PHARM TEST 2 - Drug Therapy for Regulating Calcium and Bone Metabolism

Parathyroid Gland

produces parathyroid hormone (PTH) ss

Regulates calcium levels (CA 9-11)

Indirectly regulates phosphorus (High CA = low Phos)

Calcium regulated by these three hormones

Parathyroid hormone

Calcitonin

Vitamin D

When calcium levels are low

Increased PTH released

Increased activation of Vit D

Result in

Decreased loss of CA in urine

Increased GI absorption of CA

Increased CA release from bones

Raises calcium in blood

When Calcium levels are high

Decreased secretion of PTH

Increased secretion of calcitonin

Results in

Increased loss of Ca+ in GI tract

Decreased release of CA from bones

Decrease calcium in blood

Hypoparathyroidism

Not enough PTH

Low calcium levels

Causes : Accidental removal of parathyroid glands

Hyperparathyroidism

Too much PTH

High Calcium levels

Causes : Tumor or enlargement of glands

Genetic disease (pagets)

Tx for Hypocalcemia :Calcium Supplements

Calcium Supplements

Calcium acetate

Calcium Carbonate

Calcium Citrate

Calcium gluconate

Tx for Hypocalcemia :Calcium Supplements action

Provide supplemental calcium

Tx for Hypocalcemia :Calcium Supplements use

Tx and prevent hypocalcemia

Decrease bone loss and fractures

treat high phosphorus levels

Tx for Hypocalcemia :Calcium Supplements adverse effect

GI upset : N/V constipation

EKG

Weakness

Tx for Hypocalcemia : Calcium supplements contraindications

Kidney stones

Cancer with bone involvement

Hypercalcemia

Hypopotassemia

Tx for Hypocalcemia nursing considerations

PO and IV

Give PO post meals

monitor IV closely, tissue toxic

Monitor lab values

Monitor EKG for changes

Tx for Hypocalcemia : Calcium supplements pt education

Calcium carbonate (TUMS) most calcium OTC

High calcium diet (milk, yogurt, cheese)

Take after meals

Tx for Hypocalcemia : Vitamin D

INcreases CA and pho. Absorption in GI tract

Pulls CA and pho from the bones

Decreases CA and phos loss in kidneys

Tx for Hypocalcemia : Vitamin D adverse effects

High Vit D (fat soluble)

High calcium

Tx for Hypocalcemia : Vitamin D contraindications

High Calcium

Vitamin D toxicity

Tx for Hypocalcemia : Vitamin D nursing considerations

Monitor lab values

many combination meds available

Tx for Hypocalcemia : Vitamin D PT education

High Vit D Diet (Fish, eggs, milk)

Sunlight good source of Vit D

May be taken without regard to meals

Treatment for Hypercalcemia example

Bisphosphonates

Ex : Alendronate

Treatment for Hypercalcemia : Alendronate action

Bind to bone and block calcium release, suppress osteoclasts

Treatment for Hypercalcemia : Alendronate use

Treat and prevent osteoporosis

Post menopausal

Steroid induced

Treatment for Hypercalcemia : Alendronate adverse effect

Esophageal irritation / erosion

Bone pain

Treatment for Hypercalcemia : Alendronate contraindications

Do not sit upright for 30 minutes

esophageal disorders

Treatment for Hypercalcemia : Alendronate nursing considerations

Give first thing in morning

Give with a full glass of water

Nothing to eat or drink for 30 minutes before

Remain sitting for 30 minutes

If unable to sit upright for 30 minutes will need to take CALCITONIN SALMON instead

Treatment for Hypercalcemia : Alendronate patient education

Proper administration

Report esophageal pain, heartburn, and difficulty swallowing to MD