Term
| hormone regulators of calcium and phosphate |
|
Definition
|
|
Term
| PTH increases _________ and decreases ___________ |
|
Definition
| serum calcium; serum phosphate |
|
|
Term
| PTH increases ________ production in the kidney. |
|
Definition
|
|
Term
| PTH is inhibited by _______. |
|
Definition
|
|
Term
| PTH indirectly increases.... |
|
Definition
| osteoclasts resorption of bone |
|
|
Term
| Why are low doses of PTH used to treat osteoporosis? |
|
Definition
| low doses of PTH can stimulate bone formation |
|
|
Term
| vitamin D net effect over time |
|
Definition
increased serum calcium
increased serum phosphate |
|
|
Term
| Vitamin D directly inhibits ______. |
|
Definition
|
|
Term
| High levels of calcium and phosphate... |
|
Definition
reduce the amount of vitamin D produced by the kidney
reduce PTH secretion |
|
|
Term
| mechanism of action for calcitonin |
|
Definition
decreases serum calcium and serum phosphate through bone and kidney
initially inhibits osteoclansts, but both formation and resorption ultimately reduced
decreases gastric acid output |
|
|
Term
| There are/are not major problems with decreased or increased calcitonin levels. |
|
Definition
|
|
Term
|
Definition
Paget's
hypercalcemia
osteoporosis
(all have decreased calcium) |
|
|
Term
| glucocorticoids mechanism of action |
|
Definition
antagonize vitamin D intestinal calcium transport
stimulate calcium excretion in the kidney
block bone formation |
|
|
Term
|
Definition
lymphoma
sarcoidosis
vitamin D intoxication
reverses hypercalcemia in these diseases |
|
|
Term
| side effects of prolonged administration of glucocorticoids |
|
Definition
osteoporosis in adults
stunted growth in children |
|
|
Term
| What prevents accelerated bone loss in post-menopausal women? |
|
Definition
|
|
Term
| proposed mechanism of action for estrogen in treating osteoporosis |
|
Definition
decreases bone resorption action of PTH
increases vitamin D in blood |
|
|
Term
| Estrogen is/is not indicated for primary treatment of osteoporosis. |
|
Definition
|
|
Term
| selective estrogen reuptake modulators (SERMs) |
|
Definition
| used for effects on bone without breast, uterus, and cardiovascular side effects |
|
|
Term
| major side effect of SERMs |
|
Definition
|
|
Term
| mechanism of action for calcimimetics (Cinacalcet) |
|
Definition
activate calcium sensing receptor (in parathyroid gland)
block PTH secretion |
|
|
Term
| calcimimetics (Cinacalcet) indications |
|
Definition
| secondary hyperparathyroidism in kidney disease and parathyroid cancer |
|
|
Term
|
Definition
cytotoxic antibiotic
unclear mechanism of action |
|
|
Term
| picamycin (Mithamycin) indications |
|
Definition
|
|
Term
| mechanism of action for thiazides in treating osteoporosis |
|
Definition
reduce renal calcium excretion
may increase effectiveness of PTH stimulating reabsorption of calcium by kidney and increasing sodium excretion |
|
|
Term
|
Definition
| reduces hypercalcemia and stone formation |
|
|
Term
| What nonhormonal agent is currently not indicated in osteoporosis but may stabilize hydroxypatite crystal? |
|
Definition
|
|
Term
|
Definition
nausea/vomiting
GI blood loss
arthralgias
arthritis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| zolentronate (Reclast, Zometa) |
|
Definition
|
|
Term
| bisphosphonate with least GI side effects |
|
Definition
|
|
Term
| What bisphosphonate is used in Paget's disease only? |
|
Definition
|
|
Term
| Bisphosphonates are analogs of __________. |
|
Definition
|
|
Term
| indications for bisphosphonates |
|
Definition
osteoporosis
hypercalcemia
Paget's |
|
|
Term
| drawbacks of bisphosphonates |
|
Definition
<10% absorbed in GI tract
food reduces absorption
causes gastric irritation |
|
|
Term
| bisphosphonate contraindications |
|
Definition
decreased renal function
esophagus motility disorders
PUD |
|
|
Term
| How should bisphosphonates be taken? |
|
Definition
| with full glass of water on an empty stomach and remain upright for 30 min |
|
|
Term
| Bisphosphonates have the greatest effect on __________. |
|
Definition
|
|
Term
| With bisphosphonates, half of the drug is absorbed in the ______ and retained for months; the remainder is excreted in the ______. |
|
Definition
|
|
Term
| How should a high dose (1000 mg) of calcium be taken? |
|
Definition
split between AM and PM doses
This will yield better absorption and cut down on constipation and flatulence.
If the patient is going on a high dose, advise them to up their fiber intake to counteract the constipation |
|
|
Term
| Tums, Os-Cal, Rolaids, Caltrate |
|
Definition
calcium carbonate
absorbed most efficiently when consumed with food
40% calcium by weight
inexpensive |
|
|
Term
|
Definition
calcium citrate
21% calcium by weight
absorbed euqually effectively with or without food
more expensive than calcium carbonate |
|
|
Term
| What type of calcium supplement is good for individuals with reduced levels of stomach acid? |
|
Definition
| calcium citrate (Citrucal) |
|
|
Term
|
Definition
9.3% calcium by weight
usually given IV |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| trick about calcium absorption |
|
Definition
As amount of elemental calcium increases, percentage absorption decreases.
Splitting doses >500 mg might increase absorption. |
|
|
Term
| What drugs may have use in osteoporosis but are not approved by the FDA for this use? |
|
Definition
calcitriol (Rocaltrol, Calcijex)
fluoride
HRT |
|
|
Term
| calcitriol (Rocaltrol, Calcijex) |
|
Definition
activated vitamin D
reduces fractures and increases bone mass |
|
|
Term
| What drugs are FDA approved for the treatment of osteoporosis? |
|
Definition
bisphosphonates
SERMs
teriparatide (Forteo)
calcitonin (Calcimar, Miacalcin) |
|
|
Term
|
Definition
recombinant form of PTH
protects against both spine and hip fx
shown to form new bone |
|
|
Term
| What FDA approved medication is approved in post menopausal osteoporosis and reduces fractures only in the spine? |
|
Definition
| calcitonin (Calcimar, Miacalcin) |
|
|
Term
| symptoms of hypercalcemia |
|
Definition
| CNS depression including coma |
|
|
Term
|
Definition
hyperparathyroidism
cancer
sarcoidosis
hypervitaminosis D |
|
|
Term
| Which bisphosphonates can be used for treatment of hypercalcemia? |
|
Definition
|
|
Term
| What medication is used for treatment of hypercalcemia and inhibits bone resorption? |
|
Definition
|
|
Term
| What medication can be used for treating hypercalcemia but is toxic causing thrombocytopenia? |
|
Definition
|
|
Term
| What is the fastest way to reduce calcium in hypercalcemia and is used after other methods fail? |
|
Definition
|
|
Term
|
Definition
tetany
paresthesias
laryngospasm
muscle cramps
convulsions |
|
|
Term
|
Definition
hypoparathyroidism
vitamin d deficiency
kidney disease
malabsorption |
|
|
Term
| treatment of hypocalcemia |
|
Definition
|
|
Term
| What form of calcium used to treat hypocalcemia is least irritating to the veins? |
|
Definition
|
|
Term
| What form of calcium used to treat hypocalcemia is the PO drug of choice? |
|
Definition
|
|
Term
| What form of vitamin D is best for treating hypocalcemia? |
|
Definition
|
|
Term
| causes of hyperphosphatemia |
|
Definition
renal failure
hypoparathyroidism
vitamin D intoxication |
|
|
Term
| treatment of hyperphosphatemia |
|
Definition
dialysis
glucose and insulin infusions
dietary restriction
(rarely an emergency) |
|
|
Term
| causes of hypophosphatemia |
|
Definition
hyperparathyroidism
vitamin D deficiency
hypercalciuria
rickets |
|
|
Term
| long-term symptoms of hypophosphatemia |
|
Definition
proximal muscle weakness
osteomalacia |
|
|
Term
| treatment of hypophosphatemia in x-linked and autosomal dominant disease |
|
Definition
|
|
Term
| treatment for primary hyperparathyroidism |
|
Definition
surgery is best
cinacalcet (calcimimetic) is in clinical trial for secondary hyperparathyroidism |
|
|
Term
| treatment of hypoparathyroidism |
|
Definition
vitamin D 25000-100000 IU 3x per week with calcium supplementation
calcitriol is also an option |
|
|
Term
| treatment of vitamin D deficiency/insufficiency |
|
Definition
|
|
Term
| treatment of hyperparathyroidism secondary to chronic kidney disease |
|
Definition
doxercalciferol (Hectoral)
paricalcitol (Zemplar) |
|
|
Term
| treatment of intestinal osteodystrophy |
|
Definition
| calcitrol may be helpful along with calcium and phosphate monitoring |
|
|
Term
| treatment of nephrotic syndrome |
|
Definition
| no approved treatment or clinical trials |
|
|
Term
| treatment of enteric oxaluria |
|
Definition
| calcium supplementation (binds oxalate and prevents its absorption) |
|
|
Term
| treatment of type I vitamin D dependent rickets |
|
Definition
vitamin D 4000 IU daily
OR
calcitriol |
|
|
Term
| treatment of type II vitamin D dependent rickets |
|
Definition
|
|
Term
| treatment of ideopathic hypercalciuria |
|
Definition
HCTZ
do NOT use loop diuretics!
allopurinol is an alternative |
|
|
Term
| drug of choice for treatment of Paget's disease |
|
Definition
| calcitonin and bisphosphonates |
|
|
Term
| goal of treatment for Paget's disease |
|
Definition
reduce bone pain
prevent deformity, hearing loss, cardiac failure, hypercalcemia |
|
|
Term
| What can be used in short courses for the treatment of Paget's if calcitonin and bisphosphonates have failed? |
|
Definition
|
|
Term
| What does etidronate toxicity result in? |
|
Definition
| osteomalacia and bone pain |
|
|
