Musculoskeletal Pharm

Front 1

osteoclast

Back 1

a cell that nibbles at and breaks down bone and is responsible for bone resorption

Front 2

osteoblast

Back 2

a cell that makes bone - it does so by producing a matrix that then becomes mineralized. Bone mass is maintained by a balance between the activity of osteoblasts that form bone and osteoclasts that break it down.

Front 3

reporption

Back 3

process of losing substance: bone, when it is remodeled (reshaped), undergoes both new formation and reportion. The cell responsible for the resorption of bone is the osteoclast

Front 4

reabsoption

Back 4

absorbing again - the kidney selectively reabsorbs substances such as glucose, proteins, and sodium which it already secreted into the renal tubles - these reabsorbed substances return to the blood.

Front 5

most important mineral in body that is responsible for bone formation is _____

Back 5

calcium

Front 6

Calcium levels are controlled by 2 endocrine glands:

Back 6

parathyroid gland - secretes parathyroid hormone
thyroid gland - secretes calcitonin

Front 7

________ stimulates bone cells osteoclasts

Back 7

PTH (parathyroid hormone)

- osteoclasts speed up bone resorption (demineralization that breaks down bone into components) once broken down or resorbed, Ca becomes available to be taken and transported to be used elsewhere

Front 8

bone deposition

Back 8

bone building

Front 9

Bone deposition removes Ca from the blood and is stimulated by the hormone ______-

Back 9

calcitonin

Front 10

PTH and calcitonin control Ca homeostasis by influencing 3 major areas: ___ ___ ___

Back 10

bones, gi tract, kidneys

Front 11

GI tract is influenced by ______ and involves ____ ___

Back 11

parathyroid hormone
vitamin d

Front 12

cholecalciferol

Back 12

precursor or inactive form of vit d in skin made from cholesterol

Front 13

skin exposure to sun or ultraviolet light ______ the amount of cholecalciferol in the blood

Back 13

increases

Front 14

too much vit d can cause ____

Back 14

dystrhythmias

Front 15

cholecalciferol is converted to a middle vitamin called

Back 15

calcifediol

Front 16

enzymes in the kidneys metabolize calcifediol to _____ which is the active form of vit d

Back 16

calcitriol

Front 17

PTH stimulates the formation of calcitriol at the level of the ____ - pts with ____ _____ can't make calcitriol well enough to supply the bodie's needs

Back 17

kidneys
kidney dz

Front 18

not enough PTH =

Back 18

tetany

Front 19

too much PTH =

Back 19

weakened bones

Front 20

The main function of calcitriol is to ______ Ca absorption from the _____ ______

Back 20

increase
GI tract

Front 21

Dietary intake of Ca is absorbed better when there is active ____ ____ and _____, which results in higher levels of Ca in the blood.

Back 21

vitamin D
PTH

Front 22

Calcium functions

Back 22

influence the excitability of all neurons
coagulation
muscle contraction

Front 23

If PTH is high kidneys attempt to excrete excess Ca and cause

Back 23

kidney stones

Front 24

bisphophonates are used primarily in the tx of ______, paget's dz, and postoperative for _______.

Back 24

osteoporosis
total hip replacement

Front 25

bisphosphonates result in increased bone density by

Back 25

inhibiting bone resorption - suppress osteoclast activity, thus increasing bone density

Front 26

Fosamax (alendronate) uses

Back 26

tx and prevention of postmenopausal osteoporosis, glucocorticoid induced osteoporosis, osteoporosis in men, and paget's dz

Front 27

fosamax admin

Back 27

weekly or daily, admin with 6-8 oz water while pt is in Fowler's or High Fowler's.
Instruct pt to remain upright for at least 30 minutes after taking.

Front 28

Didronel (eitdronate)

Back 28

use to tx paget's dz and postop tx total hip

Front 29

Actonel (risedronate)

Back 29

tx and prevent postmenopausal osteoporosis, glucocorticoid induced osteoporosis, and paget's dz

Front 30

bisphosphonate adverse rxn

Back 30

N/V
increased or recurrent bone pain
HA, dyspepsia, reflux,
dysphagia, abd pa

Front 31

bisphosphonate CI

Back 31

hypcalcemia - alendronate and risedronate
renal impairment
concurrent use of hormone therapy not recommended

admin cautiously when GI disorders, renal problems, and pregnancy

Front 32

calcium gluconate (ca+ salts) uses

Back 32

used to correct hypocalcemia, and for osteoporosis and paget's dz.
Antidote to mag sulfate toxicity

Front 33

calcium gluconate adverse effects

Back 33

hypercalcemia - drowsiness, lethargy, weakness, HA, anorexia, N/V, increased urination, and thirst
IV admin may cause hypotension, bradycardia, dysrhythmia, and cardiac arrest

Front 34

Calcium gluconate use with cardiac glycosides increases the risk of

Back 34

dysrhythmias

Front 35

calcium decreases the absorption of ?

Back 35

tetracyclines

Front 36

calcium gluconate admin guidelines

Back 36

give with meals or within 1 hour following meals, if IV, infuse slowly

Front 37

Calcitriol (calcijex, rocaltrol)

Back 37

active form of vit d
promotes intestinal absorption of Ca
used when impaired kidney function or hypoparathyroidism
reduces bone resorption (rickets)

Front 38

cacitriol admin guidelines

Back 38

protect oral forms from light and heat

Front 39

calcitriol adverse

Back 39

s/s hypercalcimia, HA, weakness, dry mouth, thirst, increased urination, and muscle or bone pain

Front 40

thiazide diuretics enhance effects of vit d causing ?

Back 40

hypercalcemia

Front 41

too much vit d can cause dysrhythmia when pt receiving ?

Back 41

cardiac glycosides

Front 42

mac supplements should be given with caution in combination with calcitriol due to increased risk of ?

Back 42

hypermagnesemia

Front 43

Normal levels of estrogen may reduce the life span of _____ and the bone cells that resorb bone.

Back 43

osteoclasts

Front 44

____ is one of the most common txs for osteoporosis.

Back 44

estrogen

Front 45

HRT for osteoporosis increases risk of?

Back 45

uterine cancer, blood clots, breast cancer

Front 46

calcitonin

Back 46

antihypercalcemia drug - decreases serum Ca level by decreasing bone resorption and increasing GI absorption of Ca

Front 47

Calcitonin is made from

Back 47

salmon

Front 48

calcitonin is used for osteoporosis in women greater than ___ years postmenopausal

Back 48

5

Front 49

selective estrogen receptor modulators (serms)

Back 49

bind to estrogen receptors
can be estrogen agonists or antagonists
Evista

Front 50

Evista

Back 50

blocks estrogen receptors in the uterus and breast and therefore has no estrogen like proliferative effects on these tissues (reduces risk of cancer)
does increase bone resorption, this increasing bone density, therefore decreasing incidence of fractures
also has a cholesterol lowering effect

Front 51

evista admin guidelines/teaching

Back 51

report SE: s/s blood clots, c/p, dyspnea, pain in calves and swelling in LE. Hot flashes, migraines, flulike symptoms, endometrial disorders, breast pain, and vaginal bleeding
supplements - Ca and vit D
active weight-bearing exercises
avoid prolonged immobility
not recommended for pregnant, lacting, taking HRT, premenopausal or hx of blood clots
do not take chol-lowering agents or estrogen replacement therapy at the same time
Ineractions: coumadin (decreased PT)
ampicillin - causes decreased SERM absorption
alteration in absorption of both meds if taken with ibuprofen, indomethacin, valium