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Flashcards in Other bone diseases Deck (27):
1

Paget's disease

localized bone disease characterized be uncontrolled bone resorption w/ secondary increase of bone formation, new bone is poorly organized, irregularly shaped and poor mineralization, bones are thick and brittle

2

Paget's affects how many

3-4% of all Americans over the age of 50, second bost prevalent bone remodeling disease second only osteoporosis

3

Clinical presention of Paget's

often asymptomatic, deep aching sensation worsens w/ wt bearing, pain is mild to severe unrelated to activity, may have deformities, loss of ht

4

Complication of Paget's

often occur when bony overgrowth presses against other structures- lead to blindness, vertigo, hearing loss, tinnitus, increased calcification can lead to CHF, gout, arthritic changes

5

Treatment of Paget's

Asymptomatic- monitor pt, education, symptomatic- bisphosphonates- DOC for their activity on osteoclasts to slow bone turnover, NSAIDs, Calcitonin- relieve bone pain, used if bisphosphonates cannot be used, PT, surgical intervention

6

Rickets

associated with softening and weakening of bones in children, usually related to an extreme vit d deficit, can be genetic

7

Rickets presents with

delayed growth, pain, muscle weakness, bowed legs, thickened wrists/ankles, breastbone projection

8

Rickets risk factors

age, dark skin, prematurity, exclusively breast-fed infants

9

Rickets etiology

nutritional, vit D resistant rickets, vit D dependent rickets type 1, vit D dependent rickets type II, renal osteodystrophy

10

Vit D analog

Calcitriol (Rocaltrol), Cholecalciferol, Doxercalciferol (Hectoral), Ergocalciferol (Drisdol), Paricalcitol (Zemplar)

11

Vit D MOA

Vit D analog bind to the Vit D receptors in kidneys, PTH gland, intestines and bone, doing so reduces PTH levels and improves Ca and Phos homeostasis

12

Vit D PEARLs

decreased renal conversion of vit D to its primary active metabolite in chronic renal failure leads to reduced activation of vit D receptor, removes suppression of PTH release, increased serum PTH reduces calcium excretion and enhances bone resorption

13

Calcitriol (Rocaltrol) MOA

active form of Vit D works via several pathways to increase [Ca], once daily, IV 1-2 per month, adequate dietary Ca necessary for effect

14

Calcitriol (Rocaltrol) clinical uses

rickets, hypocalcemia related to renal disease, management of hyperparathyroidism in pts w/ chronic kidney disease

15

Calcitriol (Rocaltrol) ADRs

well tolerated, GI intolerance only

16

Cholecalciferol (Vit D3) MOA

synthetic vit D3 derivative, products available OTC, often in combo w/ calcium, given PO once daily

17

Cholecalciferol (Vit D3) clinical uses

rickets, vit D deficiency, osteoporosis prevention, hypocalcemia

18

Ergocalciferol (Drisdol) MOA

Active form of Vit D works via several pathways to increase [Ca], given once daily, once weekly or monthly

19

Ergocalciferol (Drisdol) clinical uses

vit d deficiency, osteoporosis prevention, hypoparathyroidism, osteomalcia, rickets

20

Doxercalciferol (Hectoral) MOA

metabolized to the active form of vit D, given IV and PO, usually 3 x weekly, monitor and adjust dose based on PTH levels

21

Docercalciferol (Hectoral) clinical uses

secondary hyperparathyroidism in pts with CKD

22

Docercalciferol (Hectoral) ADRs

edema, GI intolerance

23

Paricalcitol (Zemplar) MOA

synthetic vit D analog, IV every 2-4 weeks, titrated to goal PTH, PO 3x weekly

24

Paricalcitol (Zemplar) caution use

hypercalcemia, excessive vit D can lead to over suppression of PTH

25

Two types of hyperparathyroidism

Primary- unknown cause, prob familial and characterized by excessive secretion of PTH, Secondary- usually due to disease state such as renal failure, cuases decrease in ionized serum calcium levels (Thyroiditis, medications)

26

Effects of hyperparathyroidism

bone looses density, hypercalcinuria, anorexia, N/V, ab pain, agitation, nervousness, anxiety, fatigue

27

Treatment of hyperparathyroidism

focuses on correcting hypertrophy of the parathyroid, vit D therapy and renal replacement therapy for pt w/ renal failure, adequate hydration, diuretics, drugs that decrease resorption of Ca, surgery