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Thyroid Gland And Bone Metabolism > Bone Mineralisation > Flashcards

Bone Mineralisation Flashcards

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1
Q

Vit D preperations

A

Cholecalciferol and calcitriol

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2
Q

Calcimimetic agents

A

Cinacalcet

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3
Q

Agents acting on bone mineral metabolism

A

Alendronic acid, zolendronic acid, Denozumab, Teriparatide

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4
Q

Main elements of bone

A

Calcium and phosphate

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5
Q

PTH and vit D also play a role in

A

Bone mineral metabolism

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6
Q

PTH is

A

Primary regulator of metabolism in bones and kidney

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7
Q

PTH has direct effect on – receptor and indirectly on —–

A

Direct effect on osteoblast PTH receptor and indirect on osteoclasts,by RANK /OPG

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8
Q

PTH action

A

Increase serum calcium and this is partially achieved by enhanced bone demineralization

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9
Q

Bone remodelling

A

Balance between bone resorption and formation process

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10
Q

RANK expression is provided by

A

Osteoclast

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11
Q

OPG is secreted by

A

Osteoblast

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12
Q

In presence of macrophage colony stimulating factor (M-CSF),RANKL stimulate

A

Osteoclast activity and bone resorption (This is main practice factor)

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13
Q

OPG are

A

Osteoblast secreted soluble misleading receptor for RANKL to bind, to stop osteoclast activation

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14
Q

Balance between Osteoblast OPG secretion and osteoclast RANKL expression are modulated by

A

Various hormones and cytokines like PTH,vit D,sex hormone,IL-1

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15
Q

OPG full form

A

Osteoprotegerin

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16
Q

Calcitonin increase

A

Calcium and phosphate excretion

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17
Q

PTH hormone increase calcitriol ,and thereby

A

Increase calcium reabsorption from kidney

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18
Q

Increased amount of calcium and phosphate are absorbed from gut into blood stream are stimulated by

A

Calcitriol (D3), Denozumab, Ergocalciferol (vitD2), Teriparatide

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19
Q

Calcitonin is a functional antagonist of

A

PTH

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20
Q

Hypercalcaemia treatment

A

Calcitonin,Bisphosphonates

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21
Q

Hypocalcemia treatment

A

Calcitriol , Denozumab, Teriparatide, Ergocalciferol

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22
Q

PTH action

A

On decreased plasma calcium -increase PTH secretion -increase calcitriol D3 formation in kidney -increase calcium absorption from gut and; increased bone resorption

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23
Q

Calcitonin is secreted in

A

Thyroid gland

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24
Q

Osteoporosis is

A

Decreased bone mineral density or bone mass loss-brittle bones

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25
BMD control is indicated for
Postmenopausal women after 65years and men over 70 ,to reduce fracture risk from primary osteoporosis
26
Causes of secondary osteoporosis
Medications like glucocorticoid,loop diuretics,proton pump inhibitors
27
Inadequate bone mineralization in children
Rickets
28
Inadequate bone mineralization in adults
Osteomalacia (soft bones)
29
Renal osteoporosis (osteodystrophy)
CKD with GFR less than 30-decresed activation of vit D in kidney and hypocalcemia (no absorptions happening),also cause hyperphosphatemia.Decreased serum calcium further activate PTH-secondary parathyroidism
30
Anti resorptives
Bisphosphonates,RANKL inhibitors, estrogens/androgens
31
Osteoanabolic agents
PTH analogue
32
Medicines for prevention and treatment of osteoporosis
Vit D and analogue
33
Bisphosphonates
Analogue of pyrophosphate,which are resistant to pyrophosphate utilizing enzyme
34
Bisphosphonates action
Inhibit farnesylpyrophosphate synthetase, binds to bone hydroxyapatite crystals and inhibit bone resorption, Together with calcium,does osteoclast inhibition and apoptosis,..... Anti resorptive effect
35
Zolendronic acid has higher effects than Bisphosphonates
As it represents amino Bisphosphonates by adding nitrogen containg side chain
36
Zolendronic acid has high
Hydroxyapatite affinity
37
Administration of zolendronic acid
Once in 12 months,T1/2 -10 years
38
Bisphosphonates
Alendronic acid and zolendronic acid
39
Uses of Bisphosphonates
Osteoporosis in postmenopause and andropause,bone tumor metastasis, secondary osteoporosis
40
SE of Bisphosphonates (alendronic acid and zolendronic acid)
Hypocalcemia,For p/o:GIT irritation, for I/v form:acute phase reactions like flu like symptoms,rare osteonecrosis of jaw bone
41
Severe hypocalcemia may manifest as
Cardiac arrythmia, neurological symptoms like seizures, tetany
42
Oral Bisphosphonates use guide
Before first meal, maintain body in vertical position for 30 min after use
43
Drug interactions with Bisphosphonates (alendronic and zolendronic acid)
NSAIDS exacerbates GIT irritation, antacids interfere with absorption
44
What should be controlled during Bisphosphonates therapy
Calcium and vit D level
45
RANKL inhibitors Denosumab intake
S/c 1*6 months
46
Denosumab action
Prevent interactions of RANKL and RANK and suppress osteoclast formation (Anti resorptive effect)
47
Denosumab has high affinity and specificity for
RANKL
48
Denosumab works similar to
OPG
49
Use of Denosumab
Osteoporosis in postmenopause and andropause,bone tumor metastasis (oncogenic hypercalcaemia), secondary osteoporosis
50
SE of Denosumab
Hypocalcemia
51
Teriparatide (PTH analogue) action
Osteoanabolic agents, steady state PTH affects osteoclast and cause intensive bone resorption Low dose PTH activate osteoblast and stimulate bone formation
52
Use of Teriparatide
Severe form of osteoporosis (in post menopause and andropause), Secondary osteoporosis (glucocorticoid induced osteoporosis)
53
Contraindication of Teriparatide
Hypercalcaemia
54
Ergocalciferol ( vitD2) is supplied by
Plant based diet
55
Body's main source of vit D
Cholecalciferol (vit D3)
56
Vit D3 is formed by
Influence of UVB radiation from skin 7-dehydrocholesterol
57
Vit D2 and D3 are metabosed in liver to
25-hydroxyvitamin D3( celcidiol)
58
Celcidiol is metabolised to 1,25 dihydroxyvitamin D3 in
Kidney
59
Which reaction is imp for formation of vit D
Hydroxylation
60
PTH acts on which enzyme in kidney to form calcitriol
1alpha hydroxylase
61
Active precursor of vit D
Ergocalciferol, cholecalciferol
62
Most biologically active form of vit D
Calcitriol
63
Calcitriol is
Non selective intracellular vit D receptor agonist
64
Calcitriol action
Regulate bone mineralization, osteoclast differentiation, reduce PTH synthesis,regulate calcium and phosphate homeostasis
65
VDRs(calcitriol) found in
Nuclei of almost all organs
66
Calcitriol has genomic effect on gene transcription as it works similar to
Steroid hormones like corticosteroids,sex hormones stc
67
Use of calcitriol
Prevention of rickets, osteoporosis,renal osteodystrophy, hypocalcemia
68
SE of calcitriol
Hypercalcaemia (headache, nausea, vomiting), calcification of organs
69
Synthetic tropically applied calcitriol derivative
Calcipotriol
70
Calcipotriol action
Modulate gene responsible for T lymphocytes differentiation and proliferation, induce keratinocyte differentiation and inhibit their proliferation
71
Use of calcipotriol
Psoriasis treatment (chronic autoimmune disease
72
VDR
Vit D receptor
73
RXR
Retinoid receptor complex
74
Vit D action on innate immune cells(macrophages, Dendritic cells)
Regulate innate immune cells maturation and production of cytokines
75
Vit D action on T cells
Decrease Th 1&17 cell dev, increase Treg/Th2 generation
76
Vit D action on B cell
Decrease IgG and IgM and plasma cells
77
Vit D also modulate
Angiogenesis and hair cycling
78
PTH and Teriparatide target organs
Kidney and bones
79
Vit D main targets
GIT, Kidney,Bones, Parathyroid bodies
80
PTH and Teriparatide action on kidney and bones
Increase calcium reabsorption and decrease phosphate reabsorption,increase 1 alpha hydroxylase activity, regulate osteoclast differentiation and function,if PTH has 24 HR duration -osteoclast activity predominates and PTH 3-5 h-osteoblast activity predominates
81
Vit D actions
Increase calcium and phosphate absorption and reabsorption in GIT and kidney, Regulate osteoclast differentiation and function in bones, decrease PTH synthesis and increase calcium sensitive receptor (CSR) expression
82
Cinacalcet action
Allosteric modulator of CSR for parathyroid cells, increase sensitivity of CSR to extracellular calcium, decrease PTH secretion -an antiparathyroid agent, anti secretory action - decrease plasma calcium levels
83
Use of cinacalcet
Primary and secondary hyperparathyroidism
84
Primary and secondary osteoporosis can be treated by
Bisphosphonates (alendronic and zolendronic acid),RANKL inhibitors (Denosumab),PTH analogue (Teriparatide)
85
Hypocalcemia is caused by
Cinacalcet, Denosumab and zolendronic acid
86
Thyroid hormone has cardiac
Inotropic and chronotropic effect

Thyroid Gland And Bone Metabolism (2 decks)

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