Term
| Ca homeostasis in the body includes tight regulation of what type of Ca? |
|
Definition
| Both extra and intracellular Ca |
|
|
Term
|
Definition
|
|
Term
| Cytoplasmic levels of Ca? |
|
Definition
|
|
Term
| What 3 locations in the body exchange Ca? |
|
Definition
1. Intestine
2. Bone
3. Kidney |
|
|
Term
| How is Ca exchange in various tissues regulated? |
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Definition
|
|
Term
| How much Ca should be taken in per day? |
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Definition
|
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Term
| The amount of Ca absorbed from the intestines depends on what? |
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Definition
|
|
Term
| How much Ca exchange take place in the kidneys? |
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Definition
| A large amount of Ca is filtered and almost as much is reabsorbed |
|
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Term
| Regulation of Ca homeostasis is through what 2 things? |
|
Definition
|
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Term
| Intestinal absorption of Ca is stimulated by what hormone? |
|
Definition
|
|
Term
| Intestinal absorption of Ca is inhibited by what hormone? |
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Definition
|
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Term
| Renal absorption of Ca is stimulated by what hormone? |
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Definition
| Parathyroid hormone (PTH) |
|
|
Term
| Effect of thiazide diuretics on Ca clearance? |
|
Definition
Decrease
Can result in hypercalcemia |
|
|
Term
| Effect of loop diuretics on Ca clearance? |
|
Definition
Increase
Can result in hypocalcemia |
|
|
Term
| What type of diuretics increase Ca clearance? |
|
Definition
|
|
Term
| What type of diuretics decrease Ca clearance? |
|
Definition
|
|
Term
| Bone resorption of Ca is stimulated by what hormone? |
|
Definition
| Parathyroid hormone (PTH) |
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|
Term
| Bone resorption of Ca is inhibited by what hormones (2)? |
|
Definition
|
|
Term
| Intestinal absorption of Ca is ____ process that takes place where? |
|
Definition
An active process
In the proximal small intestine |
|
|
Term
| Renal absorption of Ca is ____ process that takes place where? |
|
Definition
Active process
In the proximal tubule |
|
|
Term
| What cells are responsible bone resorption? |
|
Definition
|
|
Term
| What cells are responsible for bone mineralization/formation? |
|
Definition
|
|
Term
| Bone mineralization/formation is stimulated by what? |
|
Definition
1. Sodium fluoride
2. Calcium
3. Teraparatide |
|
|
Term
| When is PTH secreted from the parathyroid gland? |
|
Definition
| When plasma Ca levels get too low |
|
|
Term
| What are the 3 effects of PTH? |
|
Definition
1. Bone – stimulate resorption from bone
2. Kidney – stimulate reabsorption in the proximal tubule
3. Intestine – stimulates the final step in the activation of vitamin D |
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|
Term
| What stimulates release of calcitonin from the C cells of the thyroid gland? |
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Definition
|
|
Term
| What cells secrete calcitonin when plasma levels of Ca get too high? |
|
Definition
|
|
Term
|
Definition
| Decrease osteoclastic activity on bone and decrease plasma Ca |
|
|
Term
|
Definition
|
|
Term
| Release of PTH is stimulated by what? |
|
Definition
|
|
Term
|
Definition
1. Increases renal absorption of Ca
2. Increases osteoclastic activity
3. Activates vitamin D
All act to increase Ca in plasma |
|
|
Term
|
Definition
| 32 amino acid peptide in parafollicular cells |
|
|
Term
| Release of calcitonin is stimulated by what? |
|
Definition
|
|
Term
|
Definition
Inhibits osteoclastic activity
Decreases Ca in plasma |
|
|
Term
| Vitamin D activation is stimulated by what? |
|
Definition
|
|
Term
| The final conversion to the active form of vitamin D takes place where? |
|
Definition
|
|
Term
|
Definition
1. Increases intestinal absorption of Ca
2. Increases bone mineralization |
|
|
Term
| Effect of estrogen in Ca homeostasis? |
|
Definition
| Reduces PTH action on bone |
|
|
Term
| Effect of corticosteroids in Ca homeostasis? |
|
Definition
| Inhibits action of vitamin D in intestine |
|
|
Term
| What are the 5 clinical manifestations of hypercalcemia? |
|
Definition
1. General malaise
2. Loss of memory
3. Anorexia
4. Nausea
5. Polyuria |
|
|
Term
| What are some causes of hypercalcemia? |
|
Definition
1. Neoplasms
2. Hyperparathyroidism
3. Non-parathyroid endocrinopathy
4. Toxicities – vitamin A/D
5. Increased production or sensitivity to vitamin D
6. Dehydration with hyperproteinemia
7. Immobilization with underlying bone resorptive disorder
8. Acute renal failure with rhabdomyolysis |
|
|
Term
| What are the 6 types of treatment for hypercalcemia? |
|
Definition
1. Saline diuresis
2. Loop diuretics
3. Calcitonin
4. Corticosteroids
5. Gallium nitrate
6. Bisphosphonates |
|
|
Term
| How does saline diuresis treat hypercalcemia? |
|
Definition
| Promotes volume expansion acutely |
|
|
Term
How do loop diuretics treat hypercalcemia?
What is an example? |
|
Definition
Increase Ca clearance by the kidney
Furosemide |
|
|
Term
| How is calcitonin used in treatment of hypercalcemia? |
|
Definition
Chronically
Secreted by C cells of the thyroid and decreases osteoclastic activity |
|
|
Term
| What are the 2 forms of calcitonin? |
|
Definition
1. Human
2. Salmon – 2x more potent in humans |
|
|
Term
| What type of hormone is calcitonin? |
|
Definition
|
|
Term
| Is calcitonin orally active? |
|
Definition
|
|
Term
| Administration of calcitonin |
|
Definition
| Has to be taken by intranasal preparations because it is a peptide and therefore not orally active |
|
|
Term
| Why is calcitonin not useful long term? |
|
Definition
Ab are made to salmon calcitonin which decreases its effectiveness
Also vitamin D an PTH are more important for long term Ca homeostasis/regulation in the body |
|
|
Term
| How do corticosteroids treat hypercalcemia? |
|
Definition
| Inhibit Ca absorption from the gut |
|
|
Term
| What is given for vitamin D toxicity and why? |
|
Definition
Corticosteroids
Antagonize the effects of vitamin D in the intestine |
|
|
Term
| How does gallium nitrate treat hypercalcemia? |
|
Definition
| Inhibits osteoclastic activity |
|
|
Term
| What drug that inhibits osteoclastic activity is approved for the treatment of hypercalcemia? |
|
Definition
|
|
Term
| What are 3 bisphosphonates? |
|
Definition
1. Alendronate
2. Pamidronate
3. Zoledronate |
|
|
Term
| What do all bisphosphonates end with? |
|
Definition
|
|
Term
| How do bisphosphonates treat hypercalcemia? |
|
Definition
| Inhibit osteoclastic activity |
|
|
Term
| What are 2 causes of hypocalcemia? |
|
Definition
1. Hypoparathyroidism
2. Vitamin D deficiency |
|
|
Term
| What are the clinical manifestations of hypocalcemia? |
|
Definition
1. Tetany
2. Convulsions
3. Muscle cramps |
|
|
Term
| What are 2 ways to treat hypocalcemia? |
|
Definition
1. Calcium salts
2. Vitamin D |
|
|
Term
| 2 examples of calcium salts? |
|
Definition
| Calcium gluconate or calcium chloride |
|
|
Term
| Administration of Ca salts? |
|
Definition
|
|
Term
| When are calcium salts given for treatment of hypocalcemia? |
|
Definition
|
|
Term
| What is given following IV infusion of Ca salts for the treatment of hypocalcemia? |
|
Definition
| Oral Ca salts – calcium carbonate |
|
|
Term
| How does vitamin D treat hypocalcemia? |
|
Definition
| Increases Ca absorption by the small intestine |
|
|
Term
| What is the shortest acting vitamin D agent? |
|
Definition
|
|
Term
| what forms of vitamin D can be given in treatment of hypocalcemia? |
|
Definition
1. Calcitriol
2. Hydroxyl-vitamin D3
3. Plant steroid with vitamin D activity |
|
|
Term
|
Definition
| Disordered bone remodeling due to increased numbers and activity of osteoclasts |
|
|
Term
| What are the characteristics of Paget’s disease? |
|
Definition
| Weak bones, arthritis, deafness, elevated serum alkaline phosphatase |
|
|
Term
| What 2 drug types are used in the treatment of Paget’s disease? |
|
Definition
1. Calcitonin
2. *Bisphosphonates such as alendronate |
|
|
Term
| Why is calcitonin only used intermittently to treat Paget’s disease? |
|
Definition
| Because resistance builds up due to Abs and because PTH/vitamin D are more important hormones |
|
|
Term
| Administration of calcitonin? |
|
Definition
|
|
Term
| What bisphosphonate is used to treat Paget’s disease? |
|
Definition
|
|
Term
| Bisphosphonates are structurally similar to what compound? |
|
Definition
|
|
Term
| Bisphosphonates adsorb to what? |
|
Definition
|
|
Term
| Bisphosphonates mechanism of action? |
|
Definition
| Inhibit osteoclastic activity |
|
|
Term
| Are bisphosphonates absorbed well orally? |
|
Definition
|
|
Term
| Side effect of bisphosphonates given orally? |
|
Definition
|
|
Term
| High doses of bisphosphonates can cause what? |
|
Definition
|
|
Term
| How is the incidence of esophagitis reduced when taking oral bisphosphonates? |
|
Definition
| Oral administration requires standing up and large glasses of water; patient can’t lie down for some time after taking them |
|
|
Term
| Why must oral bisphosphonates be taken standing up and with large glasses of water? |
|
Definition
| To reduce the incidence of esophagitis |
|
|
Term
|
Definition
| Hypercalcemia, Paget’s disease, osteoporosis |
|
|
Term
|
Definition
| Reduced bone mass per volume |
|
|
Term
| Who has the highest incidence of osteoporosis? |
|
Definition
| White, postmenopausal women |
|
|
Term
| What are the pathogenic factors for osteoporosis? |
|
Definition
1. Negative Ca balance
2. Estrogen deficiency
3. Reduced vitamin D
4. Reduced exercise
5. Slight build
6. Smoking
7. Corticosteroids |
|
|
Term
| What are 6 available drugs for osteoporosis? |
|
Definition
1. Bisphosphonates
2. Raloxifene
3. Low dose estrogen patch
4. Teriparatide
5. Calcitonin
6. Vitamin D and Ca |
|
|
Term
| How often can IV bisphosphonates be given for the treatment of osteoporosis? |
|
Definition
| As often as every 2 years |
|
|
Term
| How often can oral bisphosphonates be given for the treatment of osteoporosis? |
|
Definition
|
|
Term
|
Definition
| A partial estrogen agonist given as treatment for osteoporosis |
|
|
Term
| How does raloxifene work in the treatment of osteoporosis? |
|
Definition
| A partial estrogen agonist that opposes the effect of PTH which normally activates osteoclasts and causes demineralization of bone |
|
|
Term
| How does teriparatide treat osteoporosis? |
|
Definition
| Has the first 34 amino acids of PTH but given once a day causes bone formation |
|
|
Term
| Why does teriparatide not cause the same effects as PTH? |
|
Definition
Its given once a day and causes bone formation
Continuous secretion of PTH during the day increases osteoclastic activity and demineralizes bone |
|
|
Term
| How is calcitonin used in the treatment of osteoporosis? |
|
Definition
| Intermittently to decrease osteoclastic activity |
|
|
Term
| Why are calcium and vitamin D given together in the treatment of osteoporosis? |
|
Definition
| Vitamin D will increase the absorption of the administered Ca from the small intestine |
|
|
Term
| A man receiving prostate cancer treatment (luprolide) with decreased testosterone can be prone to what bone disorder? |
|
Definition
|
|
Term
| What must be considered with a man taking luprolide or any treatment for prostate cancer that will decrease testosterone? |
|
Definition
His risk for developing osteoporosis
Take calcitonin intranasal, supplement with vitamin D, and consider bisphosphonates |
|
|
Term
Aunt Rose is a postmenopausal woman, who has been encouraged by her gynecologist to take multivitamins containing vitamin D. Vitamin D is beneficial for postmenopausal women because it:
a. Increases the synthesis of an intestinal calcium binding protein
b. Is a potent antioxidant
c. Stimulates PTH secretion
d. Stimulates glucagon secretion |
|
Definition
| a. Increases the synthesis of an intestinal calcium binding protein |
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