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Physiology > Calcium Hemostasis > Flashcards

Calcium Hemostasis Flashcards

1
Q

Ca +2 functions

A

1Bone formation
2 Muscle contraction
3 co enzyme
4 blood clotting
5 stabilizing membrane potential
6 2ndry messenger

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2
Q

Distri=ibution of Ca
Total body ca is
How much of that located in the skeleton

A

1 kg of CA
99% in the skeleton as a reservoir , 99% of it is stable , 1 % labile
In the plasma (ECF )
45 % free
55% bound to plasma proteins

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3
Q

Ca is bound to what

A

Plasma protein mainly albumin
Po4-3
Hco3-

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4
Q

Acidosis And alkalosis effect on Ca
Daily requirement of CA

A

Acidosis increased amount of ionized ca . In the blood replacement instead of h+ that will go into the cells and get ca2 out of it to neutralize the charge outside the cell ECF

1 g / day in adult
1.5 g /day in pregnant

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5
Q

What are the major pools of CA in our body

A

Mainly in the bone 99%
1 % in the ECF an intracelleuler ,]mainly ECF concentration of ionized ca in the ECf is 12000 more than ICF
ICF sequestered exclusively out of the cystol nad within the mitochondria and endoplasmic reticulum .
It’s released only by certain stimuli or cell damage as oxytocin

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6
Q

Intracellular free ca conc.

A

100nm to 1 microm

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7
Q

So where can you find ca more in the ECF or ICF

A

In the ECF

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8
Q

Main three ca modulators are

A

PTH
PTH-P releasing peptide come from brain , placenta , teeth , works as Paracrine , main fun to deliver ca to the fetus from mother
Calcitonin

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9
Q

Mention 3 ways o ca reabsorption in the git

A

Active uptake by NA CA ATPase
Transmembrane transporter calbindin which is hydrophobic and released due to the effect of vitamin D3
Endocytosis ca -calbindin complex via TRPv 6 membrane CA channel .

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10
Q

3 main fuxns for phosphate

A

Used in metabolism for ATP synthesis
Phosphorylation of enzymes
Forms phospholipids on the membrane .

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11
Q

Calcium regulatory hormones are

A

1 PTH
2 PTH -rP
3 calcitonin
4 phosphouretric hormone
5 calcitriol
6 vitamin D .

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12
Q

PTH hormone which type of hormone, how many amino acids does it contain

A

Peptide hormone , have 83 amino acid as to many iso froms

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13
Q

PTH works on which type of receptors

A

Works on G-protein receptors

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14
Q

Half life of it
And stores supply for how many min

A

Minutes
90 mins

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15
Q

Functions of PTH

A

Increases Ca
Decreases PO4
Antagonize the calcitonin

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16
Q

Does PTH hormone cross the placenta

A

PTH hormone doesnt cross the placenta .

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17
Q

At which body compartments does PTH hormone works

A

1 bone increase bone resorption works mainly at 1st on the osteoblast to increase the ca intake then 2nd phase on osteclast to retake ca and increase it in the blood from the bone
2 kidneys works on DCT to reabsorp higher Amount of Ca and increase excretion of PO4 by the PCT
Let the kindney convert calcitriol by increasing alpha 1 hydroxylase to make vitamin D with 3 OH instead of 2 then this will go to the intestines and increase absorption of Ca by calbindin activation . Increase vit D production
Promotes calcitriol production

3 intestines
Increases ca an po4 absorption

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18
Q

So does PTH increase vitamin D secretion

A

Yes , vitamin D رجل حكيم بشتغل تحت ايد ال PTH لمًا يقل الكالسيوم بزيده ولما يزيد بقاله بس باثر نفس الا-تاثير على ال فوسفيت بزيده مع الكالسيوم وبقلله لما يقلل. الكالسيوم

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19
Q

PTH-rH

A

Released by most tissues
And n=by cancer cells
Brain placenta , teeth

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20
Q

What’s the difference between PTH and PTH-rH

A

It’s fun is similar to PTH but it doesn’t increase vit D levels .
Regulate condeocyte proliferation
Important for placental transport of CALCIUM

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21
Q

Calcitonin is which type of hormone
How many amino acids does it composed of

A

Calcitonin is polypeptide hormone composed of 32 amino acids .

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22
Q

Calcitonin production site

A

C cells parafolliculer cells in the thyroid gland

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23
Q

When does calcitonin secreted and what does it do

A

Calcitonin is secreted as a response for increased levels of CA and PO4
Works o osteoclast mainly not osteoblast , by inhibiting it’s effect بحب العضم كتير بهمه يبني العضم
So increases deposition of CA and PO4 in the bone and decreases its level in the blood
Prevent reabsorption of Ca and PO4 reabsorption from the PCT . So it works on the osteoclast and PCt of the kidney
In the book it says that it decreases ca reabsorption in the intestine but on YouTube it says that calcitonin doesn’t work on the intestines .

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24
Q

Mention 3 ways how calcitonin decrease ca in our body

A
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25
Q

Phosphaturic hormone made by

A

Osteoblast

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26
Q

Function of phophaturic hormone
What’s its relationship with vit D

A

It to increase po4 in the urine and decreasing it in the blood , it counteract vit d

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27
Q

Which type of hormones vitamin D

A

It’s a prohormone

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28
Q

Mention 2 forms of vitamin D

A

Vitamin D2 ergocalciferol
Vitamin D3 cholecalciferol

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29
Q

Where is vitamin D made

A

Vitamin D is made by skin , placenta and decidua .

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30
Q

Chemical abbrec]viation for calcitriol
Define calcitriol

A

1,25oh 2vit d3
Active form of vitamin d found in the body

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31
Q

What’s the effect of calcitriol on ca and po4 and on osteoblast and osteoclast

A

Osteoblast and osteoclast f[differentiation
Increase calcium reuptake fo]rom the git
Increase ca an po4 reabsorption from the kidney s

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32
Q

Mention 2 main functions of calcitriol

A

1 anti tumor effect
2 anti calcitonin

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33
Q

Describe the synthesis for calcitriol
Skin
Liver
Kidney

A

Skin , 7-dehydrochlestrol —— by uv light ——- vitamin D3
Liver vitamin d —— 25 hydroxylase 25-oh vitnd 3
Kidney —— alpha hydroxylase = 1,25 (OH) 2 D3 this is the calcitriol

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34
Q

What’s the half life of 25(oh) d3

A

1.5 months , as a form of stored vitamin D .

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35
Q

1,25(oh)2 d3 half life

A

0.25 day كتير اقصر من اللي قبل .

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36
Q

Vitamin d deficiency leads to 4 main diseases

A

1 ) 2ndry hyperparathyrodism
2) osteomalacia
3) Rickets
4) c-linked rickets .

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37
Q

3 Types of hyperparathyrodism

A

1ry hyperparathyrodism
2ndry hyperparathyrodism
2ndry to 2ndry hyperparathyrodism

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38
Q

What does 1ry hyper parathyrodism leads to
And what causes primary hyperparathyrodism

A

Leads to hypercalcemia
Mostly caused by benign tumor .

39
Q

What are the causes of primary hyperparathyroidism
Most common cause
Least common cause
Which one is Autosomal dominant

A

1- parathyroid adenoma 80% .
2- parathyroid hyperplasia 15%
3- parathyroid carcinoma 2% mostly AD
As a part of
MEN 1
MEN 2A
Isolated familial hyperparathyroidism
All. Of those are familial endocrinopathies .

40
Q

2ndry hyperparathyroidism causes 3

A

1 ) kidney disease
2) decrease vit D
3) decrease calcium levels serum
So 2ndry hyperparathyrodism occurs when ca levels in the serum are decreased

41
Q

2ndry to 2ndry hyperparathyrodism when does it occur
What happen to the renal due to it
Mechanism

A

It occurs after a chronic hyperparathyrodism
Renal osteodystrophy
Ca resorption from the bone
Ca deposits in the g]kidney and the GFR of the kidney decreased by 50% .
Decreased GFR , increased calcium resorption by the bones .

42
Q

Define pathological calcification
Is it common

A

Abnormal tissue deposition of Ca salts and another minerals salts
Common process

43
Q

What are the 2 forms of pathological calcifications

A

1 ) dystrophic deposition
2 _ metastatic deposition

44
Q

Which form of pathological calcification occurs despite Nl serum ca levels , and despot normal metabolic ca levels

A

Dystrophic calcification , since deposition occurs locally at the dying tissue or in necrosis areas

45
Q

Which form of pathological calcification occurs in normal tissue and what causing it

A

Metastatic calcification; due to hypercalcemia , deposition occurs in normal tissues .

46
Q

What are the causes of hypercalcemia in general

A

1 ) hyperparathyroidism
2) renal failure
3) vitamin D disorders
4) destruction of bone tissue
5) drug induced
6) endocrinopathies .

47
Q

What does renal failure lead to and what it’s th effect on ca , PO4 and PTH

A

Renal failure leads to hypercalcemia , accumulation of PO4 , and 2ndry hyperparathyrodism

48
Q

What are the vit D disorders that lead to hypercalcemia

A

Sarcoidosis ; it causes dysregulation in vitamin d production with an increase in its external production .
Vitam d excess
Williams syndrome ( idiopathic hypercalcemia in infants )

49
Q

What diseases lead to bone tissue destruction and thus ; hypercalcemia

A

Primary Bone tumors
Mets breast ca
Immobilization
Pager disease ; accelerated bone turnover

50
Q

What drug induce hypercalcemia

A

Lithium
Thiazide
Estrogen
Vitamin A intoxication

51
Q

Which I-endocrinopathies leads to hypercalcemia

A

Thyrotoxicosis
Pheochromocytoma .

52
Q

What are classical clinical features to hypercalcemia

A

Bone
Stones
Groans abdominal
Psychic moans
Others proximal muscle weakness
Conjunctivitis , keratitis .

53
Q

Hypercalcemia lead to stone which included

A

Renal calculi
Nephrocalcinosis .

54
Q

How does hypercalcemia affect bones

A

Osteoporosis ostemalcia osteiitis fibrosa rickets

55
Q

How does hypercalcemia lead to abdominal groans

A

Constipation
Vomiting
Peptic ulcer
Pancreatitis

56
Q

Hypercalcemia leads to pschosis maons what mainefestations occur

A

Depression 1
Memory loss
Psychosis , paranoia coma
Less excitability

57
Q

What is the treatment of hypercalcemia 4 things ppcd

A

1 dehydration
2 pamidronate disodium
3 calcitonin
4 pilcamycin

58
Q

Describe pamidronate disodium ;

A

Bisphosphonate drug the inhibits osetoclastic activity . Bone resorption

59
Q

Define hypocalcemia

A

Is calcium serum level below Nl
Ionized ca < 1.1 mmol/l
Total ca < 2.1 mmol /L

60
Q

Causes of hypocalcemia

A

Hyopoparathyrodism
Vitamin d deficiency
Hyopmagnessemia
Citrates blood transfusion
Acute pancreatitis

61
Q

Acute pancreatitis lead to hypo or hyper ca

A

Hyopcalcemia

62
Q

Citrates blood transfusion lead to hypo or hyper ca

A

Hypocalcemia

63
Q

Clinical features of hypocalcemia include

A

Perioral tingling
Parasthesia
Tetany chovestek sign , terassaue sign
Subscapuler cataract
Cardiac arrhythmias
ECG changes pronloged QT interval , ST interval .

64
Q

Causes of hypoparathyrodism , high mg or low

A

1 ) post surgery or radiation
2) idiopathic
3 ) familial
4 ) hypomagnessemia
5) autoimmune digeorge syndrome
6) metal deposits iron copper and aluminum .

65
Q

What’s the effect of digeorge syndrome on the PTH

A

Hyopoparathyrodism .

66
Q

Remodeling of bones duration is

A

90-200 days

67
Q

Where does bone turnover occurs on the bone

A

At the surface of the bone of periosteal and endosteal .

68
Q

What is the total surface area of the bone

A

1000-5000m2

69
Q

Osteoblast modulators

A

PTH
Thyroid hormone
Estrogen
Glucocorticoids.

70
Q

Osteoclast modulators

A

tNf .
I’L 1 - IL6.
GM-CSF .

71
Q

At what age does human reach maximum bone density

A

At 25 years old .

72
Q

Which one have receptor for PTH and which one is a product of the other

A

Osteoclast have no PTH receptors
Osteoclast is. A product of osteoblast
Osetoblast have PTH receptors .

73
Q

Biochemical markers for bone turnover

A

1 AlPO4
2 TRaP
3 hydroxyproline urine
4 pyridinoline urine
Type 1 collagen urine
So TRAP as Menominee T for type 1 collagen
r=R for hydroxyproline
P for pyridinoline urine
A for ALPO4

74
Q

Define osteoperosis with the 2 main characteristics of it

A

1 reduced bone mineral density
2 Disruption at the microarchitecture of bone

75
Q

Prevelance of osteoperosis is at which age
Female and male prevelance

A

Is at > 50 years .
Males 20% .
Females 50% .

76
Q

Diagnosis of osteoporosis depends on what

A

Depend on T score

77
Q

T-score of BMD < 1 SD considered

A

Normal

78
Q

Bone density of 1 to 2,5 SD . Is considered

A

Osteopenia

79
Q

BMD o f > 2.5

A

Osteoperosis .

80
Q

Major risk factors or causes of osteoporosis environmental

A

Smokin alcohol sedentary life style malnutrition , immobilization .

81
Q

Autoimmune diseases that may lead to osteoporosis 2

A

DM .celiac

82
Q

Drugs lead to osteoporosis

A

PPI , glucocorticoid , anticonvulsant , immunosuppressive drugs

83
Q

Endocrine causes that may lead to osteoporosis

A

Hyperthyroidism
Hyperparathyrodism
Decrease estrogen
Pregnancy
Lactation hyperprolactinaemia
Cushing
Hypogonadism status

84
Q

Hematological causes that may lead to osteoporosis

A

Myeloma
Lymphoma
Sickle diastase

85
Q

Metabolic disorders that may lea dot osteoporosis

A

Heamochromatosis
Glycogen storage diastase
Porphyria
Hemocystienuria .

86
Q

Risk factors for osteoporosis

A

Low BMI ; < 19 kg / m2
Chronic diseases
Untreated premature menopause
Prolonged immobilization
Previous family he of maternal fractures at age < 75 .

87
Q

Treatment of osteoperosis has 9 drugs

A

1 ca
2 c]vitamin D
3 bisphosphonate
4 teriparatide
5 testosterone
6 hormone replacement therapy
7 clacitonin
8 calcitriol
9 strontium

88
Q

How many amount of ca you should give in case of osteoporosis

A

1 g ca

89
Q

Amount of vitamin D that should be given in case of osteoporosis

A

800 IU .

90
Q

When do we give bisphosphonate for treatment of osteoporosis without Dexa

A

> 75 years old

91
Q

When Do we give bisphosphonate for 65 to 75 years old female

A

When osteoporosis is confirmed on dexa

92
Q

When to give bisphosphonate for less than 65 years

A

If low bone mass density or high risk factors .

93
Q

When do we use Teriparatide and what’s is it

A

Is a form of PTH used in woman > 65 with low bone mass density .

94
Q

What does strontium do as treatment for osteoporosis

A

It promotes osteoblast and inhibit osteoclast

Physiology (13 decks)

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