Upgrade to remove ads
Terms in this set (110)
PTH (increases/decreases) osteoclast activity
PTH with (Increase/decrease) the urinary excretion of Ca
PTH (increases/decreases) renal tubular reabsorption of Ca
Which form of Vitamin D does PTH stimulate the synthesis of in the kidney?
1,25 OH Vit. D
What type of Vit D will be measured in the blood?
25 OH Vit. D
What does 1,25 OH Vit. D increase?
GI absorption of Calcium
What type of Vit D do you receive from the sun?
What type of Vit. D do you receive from the GI?
D2 or D3
Where does D3 convert into 25 OH Vit D?
What causes the conversion of D3 into 25 OH D?
What converts 25 OH D into 1,25 OH D?
Where is 25 converted into 1,25?
What is the function of 1,25?
Absorption of Calcium (and phosphate) from the GI
Which is the MC cause of chronic hyper-secretion of PTH?
Single Adenoma (80%)
Who gets Primary Hyperparathyroidism more often?
In Primary Hyperparathyroidism, Ca will be (Hyper/Hypocalcemia)
In Primary Hyperparathyroidism, there will be (Hyper/Hypophospthatemia)
In Primary Hyperparathyroidism PTH will be (increased/decreased)
In Primary Hyperparathyroidism 25 OH D will be (increased/decreased)
In Primary Hyperparathyroidism Urine Ca will be (increased/decreased)
In Primary Hyperparathyroidism Urine Phosphorus will be (increased/decreased)
What test would you preform to that is not required but may help with localizing tumors prior to surgery?
PTH Scanning -
Sestamibi (Tc 99m)
What imaging study would you order if you suspected renal stones?
What is the treatment for adenomas?
Surgical neck exploration and excision of the offending gland
What is the treatment for hyperplasia?
Surgical neck exploration with 3.5 gland excision
What treatment would you give post-op?
Calcium, Vi.t D supplementation and monitoring
What are the indications for surgery for primary hyperparathyroidism?
High Urine Ca excretion
Decreased Renal Fnx
When is Secondary Hyperparathyroidism commonly seen?
Chronic Renal Failure
In secondary Hyperparathyroidism, you will see (hyper/hypophosphatemia)
In secondary Hyperparathyroidism, you will see (increased/decreased) renal production of Vit D?
In secondary Hyperparathyroidism, you will see (increased/decreased) serum Ca?
What will hyperphosphatemia, ↓ renal Production of Vitamin D, and ↓ Serum Ca++, ultimately result in?
Increased Parathyroid activity
What should you also order when checking the total calcium levels in secondary hyperparathyroidism?
What is the calculation for corrected Ca?
[0.8 x (4-patient's albumin)]
When is Hypoparathyroidism MC?
after thyroid or parathyroid surgery
What is a group of disorders characterized by renal resistance to PTH?
What illness with have Chvostek's sign or Trousseau's sign?
What are some other signs of Hypoparathyroidism?
In hypoparathyroidism, the Ca and PTH levels will be (increased/decreased)?
In hypoparathyroidism, the phosphorus levels will be (increased/decreased)?
In hypoparathyroidism, the urine calcium levels will be (increased/decreased)?
If patient has a severe hypocalcemia associated with hypoparathyroidism, what is the treatment?
IV Calcium supplementation
What are the S/S of a patient with severe hypocalcemia?
tetany, seizures, or ECG
What is the preferred route for Calcium supplementation and how much?
Oral: 1-2g of Ca per day
What must you do treat to correct the Ca in Hypocalcemia?
Correct the hypomagnesemia
What type of Vitamin D supplementation would you give as treatment for hypoparathyroidism?
1,25 dihydroxycholecalciferol (calcitriol): 0.25mcg daily and maintain at .5-2.0
What are the two types of Metabolic Bone Diseases we are discussing?
Who gets osteoporosis more commonly, but not exclusively?
Postmenopausal and elderly women
What do they have?
What are the sites of common fractures?
Which scoring system for Osteoporosis shows the standard deviation from the average bone mineral density value for young healthy white individuals?
Which scoring system for Osteoporosis shows the number of standard deviations from the average bone mineral density value for women of comparable age?
When does USPSTF recommend screening for women?
Age 65 and older
Also women younger than 65 whose fracture risk is >/= to 65-year-old white woman
If you are suspicious of Osteoporosis, what would you order?
What are the conservative treatments for Osteoporosis?
Exercise (Weight or Strength)
↓ Caffeine intake
What does Ca supplements (without co-administered Vit D) cause an increased risk of? (BUT this may not be true...)
How much Ca does the AACE recommend people with osteoporosis take?
1000-1200 mg/daily (only when diet is insufficient)
For older patients, a __________ supplement of _______ daily, should be safe and beneficial.
Vit. D ; 2000 daily
What is the mechanism of action for Bisphosphonates?
What should you tell you patients to do when taking Bisphosphonates?
Take it first thing in the morning, with a lot of water, and sit upright for 30 minutes
What are the three types of Osteoporosis that Bisphosphonate is indicated for?
Male age related
What are the three contraindications for Bisphosphonate?
inability to stand upright
How long are Bisphosphonates half life?
10 years in terms of osteoclast inhibition
What adverse effect is increased after 5 years of treatment of Bisphosphonates?
Atypical chalk-stick femoral fractures
What are the other adverse effects for Bisphosphonates?
increased risk of esophageal cancer
What is the third generation bisphosphonate?
Zolendronic Acid (Reclast)
What is Zolendronic Acid (Reclast) indicated for?
Osteoporosis and Paget's
How long is Zolendronic Acid (Reclast) given?
What is a PTH analog which stimulates osteoblastic activity?
What is Teriparatide(Forteo) indicated for?
Male hypogonadal osteoporosis
What is the mode of administration for Teriparatide(Forteo), and how long is it given for?
Sub Q for 2 years
WHat are the contraindications for Teriparatide(Forteo)?
What is Teriparatide(Forteo) indicated for and what does it help the healing with?
Use for most severe patients - "at high risk for fracture"
May help healing of chalk-stick fractures associated with bisphosphonate use.
What type of drugs is...
SERMS (Selective Estrogen Receptor Modulators)
What does Raloxifene (Evista) have a selective effect on?
Estrogen effectors at the bone
What does Raloxifene (Evista) increase the risk for?
thromboembolism and hot flashes
What does Raloxifene (Evista) give protection from?
Breast CA (reduces risk 76% over 3 yrs.)
What is a monoclonal antibody to the receptor ACTIVATOR of nuclear factor-kappa B ligand (RANKL)?
What is a mediator of osteoclast formation, function and survival?
What binds with high specificity and affinity to RANKL which INHIBITS osteoclast maturation and will cause osteoclast-mediated bone resorption?
What is a second-line therapy to bisphosphonates and in high-risk patients due to cost considerations and limited long-term exposure data?
What are the adverse effects associated with Denosumab (Prolia)?
OSTEONECROSIS OF THE JAW (BRONJ)
What agent has the most reduction to Vertebral Fx?
Zoledronic Acid (72%)
What agent has the most reduction to non-vertebral Fx?
Which three agents are the only reductions to hip fractures and all have the same %?
Risedronate - 40%
Zoledronic Acid - 41%
Denosumab - 40%
What is the focal disorder of bone remodeling?
Paget's Disease (Osteitis Deformans)
What are the common bones affected by Paget's?
Sacrum & Spine (50%)
What are the two symptoms for Paget's (only 30% are symptomatic)?
What are the four signs of Paget's Disease?
Sensiorineural deafness(50% with skull involvement)
Cutaneous erythema & warmth
What are plain film imaging looking for in Paget's Dz?
Pathological Fx - Vertebral crush or fissure of long bones
What will labs show in Paget's Dz?
↑ Alkaline Phosphatase
↑ Urine hydroxyproline
Normal Ca++ and PO4
What would you give for supplementation with Bisphosphonates?
Ca and Vit D
What are the neurological symptoms associated with Paget's Dz?
cranial nerve palsies
What are the neoplastic symptoms associated with Paget's Dz?
What are the rheumatologic symptoms associated with Paget's Dz?
What are the Cardiac symptoms associated with Paget's Dz?
high-output CHF (rare)
Due to ↑ vascularity of involved bone
What Dz is the defective mineralization of the skeleton in adults aka "Rickets" in children?
What is the MC cause of Osteomalacia?
Vit D deficiency
What are the other causes of Osteomalacia?
Vitamin D resistance (rare)
Deficient Calcium Intake (rare)
Phosphate Deficiency (variable) - Genetic disorders, malignancies, GI malabsorption, aluminum toxicity
Who is Vit. D deficiency MC in?
Women of child bearing age and infants
What are the risk factors for Vit D Deficiency?
Older than 65
Nursing home residents
Nonvertebral or hip fractures
Low bone mass or osteoporosis
History of falls
What are the two general causes of Vit D deficiency?
Inadequate Sun exposure
What are some causes of decreased absorption of Vit D?
Bowel bypass surgery
Fat and cholesterol absorption inhibitors
What are some of the medications which can cause Vit D deficiency?
decrease half-life of vitamin D
Dilantin, phenobarbital, and
induce hepatic p450 enzymes to accelerate the catabolism of vitamin D.
What is the main clinical manifestation of Vit. D deficiency?
Muscle Weakness and Falls
What is the recommended Vit D supplementation for the elderly population to help reduce incidents of falls?
700 and 800 IU/d
What measurements best reflects the Vit D status of an individual?
25 OH Vit D
What is the treatment for a Vit D deficient diet?
1,500 to 5,000 IU of
orally per day
What is the treatment for Vit D deficiency due to Fat malabsorption?
What is the treatment for Vit D deficiency due to Hypoparathyroidism, Cirrhosis, nephrotic syndrome, renal failure, gastric or small bowel resection, rifampin, chronic corticosteroids, or anticonvulsants?
THIS SET IS OFTEN IN FOLDERS WITH...
Rheumatology Lecture 3
DM Lecture 1 Basics
YOU MIGHT ALSO LIKE...
CM: Menopause (Mason)
Test 2-6 Obesity
OTHER SETS BY THIS CREATOR
Fam Med EOR - Derm
Fam Med EOR: Omphthalmology-
Fam Med: EOR - ENT
IM EOR: Infectious Disease - Diptheria, EBV, HSV,…