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Pharmacology 2 > Calcium Metabolism > Flashcards

Calcium Metabolism Flashcards

1
Q

Where is calcium stored?

A

Bones

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2
Q

Where is calcium excreted?

A

Kidneys

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3
Q

Where is calcium absorbed?

A

GIT

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4
Q

How much serum calcium is bound to plasma protein?

A

~50%

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5
Q

How is calcium regulated by the body?

A

PTH

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6
Q

What are the 3 major causes of hypocalcemia?

A

Parturient paresis
Parturient eclampsia in lactating bitches
Primary hypoparathyroidism

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7
Q

What species do you see parturient paresis in? (2 species)

A

Cattle

Sheep

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8
Q

What species do you see hypoparathyroidism in?

A

Canines

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9
Q

What clinical signs do you see with hypocalcemia? (8 things)

A 
Hyperesthesia
Muscle tremors
Muscle fasciculations
Tetany
Hyperthermia
Bradycardia
Seizures
Pawing/face rubbing
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10
Q

What can hypocalcemia progress to in cattle?

A

Flaccid paralysis

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11
Q

What are the two treatment goals with hypocalcemia?

A

Correct calcium deficit

Correct underlying problems

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12
Q

What are two underlying problems of hypocalcemia?

A

Primary hypoparathyroidism

Vitamin D deficiency

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13
Q

What are the two types of parenteral calcium?

A

Calcium (boro) gluconate

Calcium chloride

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14
Q

What do you need to be cautious with when using parenteral calcium?

A

Potential to be caustic, NEVER give Sq/IM and still cautious with IV

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15
Q

What can happen with parenteral calcium if mixed with bicarbonate, acetate or lactate?

A

Can precipitate

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16
Q

What are the 5 types of oral calcium?

A 
Calcium gluconate
Calcium proprionate
Calcium lactate
Calcium carbonate
Calcium lactate
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17
Q

What does the use of oral calcium require?

A

Requires the gut to absorb the calcium

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18
Q

What varies between oral calcium products?

A

Quantity of elemental calcium

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19
Q

What oral calcium is used in cattle?

A

Calcium proprionate

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20
Q

What is the most recommended form of oral calcium?

A

Calcium carbonate

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21
Q

What might calcium carbonate cause?

A

Alkalosis

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22
Q

What oral calcium is most efficient at binding dietary phosphorus?

A

Calcium acetate

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23
Q

What is calcium acetate use for commonly?

A

Used in renal disease to bind dietary phosphorus.

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24
Q

What is an indication for using oral calcium?

A 
Antacid
Phosphate binder (calcium acetate carbonate, aluminum is more common)
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25
Q

What do you monitor when treating with IV calcium? (3 things)

A

Monitor heart rate/ECG
Response of clinical signs
Serum calcium levels

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26
Q

What do you use for long term management of hypocalcemia?

A

Vitamin D

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27
Q

What are the 3 actions of Vitamin D?

A

Increase intestinal absorption
Increase renal tubular re-absorption
Increase mineral bone resorption

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28
Q

In what situation does Vit D supplementation more effective than extra calcium?

A

PTH deficiency

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29
Q

What are 3 things that you can use to supplement Vit. D?

A

Ergocalciferol
Dihyrotachysterol
Calcitriol

30
Q

What is a drawback to using ergocalciferol?

A

Large doses are needed

31
Q

How long to see clinical response to ergocalciferol?

A

5-14 days

32
Q

What is a pro of using ergocalciferol?

A

Inexpensive

33
Q

What are two pros of using dihydrotachysterol?

A

More potent

Activated in the liver (doesn’t need PTH activation)

34
Q

How long to see clinical response to dihydrotachysterol?

A

1-7 day

35
Q

How long to see clinical response to calcitriol?

A

1-3 days

36
Q

What drugs is most commonly used for primary hypoparathyroidism?

A

Calcitriol

37
Q

Does calcitriol require renal activation?

A

No

38
Q

What must a patient be able to absorb normally to absorb calcitriol?

A

Fat

39
Q

What else is calcitriol used to help manage?

A

Chronic renal failure

40
Q

Order the three hypocalcemia drugs from most to least desirable.

A

Calcitriol > Dihydrotachysterol (DHT) > Ergocalciferol

41
Q

What is the acronym for what hypercalcemia causes?

A

HARD IONS

42
Q

What is the H in HARD IONS?

A

Hyperparathyroidism (primary)

43
Q

What is the A in HARD IONS?

A

Addison’s

44
Q

What is the R in HARD IONS?

A

Renal disease (chronic more commonly)

45
Q

What is the D in HARD IONS?

A

D-vitamin intoxication

46
Q

What is the I in HARD IONS?

A

Idiopathic

47
Q

What is the O in HARD IONS?

A

Osteolytic disease

48
Q

What is the N in HARD IONS?

A

Neoplasia (lymphoma, multiple myeloma, anal sac adenocarcinoma)

49
Q

What is the S in HARD IONS?

A

Spurious/Lab errors

50
Q

What is the most common sign of hypercalcemia?

A

PU/PD

51
Q

What 2 nonspecific signs can you see with hypercalcemia?

A

Anorexia

Lethargy

52
Q

What GI signs do you see with hypercalcemia?

A

Vomiting

Constipation

53
Q

What other signs might you see with hypercalcemia?

A 
Urinary stones (in chronic cases)
Cardiac arrhythmias possible
54
Q

What happens in cases of chronic hypercalcemia?

A

ADH antagonism at the distal tubule causing reversible, nephrogenic DI

55
Q

What do you see in the kidneys in cases of hypercalcemia? (2 things)

A

Formation of calcium-containing calculi

Vasoconstriction

56
Q

What do you see in the muscles of animals with hypercalcemia?

A

Depressed excitability of nervous and muscular tissue

Depressed excitability of GI smooth muscle

57
Q

What are the two major treatment considerations?

A

Determine underlying cause (MOST important)

Long term management (if no underlying cause/can’t be treated)

58
Q

What are 4 short-term treatment options?

A

Normal saline diuresis (simplest)
Furosemide
Sodium bicarbonate
Calcitonin

59
Q

What are 3 long-term treatment options?

A

Glucocoritcoids
Bisphosphonates
Plicamycin (mithramycin)

60
Q

How is saline diuresis used as a short-term treatment option for hypercalcemia? (3 things)

A

Corrects fluid deficits
Supplements K+
Filtered Na will compete with Ca+ for tubular absorption

61
Q

How is furosemide used as a short-term treatment option for hypercalcemia?

A

Inhibits Ca2+ reabsorption

62
Q

What must you watch when using furosemide as a short-term treatment option for hypercalcemia?

A

Hydration

Supplement K+

63
Q

How does sodium bicarbonate work as a short-term treatment option for hypercalcemia?

A

Produces an alkalosis that shifts Ca2+ toward the bound form (mild effect)

64
Q

How do glucocorticoids (predisone, dexamethasone) work as long-term treatment for hypercalcemia? (3 things)

A

Reduces bone resorption
Decreases GI absorption
Increases renal excretion

65
Q

What else are glucocorticoids useful for?

A

Vitamin D toxicity

Antineoplastic activity in lymphoma

66
Q

What do bisphosphonates (Pamidronate, Alendronate) do as a long-term hypercalcemia treatment?

A

Inhibit osteoclast activity

67
Q

What else can bisphosphonates because in?

A

Cancer therapy

68
Q

How does calcitonin help with hypercalcemia? (3 things)

A

Tones calcium down
Reduces osteoclast activity
Treat cholecalciferol toxicity

69
Q

How does Plicamycin help with hypercalcemia?

A

Inhibits RNA synthesis in osteoclasts

70
Q

What do you need to be aware of when using Plicamycin?

A

Significant toxicity concerns

71
Q

What are 3 other ways to treat hypercalcemia long-term?

A

IV Sodium EDTA (can cause renal failure)
Hemodialysis
Ca2+ receptor agonist

72
Q

What will you always be monitoring in hypercalcemia patients? (5 things)

A 
Serum Calcium
Phosphorus
Magnesium
Potassium
Renal function

Pharmacology 2 (9 decks)

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