Toxicity osteoporosis

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. 

The answer is c. (Hardman, p 15.33.) Enthusiastic over medication with vitamin D may lead to a toxic syndrome called hy/jervitamijmsis D. The initial symptoms can include weakness, nausea, weight loss, anemia, and mild acidosis. As the excessive doses are continued, signs of nephrotoxicity are manifested, such as polyuria, polydipsia, azotemia, and eventually nephrocalcinosis. In adults, osteoporosis can occur. Also, there is CNS impairment, which can result in mental retardation and convulsions. 

The answer is A. The constellation of symptoms exhibited by this patient is characteristic of homocystinuria. The impairment of her cognitive function could be attributed to many conditions, but the key findings are ectopia lentis with downward lens dislocation and osteoporosis in a female of this age. Homocystinuria is produced by inherited deficiency of one of the enzymes in the pathway of Met conversion to Cys. The most common form is cystathionine P-synthase deficiency, which results in accumulation of all upstream components of the pathway, including homocysteine, which is responsible for the toxic effects, and Met, which becomes elevated in the blood. Cystathionine and cysteine, which are both downstream of the block in the pathway caused by cystathionine P Synthase deficiency, would be decreased. Metabolic pathways for lactate and urea are not involved in this disease mechanism. 

Adverse effects include nausea, vomiting, diarrhoea, anaphylaxis, hepatic necrosis, fever, bone marrow depression, osteoporosis, menstrual dysfunction, cirrhosis, pulmonary infiltrates and fibrosis, renal toxicity and depigmentation. 

The toxicity of thyroxine is directly related to the hormone level. In children, restlessness, insomnia, and accelerated bone maturation and growth may be signs of thyroxine toxicity. In adults, increased nervousness, heat intolerance, episodes of palpitation and tachycardia, or unexplained weight loss may be the presenting symptoms. If these symptoms are present, it is important to monitor serum TSH (Table 38-2), which will determine whether the symptoms are due to excess thyroxine blood levels. Chronic overtreatment with T4, particularly in elderly patients, can increase the risk of atrial fibrillation and accelerated osteoporosis. 

Despite early promise that fluoride might be useful in the prevention or treatment of postmenopausal osteoporosis, this form of therapy remains controversial. A new formulation of fluoride (slow release, lower dose) appears to avoid much of the toxicity of earlier formulations and may reduce fracture rates. However, this formulation has not been approved by the FDA. 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Corticosteroids are extremely useful in elderly patients who cannot tolerate full doses of NSAIDs. However, they consistently cause a dose- and duration-related increase in osteoporosis, an especially hazardous toxic effect in the elderly. It is not certain whether this drug-induced effect can be reduced by increased calcium and vitamin D intake, but it would be prudent to consider these agents (and bisphosphonates if osteoporosis is already present) and to encourage frequent exercise in any patient taking corticosteroids. 

Fluorine Probably essential element used as CaFj by some mob hisks. Moderately toxic, msy cause mottled teeth. Pollution by fluoride present in superphosphate fertilizers. Ca. 1 ppm In water provides cariostatic action, beneficial in the treatment of Osteoporosis. 

The use of tamoxifen to prevent breast cancer has been reviewed (8). The merits of using tamoxifen to prevent mammary carcinoma in women who have never had the disease but are believed to be at high risk have been disputed (9), but it is clear that it would involve very long treatment and that one s view of the adverse effects might need to be revised for this class of users. The available data after 5,10, and 15 years of follow up confirmed an increase in the incidence of endometrial cancer and of thromboembolic complications and suggested ocular toxicity, but these effects were not common and should be more than balanced by the reduced risk of coronary heart disease and osteoporosis (8). 

Many symptoms of aluminum toxicity are similar to those of Alzheimer s disease and osteoporosis. This suggests that long-term accumulation of aluminum in the brain may contribute to the development of Alzheimer s disease. In addition, an unidentified protein not found in normal brain tissue has been discovered in the brain tissue of Alzheimer s patients. Because aluminum is excreted by the kidneys, toxic amounts of aluminum also may impair kidney function. People who worked in aluminum smelting plants for long periods have been found to experience dizziness, impaired coordination, and losses of balance and energy. Accumulation of aluminum in the brain was cited as a possible cause for these symptoms as well. This has caused concern, especially as it relates to neurotoxicology (Alzheimer s disease).19-21... 

The determination of trace elements in foods is very important as some minerals are toxic whereas others are essential for vital processes in humans. In fact, the knowledge of the relationship between the mineral content in the diet and some diseases such as hypertension or osteoporosis has increased the interest in the mineral content — or the presence of metals, if toxic — in food. USAL has proved an effective choice for removing metals such as Pb, Cd, Cu and Ca from meat [20], chloride salts from various types of... 

Cd toxicity to kidneys can lead to degradation of vitamin D metabolism, which leads to osteoporosis Cd-induced nephotoxicity can also lead to decreased calcium and phosphate retention, which can produce osteomalacia (weakening of bones). 

Methotrexate Nausea and vomiting diarrhoea fever anaphylaxis hepatic necrosis Oral and gastrointestinal ulceration, perforation may occur bone marrow depression hepatic toxicity including cirrhosis renal toxicity pulmonary infiltrates and fibrosis osteoporosis conjunctivFtis alopecia depigmentation menstrual dysfunction encephalopathy infertility lymphoma teratogenesis... 

For continuous therapy the minimum amount to produce the desired effect must be used. Sometimes imperfect control must be accepted by the patient because full control, e.g. of rheumatoid arthritis, though obtainable, involves use of doses that must lead to long-term toxicity, e.g. osteoporosis, if... 

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