METABOLIC PROFILE DRUGS - Agents That Affect Bone Mineral Homeostasis Flashcards
(96 cards)
1
Q
Action of the parathyroid hormone is
A
- Increased calcium and phosphate absorption in intestine (by increased 1,25-dihydroxyvitamin D3 production)
- Decreased calcium excretion and increased phosphate excretion in kidneys
- In bone, calcium and phosphate resorption increased by high doses. Low doses may increase bone formation.
2
Q
True or False. The parathyroid hormone increases serum calcium and decreases serum phosphate.
A
TRUE
3
Q
True or False about parathyroid hormone. The parathyroid hormone (PTH) is a single-chain peptide hormone composed of 84 amino acids
A
TRUE
4
Q
True or False about parathyroid hormone. The parathyroid hormone increases calcium and phosphate absorption in intestine (by increased 1,25-dihydroxyvitamin D3 production)
A
TRUE
5
Q
True or False about parathyroid hormone. The parathyroid hormone increases serum calcium and decreases serum phosphate
A
TRUE
6
Q
True or False about parathyroid hormone. The parathyroid hormone increases calcium excretion and decreases phosphate excretion in kidneys
A
FALSE
7
Q
True or False about calcitonin. Calcitonin secreted by parafollicular cells of the mammalian thyroid is a single-chain peptide hormone with 32 amino acids
A
TRUE
8
Q
True or False about calcitonin. Effects of calcitonin are to lower serum calcium and phosphate by acting on bones and kidneys.
A
TRUE
9
Q
True or False about calcitonin. Calcitonin inhibits osteoclastic bone resorption.
A
TRUE
10
Q
Mechanism of action of calcitonin is
A
Raises intracellular cAMP in osteoclasts
11
Q
Indications for calcitonin administration are
A
- Hypercalcemia
- Paget’s disease
- Osteoporosis
12
Q
Side effect of calcitonin is
A
Tetany
13
Q
Side effect of calcitonin is
A
Hypotension
14
Q
Glucocorticoid hormones alter bone mineral homeostasis
A
- By antagonizing vitamin D-stimulated intestinal calcium transport
- By stimulating renal calcium excretion
- By increasing parathyroid hormone stimulated bone resorption
15
Q
True or False. Estrogens can prevent accelerated bone loss during the immediate postmenopausal period and at least transiently increase bone in the postmenopausal subject.
A
TRUE
16
Q
Action of vitamin D3 is
A
- Increased calcium and phosphate absorption by 1,25 dihydroxyvitamin D3
- Calcium and phosphate excretion may be decreased by 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3
- Increased calcium and phosphate resorption by 1,25 dihydroxyvitamin D3; bone formation may be increased by 25,24-dihydroxyvitamin D3
17
Q
True or False. Vitamin D3 increases serum calcium and phosphate.
A
TRUE
18
Q
Route of administration of vitamin D3 is
A
Oral
19
Q
Side effect of vitamin D3 is
A
Nephrolithiasis
20
Q
Indication of vitamin D3 is
A
Hypophosphatemia
21
Q
True or False. 25-hydroxyvitamin D3 (calcifediol) is less effective than 1,25-dihydroxyvitamin D3 (calcitriol) in stimulating intestinal calcium transport, so that hypercalcemia is less of a problem with calcifediol.
A
TRUE
22
Q
Route of administration of 25-hydroxyvitamin D3 (calcifediol) is
A
Oral
23
Q
Indication for 25-hydroxyvitamin D3 (calcifediol) administration is
A
Failure of vitamin D formation in skin
24
Q
Side effect of 25-hydroxyvitamin D3 (calcifediol) is
A
- Hypercalcemia
- Pruritus
- GI toxicity
25
Indications for 1,25-dihydroxyvitamin D3 (calcitriol) administration are
- Hypocalcemia in chronic renal failure
- Vitamin D-dependent rickets
- Malabsorption of vitamin D from intestine
26
Indication for 1,25-dihydroxyvitamin D3 (calcitriol) administration is
Hypophosphatemia
27
True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). When rapidity of action is required, 1,25-dihydroxyvitamin D3 (calcitriol), 0.25-1 μg daily, is the vitamin D metabolite of choice, since it is capable of raising serum calcium within 24-48 hours
TRUE
28
True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). Calcitriol also raises serum phosphate, though this action is usually not observed early in treatment
TRUE
29
True or Falseabout 1,25-dihydroxyvitamin D3 (calcitriol). Undergoes enterohepatic circulation
TRUE
30
Which statements refers to 1,25-dihydroxyvitamin D3 (calcitriol)
The combined effect of calcitriol and all other vitamin D metabolites and analogs on both calcium and phosphate makes careful monitoring of the level of these minerals especially important to avoid ectopic calcification
31
Route of administration of 1,25-dihydroxyvitamin D3 (calcitriol) is
Oral
32
Commercially available analogs of 1,25-dihydroxyvitamin D3 (calcitriol) are
- Doxercalciferol (Hectoral)
| - Paricalcitol (Zemplar)
33
Side effect of dihydrotachysterol is
Hypertension
34
Route of administration of dihydrotachysterol is
Oral
35
Which statements refers to cholecalciferol
Mechanism of action: 1. Genomic effects 2. Cytoplasmic effects
36
Indication for cholecalciferol administration is
Malabsorption of vitamin D from intestine
37
Route of administration of cholecalciferol is
Oral
38
The unwanted effect of cholecalciferol is
CNS toxicity
39
The unwanted effect of dihydrotachysterol is
CNS toxicity
40
Indication for dihydrotachysterol administration is
Hypophosphatemia
41
Conditions associated with hypophosphatemia include
- Primary hyperparathyroidism
- Vitamin D deficiency
- Idiopathic hypercalciuria
42
True or False. The long-term effects of hypophosphatemia include proximal muscle weakness and abnormal bone mineralization (osteomalacia).
True
43
Recommended phosphorus daily allowance is
900-1200 mg
44
Interactions with other drugs of phosphorus is
Calcitonin: increases renal excretion
45
Indication for pamidronate administration is
Hypercalcemia
46
Route of administration of pamidronate is
Intravenous
47
True or False about pamidronate include. Because it causes gastric irritation, pamidronate is not available as an oral preparation
TRUE
48
True or False about pamidronate include. Skeletal half-life is 24 h
FALSE
49
True or False about pamidronate include. Fever and lymphocytopenia are reversible
TRUE
50
True or False about pamidronate include. Can be irritable to the esophagus if not washed promptly to the stomach
TRUE
51
Route of administration of alendronate is
Oral
52
True or False about alendronate include. Can be irritable to the esophagus if not washed promptly to the stomach
TRUE
53
True or False about alendronate include. 1st generation biphosphonate
FALSE
54
True or False about alendronate include. Reduces osteoclast activity without significantly affecting osteoblasts; useful in the treatment of Paget's disease
TRUE
55
True or False about alendronate include. More potent than EHDP; has a wider therapeutic window
TRUE
56
Indications of alendronate are
- Glucocorticoid-induced osteoporosis
- Paget's disease
- Syndromes of ectopic calcification
57
Indication for etidronate administration is
Paget's disease
58
Indications for etidronate administration are
- Paget's disease
- Osteoporosis
- Hypercalcemia
59
True or False about etidronate. Bioavailability increases with the administered dose
TRUE
60
True or False about etidronate include. Skeletal half-life is hundreds of days
TRUE
61
True or False about etidronate include. Bioavailability increases with the administered dose
TRUE
62
True or False about etidronate include. 2nd generation biphosphonate (amino-biphosphonate)
FALSE
63
True or False about etidronate include. 1st generation biphosphonate.
TRUE
64
Unwanted effect of etidronate is:
Defective bone mineralization
65
The major causes of hypocalcemia in the adult are
- Hypoparathyroidism
- Vitamin D deficiency
- Renal failure and malabsorption
66
The major causes of hypercalcemia in the adult are
- Hyperparathyroidism
- Cancer with or without bone metastases
- Hypervitaminosis D
67
True or False about calcium. Recommended Ca daily allowance for males: 1. 1-10 years: 800 mg 2. 11-18 years: 1200 mg 3. 19-50 years: 1000 mg 4. > 51 years: 1000 mg
TRUE
68
True or False about calcium. Ca chloride is very irritating and can cause necrosis if extravasated
TRUE
69
True or False about calcium. In achlorhydric patients calcium carbonate should be given with meals to increase absorption or patient switched to calcium citrate, which is somewhat better absorbed
TRUE
70
Indication for calcium administration is
Vitamin D deficiency
71
Which of the calcium preparations is the most preferable for IV injection
Calcium gluconate (0.45 meq calcium/mL)
72
Which of the oral calcium preparations is often the preparation of choice
Calcium carbonate (40% calcium)
73
Interactions with other drugs of calcium is
- Ethanol: decreases absorption
- Loop diuretics: increase renal excretion
- Glucocorticoids: stimulate renal excretion
74
True or False about magnesium include. Magnesium is mainly an intracellular cation, and is the fourth most abundant cation in the body
TRUE
75
True or False about magnesium include. The recommended dietary amounts of magnesium have been set at 6 mg/kg day (350-400 mg)
TRUE
76
True or False about magnesium include. The most common specific causes encountered in clinical practice are: diet, alcoholism (drinking), diarrhea and malabsorption, diabetes mellitus, diuretics, and drugs such as aminoglycosides and amphotericin
TRUE
77
True or False about magnesium include. It is a physiological calcium agonist
FALSE
78
Recommended magnesium daily allowance is
350-400 mg
79
The major causes of hypomagnesaemia are
- Insufficient dietary intake, e.g. malnutrition
- Abnormal gastrointestinal loss, e.g. severe diarrhea or chronic alcoholism
- Abnormal renal loss, e.g. diabetes mellitus or during therapy with some kind of drugs such as amphotericin B, gentamicin, cisplatin, cardiac glycosides, distal and loop diuretics
80
Which of the magnesium preparation is the most preferable for I.V. injection
Magnesium chloride
81
Which of the oral magnesium preparations is often the preparation of choice
MagneB6 (Mg pidolate / Mg lactate + pyridoxine hydrochloride)
82
True or False about fluoride include. Fluoride is effective for the prophylaxis of dental caries
TRUE
83
True or False about fluoride include. Fluoride is accumulated by bone and teeth, where it may stabilize the hydroxyapatite crystal
TRUE
84
True or False about fluoride include. Subjects living in areas with naturally fluoridated water (1-2 ppm) had more dental caries and fewer vertebral compression fractures than subjects living in nonfluoridated water areas
FALSE
85
True or False about fluoride include. Chronic exposure to very high level of fluoride dust in the inspired air results in crippling fluorosis, characterized by thickening of the cortex of long bones and bony exostoses.
TRUE
86
Recommended fluoride daily allowance is
1.5-4 mg
87
True or False about gallium nitrate. It is approved by the FDA for the management of hypercalcemia of malignancy
TRUE
88
True or False about gallium nitrate. This drug acts by inhibiting bone resorption
TRUE
89
True or False about gallium nitrate. Because of potential nephrotoxicity, patients should be well-hydrated and have good renal output before starting the infusion
TRUE
90
True or False about plicamycin (formerly mithramycin). Duration of action is usually several days
TRUE
91
True or False about plicamycin (formerly mithramycin). Mechanism of cytotoxic action appears to involve its binding to DNA, possibly through an antibiotic-Mg2+ complex.
TRUE
92
True or False about plicamycin (formerly mithramycin). The drug causes plasma calcium levels to decrease, apparently through an action on osteoclasts that is independent of its action on tumor cells and useful in hypercalcemia.
TRUE
93
Unwanted effects of plicamycin (formerly mithramycin) are
Fractures
94
Unwanted effect of plicamycin (formerly mithramycin) is
Myelosuppression
95
Indication for plicamycin (formerly mithramycin) administration is
- Testicular cancers refractory to standard treatment
- Paget’s disease
- Hypercalcemia of malignancy
96
Route of administration of plicamycin is
Intravenous
