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29 Cards in this Set
- Front
- Back
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Calcium |
Major Divallent cation Neurotransmitter Muscle contraction Blood coagulation Skeleton contains 99% of total calcium |
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Calcium in body |
8.5-10.5mgDL 50% protein bound 50% free ionized Net intestinal absorption = urinary excretion |
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Bone remodeling |
Osteoblasts -->RANK --> Osteoclasts Degrade bone section(resorption) Osteoblast precusor + Calcium + phosphate = mineralization Longer in women, less time in exercisers |
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Osteoclast Enzymes |
TRAP (tartrate resistant acid phosphatase) Cathepsin K Osteopontin seals resorp pit |
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Osteoclast order |
Osteoclast progenitors --> QWOPS --> QWOPS+Osteoblasts --> osteoclasts RANK L on QWOPS super important |
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Calcium regulation |
PTH increases Vitamin D increase Calcitonin decreases Occurs in: Osteoclasts, distal renal tubules, intestinal epthileum |
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Parathyroid hormone |
Stimulated by lowe Ca+ levels in blood Increase bone resorption Activates Vit D to increase Ca+ Overall increase Ca+ but decrease Phos |
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Vit D |
7-dehydrocholesterol --> D3 --> Liver --> 25 hydroxy D3 --> kidneys --> 1,25Vit D--> intestins/bones |
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Vit D Actions |
Stimulated when Ca+ low, Phos low, or Increase in PTH Overall, keeps Ca+ and brings back Phosphate too! |
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Calcitonin |
Stimulated by too high Ca+ Overall brings down Ca+ levels, variable effect on Phos |
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Calcium |
Essential for muscle movements |
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Hypocalcemia |
Tense muscles Cramps Seizures CHF Numbness/tingling in extremities Larryngospasms(danger)/bronchospasms Chovstek/Troussea's sign |
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Hypocalcemia Causes |
Hypoparathyroidism Magnesium deficiency Tissue resistance to PTH Vit D deficiency (rickets in kids, osteomalacia in adults) Vit D resistance Pancreatitis Drugs: mithramycin, bisphosphonates, phenobarbital |
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Rickets vs osteomalacia |
Rickets: bone deformities Ostomalacia: diffuse bone pain Rickets Loosers zone: pseudofractures |
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Hypercalcemia SX |
STONES, BONES, GROANS, psychiatric overtones |
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Hypercalcemia Causes |
Ca supplements Hyperparathyroidism Milk-alki syndrome Pagets disease Excess Vit D or A Sarcoidosis |
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Primary Hyperparathyroidism |
Increase in Vit D Increase Ca+ excretion (because soo much) Overall increase in Ca+ and decrease in Phos |
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Pagets disease |
Disorder of bones Asymptomatic usually Can have warm limbs Nerve compression Deafness >50 Treat with: calcitonin, bisphos, plicamycin in refractory |
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Hypercalcemia Tx |
Mild to moderate: Loops and hydration NO THIAZIDES Severe: Plicamycin, Salmon Calcitonin, Bisphos (pamidronate, etidronate) |
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Osteoporosis |
Higher fracture risk Pain height decrease kyphosis 1:2 W 1:8 men >50 |
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Glucorticoids on Bones |
Estrogen and strontium ranelate bind OPG Glucocorticoids inhibit OPG |
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Osteoporosis Prevent/Tx |
Diet increase Ca+vitD Exercise Bisphos, SERM (raloxifene), Thiazide( increase Ca), Teriparatide (PTH analog), Denosumab (MAB for RANKl inhibition), Calcitonin, Estrogens |
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Bisphosp MoA |
1. Replace bonds in ATP to form non-functional that induces apoptosis of osteoclasts (not as selective) 2. Inhibition of Farnesyl pyrophosphate synthase --> inhibits bone resorption (inhibits prenylation) |
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Bisphos Choices |
Third Gen Risedronate, Zoledronate, Ibandronate best choices. More selective an less inhibition of bone formation |
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Bisphos PK |
1% of drug is absored OES No food before after No antacids Stand for 30-60 minutes PC Can cause low calcium if taking aminoglycoside Very long half lifes |
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Bisphos SE |
Esophageal irritation (minized by standing) Osteonecrosis jaw (phossy jaw) Fracture risk Afib Renal? Bone pain Nausea Diarrhea |
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Bisphos Indications for use |
1.Postmenopause Osteoporosis 2. Osteoporosis 3. Pagets 4. Bone metastases |
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Bisphos Dosing |
Significant reduction in fracture risk (30-50%) Single weekly dose = daily dose with less SE Second and third gen can be dosed once yearly |
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Bisphos for cancer |
control High Ca+ reduce bone pain delay skeletal cancer effects Reduce pathological fracture prolong overall survival Works in lytic and blastic cancers |
