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ERM > Endocrinology Part 4 > Flashcards

Endocrinology Part 4 Flashcards

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1
Q

What does calcitonin do in the kidney?

A

Small decrease in Ca2+ and PO4 reabsorption

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2
Q

How is calcitonin controlled?

A

Stimulation of CSR increases calcitonin secretion

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3
Q

What stimulates the osteoclast?

A

PTH binds PTHR-1 on osteoblast which produces osteoid, OPG, and RANKL –> RANKL binds RANK on the osteoclast –> osteoclast releases H+ and proteases

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4
Q

Why is salmon calcitonin used over human calcitonin?

A

Salmon calcitonin is less likely to breakdown and has increased affinity for the receptor

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5
Q

What hormone can reduce RANKL production and increase OPG production?

A

Estrogen –> by directly increasing PTH

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6
Q

Starting with cholecalciferol how is Vitamin D activated?

A

Cholecalciferol –> 25 hydroxylase in the liver ==> calcifediol –> 1-alpha-hydroxylase in the kidney ==> calcitriol (active)

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7
Q

How does vitamin D affect Ca2+ and PO4?

A

Increase both Ca2+ and PO4 by increasing abosrption in the GI tract

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8
Q

What can excess vitamin D cause?

A

Hypercalcemia, increase RANKL expression = more resorption

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9
Q

What does vitamin D do in the kidney?

A

Small increase in Ca2+ and PO4 reabsorption

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10
Q

How is vitamin D synthesis controlled?

A

PTH increases activation of 1-alpha-hydroxylase which increase concentration of activated vitamin D

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11
Q

What is the MOA of teriparatide?

A

PTH analog –> leads to increased bone formation

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12
Q

How is teriparatid supplied?

A

Injectable

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13
Q

What are the adverse effects of teriparatid?

A

Muscle/bone pain

Osteosarcoma

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14
Q

What is the MOA of calcitonin?

A

MOA of calcitonin? How is it supplied? What are the adverse effects?
Decrease osteoclast function –> leads to decreased bone resorption, overactive remodeling, and Ca2+

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15
Q

How is calcitonin supplied?

A

Injectable and nasal spray

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16
Q

What are the AE of calcitonin

A

Low incidence of N/V

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17
Q

What is the MOA of bisphosphonates?

A

Decrease osteoclast function –> leads to decreased bone resorption and overactive remodeling

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18
Q

How are bisphosphonates supplied?

A

Oral and injectable

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19
Q

What are the AE of bisphosphonates?

A

Esophagitis
jaw necrosis,
atypical femur fractures

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20
Q

What is the MOA of raloxifene?

A

SERM –> agonist to ER in bone and liver (decrease resorption, increase formation, decrease LDL), antagonist to ER breast and uterus

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21
Q

How is raloxifene supplied?

A

Oral

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22
Q

What are the AE of raloxifene

A

Inc risk of thromboembolism & hot flashes

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23
Q

MOA of cinacalcet

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A

Calcimimetic –> increases activation of the CSR to decrease PTH

24
Q

How is cinacalcet supplied?

25
What are the adverse effects of cinacalcet?
HypOcalcemia
26
How do loop diuretics affect calcium?
Decrease renal Ca2+ reabsorption
27
How do thiazide diuretics affect calcium?
Increase renal Ca2+ reabsorption
28
What can excess calcium supplementation cause?
HypERcalcemia Constipation Kidney stones
29
What is the MOA of denosumab?
Monoclonal antibody to RANKL --> decrease bone resorption
30
How is denosumab supplied?
Injectable
31
What are the AE of denosumab?
Risk of infections/malginancies
32
What are the symptoms of hypercalcemia?
Ion channel inhibition Kidney Cardiovascular Soft tissue calcification Bone loss
33
HypERcalcemia - ion channel inhibition sx
``` Constipation N/V dec DTR's Depression Lethargy Confusion Memory loss ```
34
HypERcalcemia - kidney sx
Polyuria Polydipsia Kidney stones
35
HypERcalcemia - CV sx
BradyC Sinus arrest Dec QT
36
HypERcalcemia - soft tissue calcification sx
``` Pruritus Crunchy skin Pain/swelling joins Inflammation Risk of thromboembolism ```
37
What can cause hypercalcemia?
Parathyroid tumor excreting excess PTH Humoral hypercalcemia of malignancy releasing PTHrP Bone tumor releasing RANKL Excess vitamin D Hyperthyroidism Lithium Thiazide diuretics
38
How can hypercalcemia be treated?
Surgery of tumor, hydration, bisphosphonates, calcitonin, furosemide Cinacalcet for PT tumor High dose denosumab for bone tumor
39
What are the symptoms of hypocalcemia?
``` Muscle spasms Tetany Inc DTR's Paresthesia Hallucinations Seizures HF Inc QT Dry skin Brittle nails Hair loss ```
40
What can cause hypocalcemia?
Hypoparathyroidism (low PTH) Psuedohypoparathyroidsim (low PTHR-1) Vitamin D deficiency Ca2+ complex formation due to blood transfusion or muscle damage
41
How can hypocalcemia be treated?
Treat the cause, give Ca2+/vitamin D supplementation, thiazide diuretics, off-label use of teriparatide
42
What is rickets?
rickets? | Inadequate mineralization of bone in children (thin cortical bone)
43
What are the symptoms of rickets?
the symptoms of rickets? | Short bones, deformities, fractures
44
What is osteomalacia? symptoms?
Inadequate mineralization of bone in adults (thin cortical bone) Causes bone pain and fractures
45
What can cause inadequate mineralization of bone?
Vitamin D deficiency/activation problems, low Ca2+, low PO4-
46
How can inadequate mineralization be treated?
Treat the cause (ie. if caused by dilantin , d/c the drug) Ca2+/vitamin D supplementation
47
What is Paget's disease?
Localized hyperactive remodeling causing bone swelling, pain, fractures, and increased risk of sarcoma
48
What can cause Paget's disease?
Genetics or a virus
49
How can Paget's disease be treated?
Bisphosphonates and calcitonin
50
What is renal osteodystrophy?
Chronic renal failure coupled with excessive bone resorption
51
What can cause renal osteodystrophy?
Decreased activation of vitamin D --> decreases Ca2+ absorption in GI --> decreases fre e Ca2+ --> increases PTH --> increases resorption Increased PO4 retention --> binds free Ca2+ --> increases PTH --> increases resorption
52
How can renal osteodystrophy be treated?
Ca2+ and activated vitamin D supplementation Cinacalcet Sevelamer
53
What is osteoporosis?
Loss of cortical bone resulting in thin/weak bone --> causes vertebral fractures, kyphosis, hip fractures, and wrist/forearm fractures
54
What can cause primary osteoporosis?
Menopause and age | considered normal
55
What can cause secondary osteoporosis?
``` Excess PTH Thyroid hormones Glucocorticoids Immobilization Chronic phenytoin Barbituates Heparin use ```
56
How can primary osteoporosis be diagnosed?
Measure BMD (Bone Mineral Density) T > 2.5 sd below normal = osteoporosis 2.5 > T > 1 sd below normal = osteopenia
57
How is primary osteoporosis treated?
Excercise, fall prevention, diet Ca2+/vitamin D supplementation Bisphosphonates Estrogens, raloxifene Calcitonin Teriparatide Low dose denosumab

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