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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
Phosphaturic hormone made by
Osteoblast
26
Function of phophaturic hormone What’s its relationship with vit D
It to increase po4 in the urine and decreasing it in the blood , it counteract vit d
27
Which type of hormones vitamin D
It’s a prohormone
28
Mention 2 forms of vitamin D
Vitamin D2 ergocalciferol Vitamin D3 cholecalciferol
29
Where is vitamin D made
Vitamin D is made by skin , placenta and decidua .
30
Chemical abbrec]viation for calcitriol Define calcitriol
1,25oh 2vit d3 Active form of vitamin d found in the body
31
What’s the effect of calcitriol on ca and po4 and on osteoblast and osteoclast
Osteoblast and osteoclast f[differentiation Increase calcium reuptake fo]rom the git Increase ca an po4 reabsorption from the kidney s
32
Mention 2 main functions of calcitriol
1 anti tumor effect 2 anti calcitonin
33
Describe the synthesis for calcitriol Skin Liver Kidney
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
34
What’s the half life of 25(oh) d3
1.5 months , as a form of stored vitamin D .
35
1,25(oh)2 d3 half life
0.25 day كتير اقصر من اللي قبل .
36
Vitamin d deficiency leads to 4 main diseases
1 ) 2ndry hyperparathyrodism 2) osteomalacia 3) Rickets 4) c-linked rickets .
37
3 Types of hyperparathyrodism
1ry hyperparathyrodism 2ndry hyperparathyrodism 2ndry to 2ndry hyperparathyrodism
38
What does 1ry hyper parathyrodism leads to And what causes primary hyperparathyrodism
Leads to hypercalcemia Mostly caused by benign tumor .
39
What are the causes of primary hyperparathyroidism Most common cause Least common cause Which one is Autosomal dominant
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
2ndry hyperparathyroidism causes 3
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
2ndry to 2ndry hyperparathyrodism when does it occur What happen to the renal due to it Mechanism
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
Define pathological calcification Is it common
Abnormal tissue deposition of Ca salts and another minerals salts Common process
43
What are the 2 forms of pathological calcifications
1 ) dystrophic deposition 2 _ metastatic deposition
44
Which form of pathological calcification occurs despite Nl serum ca levels , and despot normal metabolic ca levels
Dystrophic calcification , since deposition occurs locally at the dying tissue or in necrosis areas
45
Which form of pathological calcification occurs in normal tissue and what causing it
Metastatic calcification; due to hypercalcemia , deposition occurs in normal tissues .
46
What are the causes of hypercalcemia in general
1 ) hyperparathyroidism 2) renal failure 3) vitamin D disorders 4) destruction of bone tissue 5) drug induced 6) endocrinopathies .
47
What does renal failure lead to and what it’s th effect on ca , PO4 and PTH
Renal failure leads to hypercalcemia , accumulation of PO4 , and 2ndry hyperparathyrodism
48
What are the vit D disorders that lead to hypercalcemia
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
What diseases lead to bone tissue destruction and thus ; hypercalcemia
Primary Bone tumors Mets breast ca Immobilization Pager disease ; accelerated bone turnover
50
What drug induce hypercalcemia
Lithium Thiazide Estrogen Vitamin A intoxication
51
Which I-endocrinopathies leads to hypercalcemia
Thyrotoxicosis Pheochromocytoma .
52
What are classical clinical features to hypercalcemia
Bone Stones Groans abdominal Psychic moans Others proximal muscle weakness Conjunctivitis , keratitis .
53
Hypercalcemia lead to stone which included
Renal calculi Nephrocalcinosis .
54
How does hypercalcemia affect bones
Osteoporosis ostemalcia osteiitis fibrosa rickets
55
How does hypercalcemia lead to abdominal groans
Constipation Vomiting Peptic ulcer Pancreatitis
56
Hypercalcemia leads to pschosis maons what mainefestations occur
Depression 1 Memory loss Psychosis , paranoia coma Less excitability
57
What is the treatment of hypercalcemia 4 things ppcd
1 dehydration 2 pamidronate disodium 3 calcitonin 4 pilcamycin
58
Describe pamidronate disodium ;
Bisphosphonate drug the inhibits osetoclastic activity . Bone resorption
59
Define hypocalcemia
Is calcium serum level below Nl Ionized ca < 1.1 mmol/l Total ca < 2.1 mmol /L
60
Causes of hypocalcemia
Hyopoparathyrodism Vitamin d deficiency Hyopmagnessemia Citrates blood transfusion Acute pancreatitis
61
Acute pancreatitis lead to hypo or hyper ca
Hyopcalcemia
62
Citrates blood transfusion lead to hypo or hyper ca
Hypocalcemia
63
Clinical features of hypocalcemia include
Perioral tingling Parasthesia Tetany chovestek sign , terassaue sign Subscapuler cataract Cardiac arrhythmias ECG changes pronloged QT interval , ST interval .
64
Causes of hypoparathyrodism , high mg or low
1 ) post surgery or radiation 2) idiopathic 3 ) familial 4 ) hypomagnessemia 5) autoimmune digeorge syndrome 6) metal deposits iron copper and aluminum .
65
What’s the effect of digeorge syndrome on the PTH
Hyopoparathyrodism .
66
Remodeling of bones duration is
90-200 days
67
Where does bone turnover occurs on the bone
At the surface of the bone of periosteal and endosteal .
68
What is the total surface area of the bone
1000-5000m2
69
Osteoblast modulators
PTH Thyroid hormone Estrogen Glucocorticoids.
70
Osteoclast modulators
tNf . I’L 1 - IL6. GM-CSF .
71
At what age does human reach maximum bone density
At 25 years old .
72
Which one have receptor for PTH and which one is a product of the other
Osteoclast have no PTH receptors Osteoclast is. A product of osteoblast Osetoblast have PTH receptors .
73
Biochemical markers for bone turnover
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
Define osteoperosis with the 2 main characteristics of it
1 reduced bone mineral density 2 Disruption at the microarchitecture of bone
75
Prevelance of osteoperosis is at which age Female and male prevelance
Is at > 50 years . Males 20% . Females 50% .
76
Diagnosis of osteoporosis depends on what
Depend on T score
77
T-score of BMD < 1 SD considered
Normal
78
Bone density of 1 to 2,5 SD . Is considered
Osteopenia
79
BMD o f > 2.5
Osteoperosis .
80
Major risk factors or causes of osteoporosis environmental
Smokin alcohol sedentary life style malnutrition , immobilization .
81
Autoimmune diseases that may lead to osteoporosis 2
DM .celiac
82
Drugs lead to osteoporosis
PPI , glucocorticoid , anticonvulsant , immunosuppressive drugs
83
Endocrine causes that may lead to osteoporosis
Hyperthyroidism Hyperparathyrodism Decrease estrogen Pregnancy Lactation hyperprolactinaemia Cushing Hypogonadism status
84
Hematological causes that may lead to osteoporosis
Myeloma Lymphoma Sickle diastase
85
Metabolic disorders that may lea dot osteoporosis
Heamochromatosis Glycogen storage diastase Porphyria Hemocystienuria .
86
Risk factors for osteoporosis
Low BMI ; < 19 kg / m2 Chronic diseases Untreated premature menopause Prolonged immobilization Previous family he of maternal fractures at age < 75 .
87
Treatment of osteoperosis has 9 drugs
1 ca 2 c]vitamin D 3 bisphosphonate 4 teriparatide 5 testosterone 6 hormone replacement therapy 7 clacitonin 8 calcitriol 9 strontium
88
How many amount of ca you should give in case of osteoporosis
1 g ca
89
Amount of vitamin D that should be given in case of osteoporosis
800 IU .
90
When do we give bisphosphonate for treatment of osteoporosis without Dexa
> 75 years old
91
When Do we give bisphosphonate for 65 to 75 years old female
When osteoporosis is confirmed on dexa
92
When to give bisphosphonate for less than 65 years
If low bone mass density or high risk factors .
93
When do we use Teriparatide and what’s is it
Is a form of PTH used in woman > 65 with low bone mass density .
94
What does strontium do as treatment for osteoporosis
It promotes osteoblast and inhibit osteoclast

Physiology (13 decks)

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