PHARMA calcium and bone homeostasis Flashcards Preview

Pharma > PHARMA calcium and bone homeostasis > Flashcards

Flashcards in PHARMA calcium and bone homeostasis Deck (120):
0

functions of bone

mineral reservoir
structural support
hematopoiesis

1

amt of calcium in averagediet

600-1000 mg

2

principal regulatoes

PTH
FGF 23
Steroid vitamin d

3

secondary regulators

calcitonin prolactin gh insulin
thyroid hormone, glucocorticoids, sex strroids

4

function of fgf 23

stimulates RENAL PO4 EXCRETION

5

what increases serum calcium and decrease serum phosphate
acts on bone and kidney

PTH

6

action of pth on bone

inc osteoclast activity by inducing RANK ligand (for bone REMODELING)

7

effect of low and intermittent PTH on bine

increase bone FORMATION

8

recombinant PTH 1-34

TERIPARATIDE

9

effect of pth on kidney

reabsorb calcium and magnesium
stimulate vit d production

10

forms of vit d

vit d3 cholecalciferol NATURAL
vit d2 ergocalciferol PLANT DERIVED

11

forms of vit d in liverr and kidney

liver 25OHD
kidney 1,25OH2D
kidney 24,24 OH 2D

12

calcifediol
calcitriol
secalcifediol

25 OH d3
1,25 oh 2D3
24,25 oh 2D3

13

give 3 vitamin d analogs

calcipotriene
doxercalciferol
paricalcitol

14

tx for psoriasis

CALCIPOTRIENE vit d analog

15

tx for 2ndary hyperparathyroidism

DOXERCALCIFEROL and PARACALCITOL vit d analogs

16

what inhibits and stimulates vit d metabolism

fgf23 inhibits
pth stimulates

17

which vit d is most potent and has low affinity

CALCITRIOL

18

calcifediol vs calcitriol

calcifediol more potent in stimulating renal reabsorption of ca and po4

19

pth regulated by feedback loops through?

calcium sensing receptors

20

directly inhibits PTH secretion

1,25(OH)2D

21

stimulates production of FGF23

1,25(OH)2D

22

inhibits 1,25(OH)2D production

FGF23

23

inhibit PTH secretion

Calcitriol analogs

24

mgmt of secondary hyperparathyroidism of CKD

Calcitriol analogs

25

Parafollicular cells of mammalian thyroid

Calcitonin

26

calcitonin half life

10mins

27

longer halflife, reduced metabolic clearance

salmon calcitonin

28

lowers Ca and PO4 reabsorption, dec GASTRIN secretion

calcitonin

29

potent stimulus for calcitonin secretion

Pentagastrin

30

block bone resorption and lower serum calcium

calcitonin

31

physiologic use of calcitonin

Paget's disease, Hypercalcemia, Osteoporosis

32

Glucocorticoid use

stimulates renal calcium excretion
antagonizes vit D transport
blocks bone formation

33

hypercalcemia associated with inc production of 1,25(OH)2D

Granulomatous diseases - Sarcoidosis

34

Estrogen

prevent accelerated bone loss in post menopausal women
reduce bone resorption
inc 1,25(OH)2D

35

Selective estrogen receptor modulators

breast, uterus, cardiovascular system

36

newer therapies for osteoporosis
no risk of breast and endometrial ca

raloxifene

37

Bisphosphonates

osteoclast apoptosis
inhibition of cholesterol pathway

38

amino bisphosphonates

Alendronate and risedronate

39

block farnesyl pyrophosphate synthase

amino bisphosphonates

40

First generation bisphosphonates

MEDronate
ETIdronate
CLODronate

41

second generation bisphosphonates

ALEdronate
PAMidronate

42

3rd generation bisphosphonates

RISEdronate
ZolEDdronate

10,000x more potent than 1st gen

43

All current available bisphosphonate hav this complication

Gastric irritation (possible exception of ETIdronate)

44

main contraindication of bisphosphonates

dec renal dunction
esophageal motility disorders
peptic ulcer disease

45

physiologic use of bisphosphonates

hypercalcemia
paget's disease
osteoporosis
bone metastasis

46

mineralization defect SE

ETIdronate

47

gastric and esophageal irritation SE

PAMidronate
high doses of ALEdronate

48

high doses of IV ZolEDronate SE

ONJ osteonecrosis of the jaw

49

Recombinant form of PTH stim bone formation

TERIparatide -

50

activates CaSR and blocks PTH secretion

Cinacalcet

51

Cinacalcet Tx

Secondary hyperPTH of CKD
Parathyroid carcinoma

52

cytotoxic antibody
binds to DNA and interrupts RNA synthesis

PLICAmycin

53

Thiazide use

reduces renal calcium excretion
block sodium reabsorption
inc Ca-Na exchange

54

reduces stone formation
decrease urine oxalate
increase urine Mg and Zinc

Thiazides

55

fluoride without adequate calcium produces

Osteomalacia

56

Blocks osteoclast differentiation while promoting their apoptosis

Strontium Ranelate

57

bone formation markers
inc bone density
dec fractures

Strontium Ranelate

58

for mgmt of hypercalcemia of malignancy
inhibits bone formation
potential nephrotoxic

Gallium Nitrate

59

major causes of hypercalcemia

thiazide therapy
hyperPTH
Cancer

60

less common cause of hypercalcemia

hypervitaminosis D

61

for syptomatic hypercalcemia

Saline Diuresis with furosemide

62

Tx for hypercalcemia of malignancy
has self-limited flu-like symptoms

PAMidronate
ZolEDronate

63

parentral and nasal administration of Salmon Calcitonin
ANCILLARY Tx

Calcimar

64

most dangerous SE of sudden thrombocytopenia followed by hemorrhage

PLICAmycin

65

"when all else fail"

PLICAmycin

66

fastest and surest way for hypercalcemia

IV phosphate

67

for chronic hypercalcemia of sarcoidosis, vit D intoxication etc

Glucocorticoids

68

Major causes of hypocalcemia in adult

hypoparathyroidism
vit D deficiency
CKD
Malabsoprtion

69

mainstay Tx for hypocalcemia

calcium and vitamin D

70

Calcium forms

Calcium gluceptate
Calcium GLUCOnate (preferred)
Calcium chloride

71

Oral preparation of Calcium

Ca carbonate (40%)
Ca phosphate (25%)
Ca citrate (21%)
Ca lactate (13%)

72

Ca carbonate should be given with meals
or Ca citrate alternative

Achlorydic patients

73

Tx for severe symtomatic hypocalcemia

5-20ml 10% calcium gluconate (slow infusion)

74

Vit D metabolite of choice
raises serum PO4

Calcitriol

75

Hyperphosphatemia symptoms

common complication of renal failure
vit D intoxication
hypoPTH
rare Tumoral calcinosis

76

phosphate-binding gel

SEVELAMER

77

hypophosphatemia related diseases

Vit D Deficiency
hypophosphatemic rickets
FANCONIs SYNDROME (renal wasting)

78

Reduced ATP
Decreased 2,3DPG
rhabdomyolysis

acute hypophosphatemia effects

79

For hypercalcemia

Saline + furosemide
bisphosphonate
calcitonin
plicamycin
phosphate IV - fastest
glucocorticoid - cancer

80

for hypocalcemia

Calcium gloconate IV
Calcium CO3PO
Calcitriol - RAPID

81

for hyperphosphatemia

PO4 restriction
SEVELAMER
Calcium
Aluminum antacid*
Dialysis

82

for hypophosphatemia

oral phosphate suppplment

83

Best Tx for HyperPTH

Surgery

84

Causes of HypoPTH

absence of PTH
abnormal target tissue response (pseudohoPTH)

85

nor mal or high PTH acting on the bone not kidneys

pseudohypoPTH

86

pseudohypoPTH causes

osteitis fibrosa

87

optimum level of 25(OH)D

30ng/mL

88

daily intake of Vit D

800-1200 units of vit D

89

effect of CKD in bone

Osteomalacia and Osteitis fibrosa

90

Tx for adynamic bone disease in CKD

DEFEROXAMINE

91

Analongs of calcitriol

DOXercalciferol
PARIcalcitriol

92

advantage of calcitriol analogs

less likely to induce HYPERGLYCEMIA

93

characterized by malabsorption of ca and vit d
and combined osteoporosis and osteomalacia

intestinal osteodystrophy

94

intestinal vs renal osteodystrophy

no osteitis fibrosa in intestinal dystrophy

95

tx for mild and severe int. osteodystrophy

mild vit d
severe calcitriol

96

causes of osteoporosis in men

chronic glucocorticoids
thyrotoxicosis and hyperparathyroidism
malabsorption
alcohol abuse
cigarette smoking
isionpathic

97

osteoporosis tx in postmenopausal women, may be accompanied by lower calcitriol?

estrogen cycled with progestin

98

serm for osteoporosis, preventing risk of breast and uterine cancer

RALOXIFENE

99

Raloxifene adverse effect

inc risk of thrombophlebitis

100

raloxifene clinical actions

protects against spine BUT NOT hip fractures
cant prevent HOT FLUSHES

101

recombinant pth
approved for use for ONLY 2 YEARS in sequential therapy

TERIPARATIDE

102

bisphosphonate for osteoporosis action

reduce risk of HIP SPINE AND OTHER fractures
for MEN AND WOMEN

103

toxicities of adjuvant endocrine tx

loss of BMD
bone fracture
osteoporosis
musculoskeletal / arthralgia

104

used for bmd assessment, from lumbar spine of one or both total hip sites

DXA scan

105

tx for high risk group of BMD (baseline score of <-2)

BISPHOSPHONATE therapy

106

calcitonin action on osteoporisis

affects only the SPINE

107

antibody to RANKL, for osteoporosis

DENOSUMAB

108

denosumab adverse effects

possible inc risk for infection
risk of OSTEONECROSIS OF JAW
subtrochanteric fractures

109

slow release, low dose tx for osteoporosisl

fluoride

110

loss of vit d binding protein, some develop bone disease

nephrotic syndrome

111

vit d dependent rickets type i and ii

type i - pseudovit d deficiency rickets, dec PRODUCTION, give vit d and calcitriol
type ii - hereditary vit d RESISTANT rickets, problems with receptor, give LARGE DOSES of calcitriol and calcium and po4 infusions

112

normal serum calcium and pth BUT
hypercalciuria and nephrolithiaisis

idiopathic hypercalciuria

113

idiopathoc hypercalciuria tx

hydrochlorothiazide or ALLOPURINOL

114

short bowel syndrome with fat malabsorption, with ca and oxalate renal stones

enteric oxaluria

115

enteric oxaluria etiology

calcium bound to fat fails to bind to oxalate

116

poorly organized bone, elevated ALK PHOSPHATASE and urinary HYDROXYPROLINE

pagets disease of the bone

117

pagets dse of the bone tx

first line CALCITONIN and BISPHOSPHONATES, requiring weeks to months
treatment failures PLICAMYCIN

118

etidronate adverse effects

osteomalacia
inc risk of fractures

119

alendronate adverse effects

gastric irritation, but reversible