METABOLIC PROFILE DRUGS - Agents That Affect Bone Mineral Homeostasis Flashcards Preview

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Flashcards in METABOLIC PROFILE DRUGS - Agents That Affect Bone Mineral Homeostasis Deck (96):
1

Action of the parathyroid hormone is

- 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

True or False. The parathyroid hormone increases serum calcium and decreases serum phosphate.

TRUE

3

True or False about parathyroid hormone. The parathyroid hormone (PTH) is a single-chain peptide hormone composed of 84 amino acids

TRUE

4

True or False about parathyroid hormone. The parathyroid hormone increases calcium and phosphate absorption in intestine (by increased 1,25-dihydroxyvitamin D3 production)

TRUE

5

True or False about parathyroid hormone. The parathyroid hormone increases serum calcium and decreases serum phosphate

TRUE

6

True or False about parathyroid hormone. The parathyroid hormone increases calcium excretion and decreases phosphate excretion in kidneys

FALSE

7

True or False about calcitonin. Calcitonin secreted by parafollicular cells of the mammalian thyroid is a single-chain peptide hormone with 32 amino acids

TRUE

8

True or False about calcitonin. Effects of calcitonin are to lower serum calcium and phosphate by acting on bones and kidneys.

TRUE

9

True or False about calcitonin. Calcitonin inhibits osteoclastic bone resorption.

TRUE

10

Mechanism of action of calcitonin is

Raises intracellular cAMP in osteoclasts

11

Indications for calcitonin administration are

- Hypercalcemia
- Paget's disease
- Osteoporosis

12

Side effect of calcitonin is

Tetany

13

Side effect of calcitonin is

Hypotension

14

Glucocorticoid hormones alter bone mineral homeostasis

- By antagonizing vitamin D-stimulated intestinal calcium transport
- By stimulating renal calcium excretion
- By increasing parathyroid hormone stimulated bone resorption

15

True or False. Estrogens can prevent accelerated bone loss during the immediate postmenopausal period and at least transiently increase bone in the postmenopausal subject.

TRUE

16

Action of vitamin D3 is

- 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

True or False. Vitamin D3 increases serum calcium and phosphate.

TRUE

18

Route of administration of vitamin D3 is

Oral

19

Side effect of vitamin D3 is

Nephrolithiasis

20

Indication of vitamin D3 is

Hypophosphatemia

21

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.

TRUE

22

Route of administration of 25-hydroxyvitamin D3 (calcifediol) is

Oral

23

Indication for 25-hydroxyvitamin D3 (calcifediol) administration is

Failure of vitamin D formation in skin

24

Side effect of 25-hydroxyvitamin D3 (calcifediol) is

- 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

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