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Pharmacology > Bone Metabolism > Flashcards

Bone Metabolism Flashcards

1
Q

What are the parathyroid glands responsible for?

A

4 glands responsible for the synthesis and release of parathyroid hormone

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2
Q

What are osteoclasts and osteoblasts.

A

Osteoclasts - decalcify and digest bone matrix liberating calcium

Osteoblasts - synthesis of extra cellular bone matrix and priming it’s subsequent mineralisation

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3
Q

What are the physiological effects of PTH?

A
  1. Regulation of Ca concentration in the plasma
  2. Ca concentration controlled by PTH and calcitriol and calcitonin
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4
Q

How does PTH work?

A
  1. Low levels of Ca in blood stimulates the release of PTH from the parathyroid glands
  2. This causes efflux of Ca from bone, decreased Ca loss in urine and increased absorption of Ca from intestine
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5
Q

How would you test parathyroid function?

A
  1. Calcium levels
  2. Phosphate levels
  3. Plasma PTH levels
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6
Q

Where is calcitonin secreted from?

A

Thyroid gland in response to increase in plasma Ca

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7
Q

What are the physiological effects of calcitonin?

A
  1. Minor role in regulating Ca levels
  2. Bone - inhibits osteoclast activity - decreases release of Ca and phosphate in blood
  3. Kidney - decreased Ca and phosphate reabsorption - decreased blood concentration
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8
Q

What is hyperparathyroidism?

A

Excessive release of PTH

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9
Q

What causes hyperparathyroidism?

A
  1. Primary - parathyroid adenoma
  2. Secondary - chronic renal failure
  3. Inadequate nutrition
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10
Q

What are the symptoms associated with increased plasma Ca?

A
  1. Thirst
  2. Increased urine output
  3. Constipation
  4. Memory impairment
  5. Long term - bone pain, osteoporosis, fractures and kidney stones
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11
Q

How would you diagnose hyperparathyroidism?

A
  1. Increased plasma Ca
  2. PTH increased
  3. Normal phosphate in mild cases, decreased in more severe disease
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12
Q

How would you treat hyperparathyroidism?

A
  1. Treat underlying cause - surgery
  2. Correction of hypercalcaemia
  • rehydration with IV NaCl 0.9% - first line treatment - increases GFR and therefore increases urinary Ca excretion to 4-6 litres/24 hours
  • bisphosphonates - impair function of osteoclasts decreasing plasma Ca levels - pamidronate disodium IV
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13
Q

What is hypoparathroidism?

A

Failure if the parathyroid gland to secret PTH or failure of PTH action at tissue level causing decreased plasma Ca and increased plasma phosphate

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14
Q

What causes hypoparathyroidism?

A
  1. Post operative
  2. Multiple endocrine deficiency
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15
Q

What are the symptoms of hypoparathyroidism?

A

Mainly due to hypocalcaemia

  1. Numbness and tingling in extremities and mouth
  2. Muscle spasm
  3. Irritability
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16
Q

What are the investigations of hypoparathyroidism?

A
  1. Decreased plasma Ca
  2. Increased phosphate
  3. Decreased PTH
17
Q

How would you treat hypoparathyroidism?

A
  1. Hypocalcaemic tetany
  • Ca gluconate IV
  • ECG monitoring
  • caution in cardiac glycosides - digoxin
  • monitor Ca levels
  • commence oral supplements immediately
  1. Chronic treatment
  • oral Ca supplement
  • vit D preparations
18
Q

Oral Ca supplements…

A
  1. Used alone in mild diesease
  2. More severe disease - combination with vit D
  3. Take between meals to avoid binding to dietary phosphate
  4. S/E’s are bradycardia, arrhythmias and constipation
19
Q

Vitamin D….

A
  1. Main treatment for more severe disease
  2. Increase intestinal Ca absorption
  3. Calcitriol or alfacalcidol
  • restores normal Ca levels within one week
  • effects last 1 week following withdrawal
20
Q

What is pagets disease

A

Disturbance of bone remodelling caused by excessive bone resorption by osteoclasts and increased in formation of poor quality bone

21
Q

New bone is…

A

Structurally enlarged and weakened with heavy calcification

22
Q

Paget’s disease mainly effects…

A

Skull and long bones - femur and tibia

23
Q

What are the symptoms of Paget’s disease?

A
  1. Bone pain
  2. Joint pain
  3. Fractures
  4. Hearing loss
  5. Blindness
24
Q

What is the treatment for Paget’s disease?

A
  1. Analgesics for symptomatic relief
  2. Bisohosphonates
  3. Calcitonin

Pharmacology (19 decks)

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