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1.11
Calcium Hormones
| Term | Definition |
|---|---|
| "osteo" | bone |
| "clast" | destroy/breakdown |
| with osteoclasts, calcium levels: | increase (from bone to blood) |
| "blasts" | crease/build up |
| with osteoblasts, calcium levels: | decrease (from bone to blood) |
| calcium regulation (parathyroid hormone (PTH)) | increases serum calcium |
| calcitonin decreases | serum calcium |
| parathyroid gland: chief cell | almost all of the PTH is synthesized and secreted here |
| parathyroid gland: oxyphil cell | function is uncertain may be modified or depleted chief cells that no longer secrete PTH |
| parathyroid hormone (PTH) | increases serum calcium concentrations |
| PTH 1st mechanism to increase serum calcium | increase reabsorption of calcium and increase excretion of PO3-4 |
| PTH 2nd mechanism to increase serum calcium | stimulates osteoclast activity |
| PTH 3rd mechanism to increase serum calcium | activates enzymes |
| Calcitonin regulates: | calcium |
| Calcitonin decreases serum calcium by (3 ways): | 1. inhibits osteoclast 2. decreases calcium absorption 3. decreases calcium reabsorption |
| Vitamin D increases Calcium absorption from the ______________ | intestine |
| Vitamin D increases Calcium reabsorption from the ______________ | bone |
| Which form of Vitamin D is best? | Vitamin D3 |
| What does Vitamin D need to do, regardless of form? | it needs conversion to active form |
| hypocalcemia: Elemental Calcium 21% is: | calcium citrate |
| hypocalcemia: Calcium citrate has better absorption without ______ but has a bigger _____ | acid but bigger tab |
| hypocalcemia: Elemental Calcium 40% is: | calcium carbonate |
| hypocalcemia: Calcium carbonate has better absorption with _________but needs ______ | food, acid |
| hypocalcemia: Elemental Calcium 9% is: | calcium gluconate |
| hypocalcemia: calcium gluconate = loose ____ >>> good ______ >> good ______ | loose salt>>> good dissociation >>good absorption |
| hypercalcemia treatments: (2) | 1. loop diuretics (furosemide) plus saline 2. bisphosphonates if diuretic fails |
| Activation of RANK receptor is necessary for: | formation, function and survival of osteoclasts |
| Activation of RANK increases | bone resorption |
| Activation of osteoclasts occurs when _____binds to ______ | Rank ligand (RANKL), RANK |
| Which hormone inhibits the release of RANKL | estrogen |
| When estrogen levels decline during and after menopause, _____ RANKL is released | more |
| Estrogen levels ______, _______ osteoclasts are activated. resulting in more bone _______ | decline, more, reabsorbed |
| bisphosphonate MOA causes: | osteoclast apoptosis |
| Nitrogen containing bisphosphonates inhibit: | osteoclast farnesyl pyrophosphate synthase |
| Bisphosphonates major side effects: | esophagitis, esophageal erosions, esophageal ulcers (GI irritation) |
| Bisphosphates food interactions | anything other than water (decreases absorption) |
| Avoid taking _______ with bisphosphates | calcium supplements or calcium-containing antacids |
| Bisphosphate contraindications | 1. esophageal abnormalities that delay esophageal emptying 2. inability to sit or stand upright for at least 30 minutes 3. hypocalcemia |
| DRUG: Raloxifene (EVISTA) is a | SERM (selective estrogen receptor modulator) |
| DRUG: Raloxifene (EVISTA) MOA | 1. binds and stimulates estrogen receptor in bone (does not stimulate breast or endometrial hyperplasia) 2. decreases osteoclast activity |
| DRUG: Raloxifene (EVISTA) ADR | hot flashes, leg cramps, risk of venous thromboembolism |
| DRUG: Raloxifene (EVISTA) contraindications: | history of venous thromboembolism women that are pregnant, have plans to become pregnant, or are nursing |
| DRUG: Raloxifene (EVISTA) drug interaction: | ion exchange resins (cholestyramine) inhibits absorption monitor bleeding times in patients on warfarin |
| DRUG: Denosumab (PROLIA, XGEVA) | binds to RANKL |
| DRUG: Denosumab (PROLIA, XGEVA) MOA (3) | 1. inhibits RANKL from binding to RANK 2. prevention of RANL/RANKL interaction prevents osteoclast activation, function and survival 3. decreases bone resorption |
| DRUG: Denosumab (PROLIA, XGEVA) contraindicated in patients with: | hypocalcemia |
| DRUG: Teriparatide (FORTEO) | recombinant human PTH |
| DRUG: Teriparatide (FORTEO) MOA | preferential stimulation of osteoblasts over osteoclasts |
| DRUG: Teriparatide (FORTEO) black box warning: | potential to cause osteosarcoma (last drug in the tool box) |
Created by:
megangodfrey97
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