Br Pharmacology: Bone Mineral Homeostasis

Front 1

What type of receptor does PTH act on? What is increased and it what parts of the body?

Back 1

1) G protein coupled receptor
2) increases cAMP in bone and renal tubular cells

Front 2

What is teriparatide? What is it used for?

Back 2

1) recombinant truncated PTH
2) osteoporosis

Front 3

How does PTH effect bone in continuous doses vs low intermittent doses?

Back 3

1) Continuous = Ca2+ and phosphate resorption increased
2) intermittent = increase bone formation

Front 4

What is the direct effect of vitamin D on bone? What is the indirect effect?

Back 4

1) direct = increased calcium and phosphate resorption
2) indirect = promotes bone mineralization by increasing blood levels of calcium and phosphate

Front 5

What is the net effect of PTH on calcium and phosphate levels?

Back 5

1) hypercalcemia
2) hypophosphatemia

Front 6

What is the net effect of vitamin D on serum calcium and phosphate?

Back 6

1) hypercalcemia
2) hyperphosphatemia

Front 7

what is the animal form of vitamin D? what is plant form?

Back 7

1) cholecalciferol
2) ergocalceferol

Front 8

What inhibits renal vit D synthesis?

Back 8

1) increased vit D
2) increased phophates

Front 9

What are topical formulations of vit D used for?

Back 9

1) psoriasis
2) hyperproliferative skin disorders

Front 10

doxercalciferol is a prodrug that is also known as?

Back 10

1) 1alpha-hydroxyvitamin D2
a. converted in liver to 1,25-dihydroxyvitamin D

Front 11

paricalcitol and calcipotriene are analogs of what?

Back 11

calcitriol

Front 12

administration of doxercalciferol, paricalcitol and calcipotriene effect the body how?

Back 12

1) less hypercalcemia in patients with normal renal function
2) less hypercalciuria than calcitriol
Note: these occur because they have shorter half-lives than vit D

Front 13

Calcipotriene is approved for treatment of what?

Back 13

topical treatment of psoriasis

Front 14

What is the primary toxicity of vitamin D or active metabolites with chronic overdose?

Back 14

1) hypercalcemia
2) hyperphosphatemia
3) hypercalciuria

Front 15

What is calcitonins effect on body?

Back 15

1) Inhibits Ca2+ absorption by the intestines
2) Inhibits osteoclast activity in bones
3) Inhibits phosphate reabsorption by the kidney tubules
4) Calcitonin increases tubular reabsorption of Ca2+, leading to decreased rates of its loss in urine

Front 16

In what conditions has calcitonin been used?

Back 16

1) hypercalcemia
2) Pagets disease
3) osteoporosis

Front 17

what type of calcitonin is prescribed because it has a longer half-life and greater potency than human calcitonin?

Back 17

salmon calcitonin

Front 18

Which SERM is prescribed for osteoporosis is postmenopausal women?

Back 18

raloxifene

Front 19

What are examples of bisphosphonates?

Back 19

1) alendronate
2) etidronate
3) ibandronate
4) pamidronate
5) risedronate
6) tiludronate
7) zoledronic acid

Front 20

what is the MOA of bisphosphonates?

Back 20

1) they are short-chain polyphosphate compounds that reduce bone resorption and formation
2) inhibit osteoclastic activity
3) inhibit farnesyl pyrophosphate synthase needed for osteoclast survival

Front 21

What conditions are bisphosphonates used for?

Back 21

1) hypercalcemia of malignancies
2) osteoporosis
3) Pagets disease of bone

Front 22

What are the toxic effects of bisphosphonates?

Back 22

1) low dose use for osteoporosis causes GI and esophageal irritation
2) higher dose use for malignancy causes renal impairment and osteonecrosis of the jaw

Front 23

what is the MOA of cinacalect?

Back 23

1) lowers PTH by activating calcium sensing receptor in parathyroid gland
2) treats secondary hyperparathyroidism seen in chronic renal disease
3) treats parathyroid carcinoma

Front 24

What are toxicities of cinacalet?

Back 24

1) hypocalcemia
2) adynamic bone disease
a. profoundly decreased bone cell activity

Front 25

When does acute toxicity of fluoride occur? what are toxic effects?

Back 25

1) ingestion of rat poison
2) GI and neurological symptoms

Front 26

What is gallium nitrate used for?

Back 26

managing hypercalcemia associated with malignancies and possibly pagets

Front 27

What is MOA of gallium nitrate?

Back 27

1) inhibits bone resorption
2) nephrotoxic

Front 28

What antibiotics are used for hypercalcemia and Pagets disease of bone?

Back 28

1) plicamycin
2) mithramycin
Note: used only for short term use because of side effects

Front 29

What are toxic effects of plicamycin?

Back 29

1) thrombocytopenia
2) hemorrhage
3) hepatic and renal damage

Front 30

Which diuretics can be used for hypercalcemia?

Back 30

1) loop diuretics
Note: thiazides retain Ca2+ so they are contraindicated

Front 31

What is sevelamer?

Back 31

1) phosphate binding gel
2) treats hyperphosphatemia
a. a complication of renal failure
b. hypoparathyroidism
c. vitamin D intoxication

Front 32

Names of three bisphosphonates available IV

Back 32

Pamidronate, zoledronate, ibandronate

Front 33

Major SE of bisphosphonates

Back 33

Chemical esophagitis

Front 34

Bisphosphonates that cannot be used on continuous basis because it caused osteomalacia

Back 34

Etidronate

Front 35

Used for prevention of postmenopausal osteoporosis in women

Back 35

Estrogen (HRT-Hormone replacement therapy)

Front 36

Increase bone density, also being tested for breast CA prophylaxis

Back 36

Raloxifene (SERM-selective estrogen receptor modulator)

Front 37

Used intranasally and decreases bone resorption

Back 37

Calcitonin (salmon prep)

Front 38

Used especially in postmenopausal women, dosage should be 1500 mg

Back 38

Calcium

Front 39

Vitamin given with calcium to ensure proper absorption

Back 39

Vitamin D