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SBM > SBM: Pharmacology & therapeutics - Calcium Metabolism & Therapeutics > Flashcards

SBM: Pharmacology & therapeutics - Calcium Metabolism & Therapeutics Flashcards

1
Q

How much calcium is there in the body?

A

1000g

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2
Q

what is our avg daily intake?

A

1000mg

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3
Q

How is our daily intake broken down?

A

lost in lumen of GI (200mg)
Absorbed from bowel (200-400)
in stool (800-1000mg)

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4
Q

How is net Ca balance maintained?

A

Renal Ca excretion averaging 200mg/day

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5
Q

There are 3 areas where extracellular Ca can be found. list them

A

ionised 50%
protein bound 40% (90% with albumin)
Calcum/Phosphate/Citrate complexs 10%

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6
Q

What level is Serum Ca maintained at?

A

2.2-2.6mM

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7
Q

What is the clinical importance of ionised Ca?

A

cofactor in coagulation cascade (Factor 7,9,PT)

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8
Q

Where are the intracellular Ca found?

A

Mitochondria and microsomes.

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9
Q

How is calcium excreted?

A

Complex and ionised are filtered by glomerulus.

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10
Q

How much Ca is reabsorbed and where?

A

98% - Kidney

70% in the PROXIMAL, 20% in loop, 18% in distal convoluted tubule.

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11
Q

PLEASE TRY AND UNDERSTAND THIS…

sLIDE 10/54

A 
↑ glomerular filtration
Hypercalcaemia
 ↓glomerular filtration
Hypocalcaemia
Renal impairment
 ↑ tubular reabsorption
Metabolic alkalosis
Thiazide diuretics (use in renal stones)
Parathyroid hormone
 ↓ tubular reabsorption
Metabolic acidosis
Loop diuretics
↑ extracellular fluid volume
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12
Q

What is PTH

A

parathyroid hormone

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13
Q

where is PTH secreted

A

chief cells in parathyroid

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14
Q

what effect does PTH have?

A

Increase bone resorption, increase Ca reabsoption in DISTAL. Increase Active VIT D production

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15
Q

what is Vit D

A

a secosteroid made in the skin by sun

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16
Q

What make it activate?

A

2 hydoxylations: in liver and kidney

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17
Q

What is the active form called?

A

1,5 (OH)2 D

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18
Q

Where can you get vit D?

A

Vit D2 - yeast/plants

Vit D3 - Fatty fish/cod liver oil

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19
Q

What effect does Vita D have?

A

intestine - increase ca absorption. Bone - mobilisation of calcium stores and mineralisation of bone matrix. And decreases PTH secretion

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20
Q

What effect does PTH have on Vit D? And what does Vit D do for PTH?

A

PTH stimulates increase in active Vit D production. Vit D inversely reduces PTH.

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21
Q

What stimulates PTH secretion?

A

hypocalcaemia

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22
Q

factors that affect vit d production?

A

increase Melanin.
Age .
Lattitude, day, time, season, .
Clothing .

23
Q

What are 2 parts of bone?

A

Cortical and spongy (trabecular)

24
Q

Describe cortical bone

A

85% of bone. dense, and compact

25
Q

describe trabecullar bone

A

15% of bone. Spongy, There is fracture risk here.

26
Q

Describe the bone remodelling cycle.

A

-

27
Q

What are osteoblasts?

A

help with bone formation

28
Q

What are osteoclasts?

A

break down bone

29
Q

What are the clincal symptoms of HYPERcalcaemia?

A

Poor concentration, confusion, depresion, coma, anorexia, POLYURIA, POLYDIPSIA, NEPHROLITHIASIS, dehydration, SHORT QT interval

30
Q

What differential would flag in your mind for HYPERcalcaemia?

A

Malignancy (90% cases). Primary HyperParathryoidism. Thyroxicosis. Drug induced (Vit D toxication, Thiazide diuretics, lithium).

31
Q

How would you investigate Hypercalcaemia?

A

CXR, bloods (renal, PSA, PTH, Vit D). Isotope bone scan

32
Q

how would you treat Mr Smith presenting with Ca levels between 2.6 to 2.8mM? (mild hypercalcaemia)

A

may not need treatment. Treat symptoms.

33
Q

Severe hypercalcaemia is classified at what stage?

A

> 3mM.

34
Q

how would you treat Mr Smith presenting with Ca levels greater than 3mM?

A

Rehydrate (0.9% saline), Bisphosphonates (IV pamidronate) , Loop diuretics

35
Q

Define osteoporosis?

A

Systemic skeletal disease that involves deterioration of bone tissue, leading to bone fragility and increase fracture risk

36
Q

Men or women are more at risk?

A

Woman 1in2, men = 1in5

37
Q

Risk factors for osteoporosis?

A

Early menopause, low BMI, low testosterone, glucocorticoid use, malignancy, GI diease, inflammatory disease, FH, smoking/alcohol

38
Q

How would you diagnose osteroporosis?

A

history. X Ray of thoracolumbar spine. DEXA.

39
Q

What is DEXA?

A

Bone density scan.

40
Q

A patient with a DEXA score of 0 to -0.1 should be diagnosed with what?

A

Nothing - normal

41
Q

A patient with a DEXA score of less than -2.5 should be diagnosed with what?

A

Osteoporosis

42
Q

What are the drugs you can give to treat osteoporosis? (6)

A 
Vit D/Calcium. 
Bisphosphonates.  . 
Strontium Ranelate  . 
Teriparatide  .
Raloxifene  .
Densoumab
43
Q

How could you maximise Ca/Vit D intake?

A

Give ca and vit d.

Adcal D3

44
Q

What are bisphosphonates?

A

Inhibits osteoclastic bone resorption

45
Q

What bisphosphonates are licensed for use?

A

Alendronate

Risedronate

46
Q

What is Strontium Ranelate?

A

drug that stimulates bone formation and reduces resorption.

47
Q

What is Teriparatide

A

A form of of PTH. Severe cases only.

48
Q

How does Densoumab work?

A

Monoclonal antibodies against the RANK Ligand. The RANK ligand on osteoblasts bind to RANK on osteoclasts to activate the resorption. Therefore antibody blocks this.

49
Q

What is osteomalacia?

A

Rickets

50
Q

Define rickets?

A

Defect of bone matrix mineralisation occuring after skeletal growth is COMPLETE.

51
Q

What can cause osteomalacia? And how will it present?

A

Poor sunlight, bowel disease, elderly. —- Bone pain, and waddling gait.

52
Q

How do you treat rickets?

A

Vit D and Ca. Adcal?

53
Q

What investigation for Rickets?

A

Ca and phosphate. (Low ca and high phosphatase). Serum 1,25 (OH)2D. Pelvic X ray looking for Loose’s Zone.

SBM (13 decks)

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