. emergency treatment is rarely needed 2. restrict dietary intake 3. phosphate binding gels (sevelamer)
67
What are the 5 causes of Hypophosphatemia?
1. Primary Hyperparathyroid 2. Vitamin D deficiency (intake or genetic rickets) 3. Idiopathic hypocalcemia 4. Renal phosphate wasting 5. Overuse of phosphate binders
68
How do you treat hypophosphatemia?
emergency treatment is rarely needed, oral supplementation
69
What is the radiopharmaceutical MINERAL in the US used to suppress bone resorption and increases bone formation?
Strontium (pipeline) | *IN Europe its used for osteoporosis and osteomalacia

Pharm II (13 decks)

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