Calcitriol
INTRODUCTION Cessation of ovarian function, whether due to natural menopause or to surgical ovariectomy, leads to a loss of bone mass and is a contributing factor to osteoporosis. Alterations in Ca metabolism following menopause or ovariectomy include decreased intestinal Ca absorption [1, 2] possibly resulting from a lower responsiveness [3] to calcitriol 1, 25-dihydroxyvitamin D3 ; , increased urinary Ca excretion [4], a transient increase in bone remodeling lasting several years [5], and a lower "set-point" for bone mass [6]. Most of these changes are thought to result from low estrogen levels, but a lack of progesterone may also be a contributing factor [7]. Since normal ovarian function produces cyclical changes in the circulating levels of the sex hormones, the beneficial effects of ovarian activity on bone mass and Ca metabolism might vary during the menstrual cycle. These effects could be mediated by estrogen and progesterone directly or through alterations in serum levels of parathyroid hormone PTH ; , calcitonin, and calcitriol, the three major Ca-regulating hormones. Evidence supporting cyclical changes in Ca metabolism during the menstrual cycle includes observations of variations in the serum levels of ionized Ca [8], PTH [9], calcitriol [10-12], and osteocalcin [13], a presumed marker of osteoblastic, and hence bone-forming, activity. In each instance, serum concentrations were highest around the time of ovulation. However, these changes have not been consistently observed, as other investigators have found no influence of the menstrual cycle on serum levels of total Ca [3, 14, 15], PTH [8, 13, 14], calcitriol [13-16], or osteocalcin [17]. Possible variations in intestinal Ca absorption, total urinary Ca excretion, and bone resorption during the.
Figure 5.13: Graph comparing medic and CLU midwives mean scores along the control dimension, for example, calcitriol medication. Avoid turbulent vortexing which can trap air bubbles in the viscous inoculating fluid. Adjust the turbidity to correspond precisely with the target cell density. This is very important! If the turbidity is too light, add more cells. If it is too dense, dilute it with inoculating fluid. STEP 3: Inoculate a Cell Suspension into each PM. Pour each cell suspension into a sterile filling reservoir and inoculate the PMs by pipetting 100 L per well. STEP 4: Incubate the PMs. Incubate the PMs at the recommended temperature Table 1 ; in a humidified incubator to prevent drying of the outer wells. PM1 and PM2 are typically incubated for 24 hr and PM3 and PM4 for 36-48 hr. STEP 5: Read and Score the Results. Examine the wells for the formation of purple color which indicates utilization of the C, N, P, or S source in a particular well. Use the A-1 well as a reference well for a "negative" reaction also the F-1 well in PM4 ; . Any well with more color than the reference well is considered "positive". Typical reactions in PM1-4 for the species listed in Table 1 are posted on Biolog's website biolog ; . Different strains will vary, but your result with non-mutated strains should be similar. PROTOCOLS FOR SPECIFIC SPECIES Recommended testing protocols are summarized in Table 1 below. PM1-2 measure carbon utilization in a fully supplemented medium and should not require any supplements to the inoculating fluid other than menadione, salicylate or thioglycolate. PM3-4 measure nitrogen, phosphorus, and sulfur utilization in a minimal defined medium. A carbon source must always be added to the inoculating fluid for these PMs. The choice of the carbon source can have a strong effect on the result obtained. For example, succinate is recommended instead of glucose for enteric bacteria because many more positive reactions are obtained glucose represses formation of many secondary utilization pathways ; . The supplements in Table 1 have been optimized and they should be prepared and added precisely as specified unless there are reasons to depart from the recommendations. Also, for PM3-4, you need to know whether your strain requires special organic or inorganic growth supplements to be added to the minimal inoculating fluid. If it does, these must be provided as additional supplements in the inoculating fluids for PM3 and PM4. ADDITIONAL TECHNICAL ASSISTANCE AND WEBSITE INFORMATION The most current information on Phenotype MicroArrays is posted on the Biolog website biolog ; . If you need additional help or advice, please call us before you attempt to use the Phenotype MicroArrays. You can call Biolog Technical Service at 510-785-2564 or send an Email to info biolog . REFERENCES [1] Phenotype MicroArrays for High Throughput Phenotypic Testing and Assay of Gene Function. B.R. Bochner, P. Gadzinski, and E. Panomitros, Genome Research, 2001, v. 11, p. 1246-1255. [2] Sleuthing Out Bacterial Identities. B.R. Bochner, Nature, 1989, v.339, p.157-158. [3] The Consequences of Growth of a Mutator Strain of Escherichia coli as Measured by Loss of Function Among Multiple Gene Targets and Loss of Fitness. P. Funchain, A. Yeung, J.L. Stewart, R. Lin, M.M. Slupska, and J.H. Miller, Genetics, 2000, v. 154, p. 959-970. [4] Megaplasmid pRme2011a of Sinorhizobium meliloti Is Not Required for Viability. I.J. Oresnik, S.-L. Liu, C.K. Yost, and M.F. Hines, Journal of Bacteriology, 2000, v. 182, p.3582-3586. [5] A new medium for the enumeration and subculture of bacteria from potable water. D.J. Reasoner and E.E. Geldreich, Applied and Environmental Microbiology, 1985, v. 49, p. 1-7. Calcitriol equivalentsMeunier PJ. Evidence-based medicine and osteoporosis: a comparison of fracture risk reduction data from osteoporosis randomised clinical trials. Int J Clin Pract 1999; 53: 1229. Bjarnason NH, Christiansen C. Early response in biochemical markers predicts long-term response in bone mass during hormone replacement therapy in early postmenopausal women. Bone 2000; 26: 5619. Cheng S, Sipila S, Puolakka H, Suominen H. Effects of hormone replacement therapy and high impact physical activity on bone muscle ratio in postmenopausal women. Osteoporos Int 2000; 11 Suppl 2 ; : 175. Falch JA, Odegaard OR, Finnanger AM. 3 years treatment with 1, 25 OH ; 2 vitamin D3 does not reduce bone loss or fracture rate in postmenopausal women with fracture of the distal forearm. In Norman AW, Schaefer K, Grigoleit H, von Herrath D, editors. Vitamin D. Chemical, biochemical and clinical update. Berlin: Walter de Gruyter; 1985. pp. 10045. Gallagher JC, Riggs BL, Recker RR, Goldgar D. The effect of calcitriol on patients with postmenopausal osteoporosis with special reference to fracture frequency. Proceedings of the Society for Experimental Biology and Medicine 1989; 191: 28792. Herrington DM, Reboussin DM, Broshnihan KB, Sharp PC, Shumaker SA, Snyder TE, et al. Effects of estrogen replacement on the progression of coronary artery atherosclerosis. N Engl J Med 2000; 343: 5229. Mulnard RA, Cotman CW, Kawas C, van Dyck CH, Sano M, Doody R, et al. Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease: a randomized controlled trial. JAMA 2000; 283: 100715. Nachtigall LE, Nachtigall RH, Beckman M. Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis. Obstet Gynecol 1979; 53: 27781. Writing Group for the PEPI Trial. Effect of hormone therapy on bone mineral density. JAMA 1996; 276: 138996. Strickler R, Stovall DW, Merritt D, Shen W, Wong M, Silfen SL. Raloxifene and estrogen effects on quality of life in healthy postmenopausal women: a placebo-controlled randomized trial. Obstet Gynecol 2000; 96: 35965. Adami S, Passeri M, Ortolani S, Broggini M, Carratelli L, Caruso I, et al. Effects of oral alendronate and intranasal salmon calcitonin on bone mass and biochemical markers of bone turnover in postmenopausal women with osteoporosis. Bone 1995; 17: 38390. Mechanism of action inhibits calcium ion from entering the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina pharmacodynamics kinetics onset of action: 20 minutes protein binding concentration dependent ; : 92% to 98% metabolism: hepatic to inactive metabolites bioavailability: capsules: 45% to 75%; sustained release: 65% to 86% half-life elimination: adults: healthy: 2-5 hours, cirrhosis: 7 hours; elderly: 7 hours excretion: urine dosage oral: children: hypertrophic cardiomyopathy: 6- 9 mg kg 24 hours in 3-4 divided doses adolescents and adults: note: when switching from immediate release to sustained release formulations, total daily dose will start the same ; initial: 30 mg once daily as sustained release formulation, or if indicated, 10 mg 3 times day as capsules usual dose: 10-30 mg 3 times day as capsules or 30-60 mg once daily as sustained release maximum dose: 120-180 mg day increase sustained release at 7- to 14-day intervals hemodialysis: supplemental dose is not necessary and rocaltrol. Dozens of different drugs have been associated with stevens-johnson syndrome, although it is a rare condition. Calcitriol 25Table 1. Resistance of 5 Dry Powder Inhalers Manufacturer GlaxoSmithKline Sanofi-Aventis GlaxoSmithKline Boehringer Ingelheim AstraZeneca Resistance H2O L s ; 0.015 0.016 0.032. Some measurements have been performed at concentrations of 3% V V ; Table 4. Solubility of SeboCure in different solvents and for different concentrations SOLVENTS Sunflower oil Mineral oil Glycerol Propylene glycol Alcohol 100% ; Water Alcohol 25 75 ; Water Alcohol 50 ; Water Alcohol 75 25 ; Water 100% ; SOLUBILITY Dispersible Dispersible Soluble Soluble Soluble Soluble Soluble Soluble Soluble and carbimazole. Calcitriol and cholecalciferolCalcitriol calciumC-Hist SR . 54 C-Phed Tannate . 55 C-Phen . 55 Cabergoline . 36 Caduet. 17 Cafergot . 46 Cafgesic . 39 Calan . 14 Calan SR . 14 Calcijex . 30 Calcitril . 30 Camila . 33 Campath. 19 Campral . 62 Camptosar . 19 Canasa . 27 Cancidas . 11 Cantil . 29 Capastat Sulfate . 13 Capex . 25 Caphosol . 21 and duricef. SUMMARY FINANCIAL DATA The following tables summarize our financial data, prepared using U.S. generally accepted accounting principles, for the periods presented. You should read the following financial information together with the information under "Selected Financial Data, " "Operating and Financial Review and Prospects, " "Risk Factors" and our financial statements and the notes to those financial statements appearing elsewhere in this prospectus. The summary financial data as of December 31, 2003 and September 30, 2004, and for each of the two years ended December 31, 2003 and the nine month period ended September 30, 2004, are derived from our audited financial statements included in this prospectus. The summary financial data for the year ended December 31, 2001 has been derived from our unaudited financial statements not included in this prospectus. The summary financial data as of and for the nine month period ended September 30, 2003 is derived from our unaudited financial statements included in this prospectus, because caalcitriol 25. Plus calcium 500 mg daily increased spine BMD by a nonsignficant 1.4% compared with an increase on placebo of 0.8%. In this study, there was a small but significant change in total body BMD but no significant change in femoral neck BMD 40 ; . However, despite these unremarkable changes in BMD, there was a significant reduction in nonvertebral fractures, although the study sample is small. Another study of vitamin D and calcium in 80-yr-old women living in nursing homes in France showed a reduction in fractures in the first 2 yr but not in yr 3 and 4 37 ; . this group mean baseline serum 25OHD was only 32.5 nmol liter, which suggests that the majority of the elderly French women in this study had marked vitamin D deficiency. Certainly providing vitamin D 400 600 U d to high-risk group to maintain normal vitamin D nutrition and avoid osteomalacia is sensible but there is no data to show that this dose will reduce osteoporotic fractures in women with normal vitamin D nutrition. A 4-yr study that compared 25 hydroxyvitamin D3, 15 micrograms daily to calcium supplements 750 mg d or placebo 41 ; found that the 25OHD treatment increased serum 25OHD to the same level as that in the vitamin D 700 IU daily study 40 ; . It was ineffective in reversing bone loss at the hip and spine and had no significant effect on fractures. Because a major effect of calctriol is to increase calcium absorption, another important question is whether calcium treatment alone would be just as effective as calcitriol therapy. Unfortunately there is little clinical trial data comparing the effects of calcium supplements against placebo on BMD and fractures in elderly women 41, 42 ; . In these studies, calcium supplements, 500 or 750 mg d, reduced the rate of bone loss in the femoral neck and spine compared with placebo. However, these studies were not powered as fracture studies and there was no effect on fracture rates. Calcium absorption was significantly increased in both groups receiving calcitriol whereas estrogen had no effect on absorption. Some studies have previously shown an increase in calcium absorption on conjugated equine estrogens 43, 44 ; , probably because estrogen increases serum PTH and calcitriol 43, 45 ; . In another study, calcium absorption increased on estrogen in younger women but not in older women 45 ; , and a decrease in absorption on estrogen was also noted in another study 46 ; . It may be that the reason for the lack of response in these other groups can be attributed to the intestinal resistance to endogenous calcitriol that occurs with aging. Serum PTH was significantly reduced in both groups treated with calcitriol, but increased in the estrogen and placebo groups. It is likely that the antiresorptive action of calcitriol is due to a decrease in secondary hyperparathyroidism, mediated either by a direct effect of calcitriol on the gland or via increased calcium availability subsequent to enhanced intestinal absorption of calcium. The incidence of nonvertebral fractures was a secondary outcome and the study was not powered to detect significant differences between treatments. It is interesting that the incidence of fractures was about 50% lower in the two groups on calcitriol compared with HRT ERT and placebo, and this deserves further study. In two other recent large-scale studies of antiresorptive agents, of raloxifene in 7700 osteoporotic women 32 ; and alendronate 33 ; in 4400 women with low bone mass, neither study demonstrated a significant reduc and cefdinir. Drug Name Hormonal Agents, Stimulant Replacement Modifying Parathyroid Metabolic Bone Disease Agents ; Bisphosphonates, Oral ACTONEL 5MG, 35MG TABLETS ACTONEL 30MG TABLETS BONIVA 2.5MG, 150MG TABLETS FOSAMAX PLUS D FOSAMAX 5MG, 10MG, 35MG, TABLETS FOSAMAX 40MG TABLETS FOSAMAX SOLUTION SKELID Bisphosphonates, Parenteral BONIVA INJECTABLET pamidronate disodium Calcium Regulating Hormones FORTEO fortical MIACALCIN Parathyroid Hormone Analogs FORTEO Vitamin D-related Agents Metabolic Bone Disease Agents calcitriol capsules calcitriol solution HECTOROL CAPSULES HECTOROL INJECTABLE ZEMPLAR CAPSULES ZEMPLAR INJECTABLE Hormonal Agents, Stimulant Replacement Modifying Pituitary ; Hormonal Agents, Stimulant Replacement Modifying Pituitary ; desmopressin acetate solution desmopressin acetate tablets GENOTROPIN HUMATROPE minirin NORDITROPIN CARTRIDGE NUTROPIN AQ NUTROPIN SAIZEN CMS Approval Date: 08 2007 Material ID: H2931015 7434. Her medications included cyclosporine, azathioprine 75 mg per day in divided doses ; , prednisone 5 mg per day ; , nifedipine, thyroxine, calcitriol, high blood pressure - on the sunny side of the street - apr 12, 2007 market-day , in the liver it helps to produce a substance called calcidiol, which in turn creates calcitriol and omnicef.
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