Term
| Name the principal regulators of plasma Ca2+ within the body- |
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Definition
Parathyroid hormone (PTH)
1,25 Dihydroxyvitamin D (calcitriol)
Calcitonin |
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Term
| What drugs should be considered when treating hypocalcemia? |
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Definition
Calcium gluconate
Calcium chloride
Calcium carbonate (oral)
Calcium lactate (oral)
Calcitriol |
|
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Term
| Clinical presentation of HYPERcalcemia? |
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Definition
Fatigue
Mental confusion
Nausea, vomiting
Anorexia
Polydipsia (excessive thirst)
Polyuria (peeing often)
Cardiac conduction abnormalities |
|
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Term
| Treatment of hypercalcemia (three steps)? |
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Definition
1. Volume expansion (rehydration)
2. Increase calcium excretion using loop diuretics (Furosemide acts on thick ascending loop of Henle to knock out the Na-K-Cl cotransporter, all of the electrolytes go out)
3. Short term therapy with Calcitonin (in CHF or renal dysfuction patients) |
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Term
| Bisphosphonates you can use for treatment of hypercalcemia? |
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Definition
Pamidronate
Etidronate
Zoledronate |
|
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Term
| What would severe hypercalcemia be best managed with? |
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Definition
| Loop diuretic (Furosemide) plus saline infusion |
|
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Term
| Clinical presentation of HYPOcalcemia? |
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Definition
Muscle spasms (Chvostek's & Trousseau's sign)
Seizure
Respiratory arrest
Laryngeal spasm
Irritability |
|
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Term
| Calcium is given to somebody with hypocalcemia. What are the two forms of elemental calcium? Two forms of oral calcium? |
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Definition
Elemental
1. Calcium gluconate
2. Calcium chloride (Tums)
Oral
1. Calcium carbonate
2. Calcium lactate |
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Term
| What is given to a patient suffering from hypocalcemia that has renal dysfunction? |
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Definition
| Calcitriol (a Vitamin D metabolite) |
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Term
| What are the bisphosphonates to know? What do they all end in? |
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Definition
-nate
Etidronate
Alendronate
Ibandronate
Pamidronate
Tiludronate
Risedronate |
|
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Term
| What bisphosphate is first line therapy for treatment of osteoporosis and Paget's disease? |
|
Definition
|
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Term
| What bisphosphate is used for prophylaxis of osteoporosis and is the DOC for prophylaxis of glucocorticoid-induced osteoporosis? |
|
Definition
|
|
Term
|
Definition
| Inhibit osteoclastic activity - more specifically, the reduce both the resorption and formation of hydroxyapatite crystals. |
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Term
| How are bisphosphonates administered? |
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Definition
| IV only (lousy bioavailability if given orally) |
|
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Term
| Clinical indications for bisphosphonates? |
|
Definition
First-line therapy for osteoporosis
Osteoporosis prevention
Osteolysis associated with tumor
Hypercalcemia (prevent unlocking of calcium from bone) |
|
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Term
| Adverse effects of bisphosphonates? |
|
Definition
Esophageal and gastric irritation, GI bleeding
Diarrhea, nausea |
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Term
| When are bisphosphonates CI? |
|
Definition
| CI in compromised renal function, peptic ulcer disease |
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Term
| What drug is a calcimimetic? |
|
Definition
|
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Term
| When is Cinacalcet indicated? |
|
Definition
| Used for treatment of hypercalcemic states or when there are excessive calcium levels resulting from parathyroid carcinoma |
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Term
| What characteristic of Cinacalcet makes it likely to have a high risk of interactions with other drugs? |
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Definition
| It is highly bound to plasma proteins (high risk of interaction with NSAIDS, Verapamil, Digoxin) |
|
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Term
| What two kinds of calcitonin may be taken? How are they administered? |
|
Definition
|
|
Term
| What is calcitonin indicated for? |
|
Definition
Paget's disease
Adjunctive treatment of hypercalcemic emergencies (when a pt presents with hypercalcemia, a ventricular arrhythmia may be present) |
|
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Term
| Adverse effects of calcitonin? |
|
Definition
Headache
Weakness
Nausea, vomiting (likely with initial dose, then will subside) |
|
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Term
| Other than calcitonin, what else is used to counteract the actions of parathyroid hormone? |
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Definition
|
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Term
| What is Plicamycin and what does it do? |
|
Definition
A cytotoxic antibiotic that also lowers serum calcium concentration.
It inhibits hypercalcemic action of Vitamin D AND inhibits the effects of PTH on osteoclasts. |
|
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Term
| What are the indications for use of Plicamycin? |
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Definition
| Because of its high toxicity and low therapeutic index, it is used only is hospital settings. It is used for treatment of hypercalcemia resulting from advanced neoplasms. |
|
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Term
| What are the CIs for Plicamycin? |
|
Definition
Myelosuppression
Pregnancy
Bleeding disorders
Hepatic & renal dysfunction |
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Term
| What are the three Vitamin D preparations? |
|
Definition
1,25 Dihydroxyvitamin D3 (Calcitriol)
Vitamin D2 (Ergocalciferol)
Doxercalciferol |
|
|
Term
| What is Calcitriol indicated for? |
|
Definition
Hypocalcemic patients
Patients with hypoparathyroidism |
|
|
Term
|
Definition
| CI in hypercalcemia and in patients on cardiac glycosides |
|
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Term
| What is Ergocalciferol indicated for? |
|
Definition
Hypophophatemia
Osteomalacia
Osteoporosis
Prophylaxis and treatment of rickets |
|
|
Term
| What is Doxercalciferol indicated for? |
|
Definition
| Hyperparathyroidism (reduction of PTH) |
|
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Term
| When should Doxercalciferol not be used? |
|
Definition
| Cautious use in renal of hepatic dysfunction and in pregnancy |
|
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Term
| What is the recombinant drug used in treatment calcium homeostasis? |
|
Definition
|
|
Term
|
Definition
A recombinant form of PTH.
It stimulates osteoblastic activity (new bone formation). Only agent that does this! (IMPORTANT! Possible STEP 1 question!) |
|
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Term
| How is Teriparatide adminstered? |
|
Definition
|
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Term
| When is Teriparatide indicated? |
|
Definition
| Indicated in osteoporosis in women and men who fail conventional therapy |
|
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Term
| How long can Teriparatide be used? |
|
Definition
| 21 months, beyond that is causes osteosarcoma |
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Term
| What drug is a selective estrogen receptor modulator? |
|
Definition
|
|
Term
|
Definition
| It is an agonist to bone (prevents osteoporosis) and antagonist to breast tissue (reduces incidence of estrogen-dependent breast cancers) |
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