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34 Cards in this Set

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Organs involved in calcium regulation?
Intestine(10-20% absorbed)
Kidney(99% absorbed)
Bone
Calcium in Bone?
1 KG, 99% stable, 4-5 grams of exchangable calcium, 20 grams per day turnover
Symptoms of hypocalcemia?
Neuromuscular tetany, muscle cramps, convulsions, laryngiospasms, Rickets, osteomalacia
Causes of Hypocalcemia?
Diatry calcium of Vit D, malabsorption due to Vit D activation or endorgan resistance, hypoparathyroidism, renal failure
Symptoms of hypercalcemia?
Cardiac arrhythias, renal damage(calculi), soft tiddue calcification, CNS abnormalities
Causes of hypercalcemia?
hyperparathyroidism, Hypervitiminosis D, Sarcoidosis, neoplasia, hyperthyroidism
types of Vit D
Vit D2: from UV
Vit D3: from diet
Activation of Vit D
Vit D to 25-OH-Vit D in liver
25-OH-Vit D to 1,25-diOH-Vit D in kidneys.
Inhibeted by Calcium, phosphate, and 1,25-diOH-Vit D, activated by PTH of low phoshate
Calcium effects on Vit D
Inhibits directly and indirectly by decreasing PTH
Therapeutic use of Vit D
Prophylaxis and cure of rickets/ osteomalacia, htpoparathyroidism and osteoporosis
Actions of PTH?
directly on kidneys to stimulate reabsorption of Calcium, activates Vit D, decreases PO4 reabsorption, increase calcium resorption from bone
PTH as a diagnostic tool?
Examine cAMP production by kidneys to detect pseudohypoparathyroidism
Treatment for hypoparathyroidism?
Calcium and Vit D
Treatment for hyerparathyroidism?
Surgical resection
Actions of Calcitonin?
Decrease Calcium absorption from intestines, increase urinary excretion of Calcium, Magnesium, Cloride, phosphate, inhibits ostroclasts
Therapeutic use of Calcitonin?
treat paget's disease, osteoporosis, hypercalcemia associated with malignancy, Vit D toxicity
Gallium nitrate indication?
Hypercalcemia of malignancy, decreases bone resorption
Glucocorticoid indication?
Hypercalcemia associated with sarcoidosis or Vit D toxicosis, noy PTH induced
Glucocorticoid MOA?
Antagonize aaction of Vit D
Thiazide Indication and site of action?
Renal hypercalciuria, early segment of distal tubule, inhibits renal stone formation
Bisphosphonates?
Etidronate, Pamidronate B, Aldendronate
Pharmacokinetics of Bisphosphonates?
Low absorption when orally administered, decreased further by food!, short plasma half-life, but half-life after deposition is long
Bisphosphonates Contraindications?
Children, pregnancy, breast feeding, GIulcers, decreased renal function.
Drug interactions of Bisphosphonates?
Al(OH)3, Antacids, Ca, Mg,Fe salts,NSAIDs -None with Palmidronate (i.v.)
Indications of Bisphosphonates?
Paget’s disease, Osteoporosis
Bisphosphonates MOA?
absorbs into bone, inhibits osteoclast, decrease activation of Vit D
Flouride MOA?
Mitogen for osteoblast bone formation
Flouride CI?
arthralgia, pregnancy, breast-feeding, children, dental fluorosis-mottled enamel
Flouride adverse effects?
Dermatitis, GI bleeding...
Estrogen indication?
Post-menopausal women to prevent osteoporosis
SERMs?
Specific Estrogen Receptor Modulators
Reloxifene, increased risk of DVT's
Teriparatide?
1-34 PHT for osteoporosis
Teriparatide CI?
Paget's and kids b/c causes osteosarcoma
Cinacalcet, MOA, indications?
Calcium mimetic, inhibits PTH release, secondary hyperparathyroidism, parathyroid carcinoma, chronic kidney disease