Which of the following drugs is routinely added to calcium supplements and milk for the purpose of preventing rickets in children and osteomalacia in adults?
(A) Cholecalciferol
(B) Calcitriol
(C) Gallium nitrate
(D) Sevelamer
(E) Plicamycin
Cholecalciferol
- A 65-year-old woman presents with chronic intermittent lower back pain for the last 8-10 years. She has spinal cur-vature. Six months ago back pain and spasms kept her in bed for 2 weeks. Radiographs of her lower back and pelvis showed increased bone density with cortical thickening with a coarse trabecular pattern and a lytic area in the greater trochanter.
Which of the following drugs is most useful for the treatment of hypercalcemia in her disease?
(A) Fluoride
(B) Hydrochlorothiazide
(C) Pamidronate
(D) Raloxifene
(E) Teriparatide
C) Pamidronate
The active metabolites of vitamin D act through a nuclear receptor to produce which of the following effects?
(A) Decrease the absorption of calcium from bone
(B) Increase PTH formation
(C) Increase renal production of erythropoietin
(D) Increase the absorption of calcium from the GI tract
(E) Lower the serum phosphate concentration
D) Increase the absorption of calcium from the GI tract
A 59-year-old female was referred to your clinic for evaluation of osteopenia. She was diagnosed with adult-onset cystic fibrosis (CF). She reported being treated with prednisone 2 times in the past for CF exacerbations. Since menopause at 52 years of age, she had been treated with raloxifene for osteoporosis prevention. She also was on daily calcium and vitamin D supplementation. Her bone mineral density test revealed a T score of -1.6 at the lumbar spine, -2.2 at the left femoral neck, and -1.6 at the total left hip. Which of the following drugs can be used to reduce the fracture risk by further stimulating bone formation in this patient?
(A) Cholecalciferol
(B) Ergocalciferol
(C) Furosemide
(D) Tamoxifen
(E) Teriparatide
E) Teriparatide
58-year-old postmenopausal woman was sent for dual-energy x-ray absorptiometry to evaluate the bone mineral density of her lumbar spine, femoral neck, and total hip. The test results revealed significantly low bone mineral density in all sites. Chronic use of which of the following medications is most likely to have contributed to this woman’s osteoporosis?
(A) Lovastatin
(B) Metformin
(C) Prednisone
(D) Propranolol
(E) Thiazide diuretic
C) Prednisone
- If this patient began oral therapy with alendronate, she would be advised to drink large quantities of water with the tablets and remain in an upright position for at least 30 min and until eating the first meal of the day. These instructions would be given to decrease the risk of which of the following?
(A) Cholelithiasis
(B) Diarrhea
(C) Constipation
(D) Erosive esophagitis
(E) Pernicious anemia
D) Erosive esophagitis
- The patient’s condition was not sufficiently controlled with alendronate, so she began therapy with a nasal spray containing a protein that inhibits bone resorption. The drug contained in the nasal spray was which of the following?
(A) Calcitonin
(B) Calcitriol
(C) Cinacalcet
(D) Cortisol
(E) Teriparatide
Calcitonin
Questions 8-10. A 67-year-old man with chronic kidney disease was found to have an elevated serum PTH concentration and a low serum concentration of 25-hydroxyvitamin D. He was successfully treated with ergocalciferol. Unfortunately, his kidney disease progressed so that he required dialysis and his serum PTH concentration became markedly elevated.
8. Which of the following drugs is most likely to lower this patient’s serum PTH concentration?
(A) Calcitriol
(B) Cholecalciferol
(C) Furosemide
(D) Gallium nitrate
(E) Risedronate
Calcitriol
- Although the drug therapy was effective at lowering serum
PTH concentrations, the patient experienced several episodes of hypercalcemia. He was switched to a vitamin D analog that suppresses PTH with less risk of hypercalcemia. Which drug was the patient switched to?
(A) Calcitriol
(B) Cholecalciferol
(C) Furosemide
(D) Paricalcitol
(E) Risedronate
Paricalcitol
- In the treatment of patients like this with secondary hyper-parathyroidism due to chronic kidney disease, cinacalcet is an alternative to vitamin D-based drugs. Cinacalcet lowers PTH by which of the following mechanisms?
(A) Activating a steroid receptor that inhibits expression of the PTH gene
(B) Activating the calcium-sensing receptor in parathyroid cells
(C) Activating transporters in the Gl tract that are involved in calcium absorption
(D) Inducing the liver enzyme that converts vitamin D, to
25-hydroxyvitamin D3
(E) Inhibiting the farnesy\ pyrophosphate synthase found in osteoclasts
B) Activating the calcium-sensing receptor in parathyroid cells
