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Endocrinology > Calcium Regulation and Pharmacology > Flashcards

Calcium Regulation and Pharmacology Flashcards

1
Q

What is calcium?

A
  • major EXTRACELLULAR divalent cation (Ca2+)

- 45% ionized Ca2+ exerts physiologic effects

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2
Q

Where is 99% of calcium stored?

A
  • in BONE
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3
Q

How do we get calcium?

A
  • in the diet.
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4
Q

Do men have more calcium than women?

A
  • YES by a little bit.
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5
Q

*** For what is calcium needed?

A
  • neuronal excitability
  • neurotransmitter release
  • cardiac function (PHASE 2 of cardiac action potential as calcium enters).
  • muscle contractions
  • membrane integrity
  • blood coagulation
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6
Q

Does calcium use a second messenger system?

A
  • YES
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7
Q

What does endocrine regulation of extracellular calcium affect?

A
  • entry at the intestines
  • secretion/reabsorption at the kidney
  • storage/release (bone absorption/release of Ca2+)
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8
Q

What regulates calcium absorption/excretion?

A
  • kidneys and bones
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9
Q

What are osteoCLASTS?

A
  • break down (reabsorb) bone to INCREASE serum calcium
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10
Q

What are osteoBLASTS?

A
  • build up bone thus DECREASING serum calcium
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11
Q

How is calcium absorbed?

A
  • ACTIVE vit. D-dependent transport in PROXIMAL DUODENUM.
  • FACILITATED DIFFUSION in small intestines
  • efficiency is inversely related to Ca2+ intake.
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12
Q

Does calcium intestinal absorption increase or decrease with age?

A
  • decrease
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13
Q

Is vitamin D a fat or water-soluble vitamin?

A
  • FAT-soluble.

* remember A, D, E, and K are fat soluble.

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14
Q

What happens to the QT with HYPOcalcemia?

A
  • WIDENS the QT
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15
Q

What happens to the QT with HYPERcalcemia?

A
  • NARROWS the QT
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16
Q

What depresses intestinal calcium transport?

A
  • glucocorticoids

- phenytoin (used for seizures)

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17
Q

What do disease states do to calcium?

A
  • lead to fecal loss of calcium
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18
Q

What regulates urinary excretion of Ca2+?

A
  • PARATHYROID HORMONE (PTH)

* urinary calcium loss is influenced by filtered Na2+ and presence of non-reabsorbed anions.

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19
Q

Can lactation and sweat affect loss of calcium?

A
  • YES
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20
Q

Can some diuretics increase urinary loss of Ca2+?

A
  • YES, furosimide

* thiazides will reabsorb calcium!

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21
Q

How often is your entire bone mass modified?

A

every 6 months via osteoclasts and osteoblasts

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22
Q

What regulates blood calcium levels?

A
  • PARATHYROID hormone by regulating osteoclasts and osteoblasts.
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23
Q

What factors influence bone remodeling?

A

INCREASE in the activation of remodeling units:

  • hyperthyroidism
  • hypervitaminosis D
  • hyperparathyroidism
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24
Q

What is the etiology of impaired osteoBLASTIC function?

A
  • high dose CORTICOSTEROIDS

- high dose ETHANOL

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25
Q

What will augment osteoCLASTIC resorptive capacity?

A
  • decreased estrogen
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26
Q

What promotes HYPOcalcemia?

A
  • deprivation of Ca2+ and vitamin D
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27
Q

What stimulates PTH release?

A
  • HYPOcalcemia
28
Q

What are the signs of symptoms of HYPOcalcemia?

A
  • tetany
  • paresthesias
  • increased neuromuscular excitability
  • laryngospasm
  • muscle cramps
  • tonic-clonic convulsions (GRAND MAL)
29
Q

If a patient is having a seizure what should you not forget to check?

A
  • CALCIUM
30
Q

What are some hypocalcemic states?

A
  • hypoparathyroidism
  • advance renal insufficiency
  • excessive use of K+ phosphate in the tx of DKA
  • sodium fluoride (large quantities)
  • massive transfusions with CITRATED BLOOD.
31
Q

How do we treat HYPOcalcemia?

A
  • REPLACEMENT (dietary Ca2+ or IV calcium chloride)

- oral supplements often in combination with vitamin D

32
Q

What can cause HYPERcalcemic states?

A
  • very high ingestion of Ca2+ (rare except in hypothyroidism)
  • milk alkali syndrome
  • hyperparathyroidism (MOST COMMON)
  • systemic malignancy (looks like holes in the bones)
  • vitamin D excess
33
Q

How do we treat HYPERcalcemia?

A
  • fluids
  • increased Ca2+ EXCRETION (loop diuretics)
  • corticosteroids
  • calcitonin
  • sodium phosphate
  • EDTA
34
Q

What substances are involved with calcium regulation?

A
  • phosphate= binds ca2+
  • PTH
  • vitamin D
  • calcitonin (tones the bones), lowering serum calcium levels
35
Q

What does phosphate do to calcium?

A
  • causes precipitation, thus lowering calcium
36
Q

What does PTH do to phosphate?

A
  • increases urinary excretion of phosphate by preventing its reabsorption in the kidney.
37
Q

What does vitamin D do to phosphate absorption in the DCT?

A
  • increases it
38
Q

What are some pathologic states of phosphate?

A
  • RICKETS= vitamin D deficiency
  • osteomalacia
  • chronic renal failure
39
Q

What does PTH do to intestinal Ca2+ absorption?

A
  • increases it
40
Q

What does PTH do to calcium in the bone?

A
  • mobilizes it by activating osteoCLASTS to break down bone.

* aka increases overall bone resorption.

41
Q

Where is Vitamin D (calcitriol) synthesized?

A
  • in the skin
42
Q

What stimulates calcitonin?

A
  • hypercalcemia, to lower blood calcium.
43
Q

What can stimulate calcitonin release?

A
  • glucagon
  • gastrin
  • serotonin
44
Q

What does calcitonin do?

A
  • causes direct inhibition of osteoclastic bone resorption, which results in HYPOcalcemia and HYPOphosphatemia.
  • lowers calcium and phosphate in the blood
45
Q

What is Alendronate?

A
  • inhibits osteoclast-mediated bone resorption
46
Q

What is Raloxifene?

A
  • reduces bone turnover
  • decreases LDL levels (no change on HDL)
  • no increase in triglycerides
47
Q

What are the 2 parts of the adrenal glands?

A
  • cortex (outer part)

- medulla (inner part)

48
Q

What does the adrenal cortex produce?

A
  • minearlocorticoids= aldosterone (N+/K+ balance)
  • glucocorticoids= cortisol (raises glucose and suppresses inflammatory response).
  • adrenal androgens
49
Q

What does aldosterone do?

A
  • causes the DCT to reabsorb Na+ and thus water
50
Q

What are the 3 levels of the adrenal cortex?

A
  • zona GLOMERULOSA= produces ALDOSTERONE
  • zona FASCICULATA= produces CORTISOL
  • Zona RITICULARIS= DHEA, androstenidione
51
Q

What does the adrenal medulla?

A
  • EPINEPHRINE= increased chronotropy and inotropy, bronchodilation, increased glucose
  • NOREPINEPHRINE= ditto
52
Q

What is needed for synthesizing adrenal hormones?

A
  • CHOLESTEROL
53
Q

What is prednisone?

A
  • glucocorticoid that is 4x as potent as cortisol, used to suppress the inflammatory response.
54
Q

What is mehtylprednisolone?

A
  • synthetic glucocorticoid that is 5x as potent as cortisol.
55
Q

What is dexamethasone?

A
  • glucocorticoid that is 30x as potent as cortisol
56
Q

Do plasma proteins bind adrenocortical hormones?

A
  • YES
57
Q

Where are adrenal hormones metabolized?

A
  • liver
58
Q

What electrolyte problems can we see with low levels of mineralocorticoids?

A
  • sodium chloride wasting and high potassium in the blood.
59
Q

What can HYPOkalemia lead to?

A
  • muscle weakness

- cardiac conduction issues

60
Q

What acid base issue can elevated aldosterone cause?

A
  • METABOLIC ALKALOSIS

* remember H+ follows K+

61
Q

What do glucocorticoids do?

A
  • stimulate GLUCONEOGENESIS in the liver
  • decreased glucose utilization by cells
  • STEROID INDUCED DM
  • reduction of cellular protein
  • increased liver and plasma proteins
62
Q

How does cortisol mitigate stress and inflammation?

A
  • stabilize lysosomes

- decreases eosinophils and lymphocytes

63
Q

What is Addison’s disease?

A
  • hypoadrenalism (mineralocorticoid deficiency)= loss of NaCl and water, hyponatremia, hyperkalemia, mild acidosis, increased RBC concentration, decreased CO, and death.
64
Q

What will glucocorticoid deficiency lead to?

A
  • low glucose
  • muscle weakness
  • respiratory difficulties
65
Q

Do the adrenal glands contribute to precursors of melanin pigmentation?

A
  • YES
66
Q

How do we treat loss of glucocorticoids or mineralocorticoids?

A
  • replace them

Endocrinology (18 decks)

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