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623 - Exam 2
Terms in this set (33)
What are 3 common treatments for PCOS?
1. target HPG: estrogen-progestin contraceptive to suppress LH
2. Use anti-androgen to decrease testosterone like spironolactone
3. Use metformin to decrease sugars and insulin
In the LH hypothesis for PCOS how does the fact that increased LH and androgen levels prevent normal follicular development, lead to there not being ovulation?
Since the follicle can't develop properly, it won't be able to secrete large amts of estrogen, in which the large amts of estrogen usually stimulate the LH surge and then you have ovulation
For the insulin theory of PCOS, how does increased insulin levels effect levels of testosterone?
Increased insulin will decrease the amt of sex hormone binding protein, so this will result in more free testosterone floating around (b/c less of it will be bound)
How will high prolactin levels effect GnRH, FH, FSH, and estrogen levels?
high prolactin levels will lead to suppression of GnRH, which will then cause reductions in circulating LH, FSH, and estrogens
What can dopamine agonists, such as cabergoline and bromocriptine be sued to treat?
Prolactin secreting tumors
What are the two ways in which osteoclasts will break down the organic component of bone, and then the hydroxyapatite in bone?
villi secrete proteolytic enzymes that digest the organic component, then it creates an acidic environment that will pump protons onto the bone surface and dissolve the hydroxyapatite
What two factors do osteoblasts secrete and what is the function of them
1. alkaline phosphatase: increase concentration of inorganic phosphate
2. Calcium binding proteins: increase concentration of local calcium
When talking about bones, what are the primary mediators of hormonal control? Secondary mediators?
primary - PTH, vit D, calcitonin
Secondary - glucocorticoids, thyroid hormone, and gonadal steroids
What is the most important endocrine regulator of calcium homeostasis?
Where does the PTH have the most rapid physiologic effect of the following: bone, GI, kidney
What is the effect of PTH on the kidney?
raise plasma calcium, and decrease plasma phosphate
Effect of PTH on the bone?
increase the expression of RANKL which will ultimately promote the differentiation of mature osteoclasts
PTH effects on the GI tract?
Indirect effects. It will increase the formation of calcitriol in the kidney. Then calcitriol will increase the absorption of calcium in the small intestine.
What is the difference in bone formation/resorption when there is continuous PTH verses intermittent PTH?
continuous: bone resorption overrides bone formation
intermittent: bone formation overrides bone resorption
T/F - Calcitriol will pretty much add pumps to the GI tract that will increase absorption of calcium
Calcitriol effects on PTH, osteoclasts, and kidney
increase reabsorption of calcium and phosphate in the kidney
What triggers the release of calcitonin?
Calcitoin will inhibit or stimulate osteoclasts
Glucocorticoids will decrease calcium levels, but they are not associated with causing hypocalcemia, why?
because of the increase in PTH due to the low calcium levels
Glucocorticoid effect on osteoblasts (inhibit or stimulate)
Thyroid hormone favors bone resorption or formation?
Estrogens and androgens favors bone resorption or formation?
T/F - Estrogens and androgens will stimulate cytokines which will then lead to less activation of osteoclasts
false - everything is true, but it will INHIBIT cytokine levels
What are the 4 anti-resorptive drug classes?
hormone replacement therapy (no longer used), SERMs, bisphosphonates, calcitonin
When taking a bisphosphonate drug orally, what do you need to make sure you do?
Drink lots of water because they have poor bioavailability. Pt should also remain in the upright position for 30 minutes before laying down due to risk of esophageal erosion
When a patient has a large bone loss, would recommend anti-resorptive agents or anabolic agents?
What is teriparatide and how is it administered and what is it used to treat?
drug form of PTH, administed subq
osteoporosis in postmenopausal men and women
Drugs that lower plasma phosphate levels:
oral phosphate binders, and increasing phosphate intake from diet
Drugs that decrease PTH synthesis and secretion
vit D and analogues; calcimimetics
What is the purpose of using a vitamin D analogue in CKD?
it will by pass the step that takes place in the kidney for activation of the product
What is the purpose of calcimimetics in CKD?
they will adjust the sensitivity of the calcium-receptors in the chief cells
T/F - Calcimimetics will lead to hypercalcemia and hyperphosphatemia
false - will not have these
T/F - Vit D and analogues will lead to hypercalcemia and hyperphosphatemia
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