Bone Modifying Flashcards
pathophysiology of hypercalcemia metastatis
increased PTH
increasedcalcitriol
increased resporption
decreased elimination
bone metastasis
mild hypercalcemia level
10-12
moderate hypercalcemia level
12-14
severe hypercalcemia level
14+
mild hypercalcemia symptoms
polyuria
polydypsia
moderate hypercalcemia symptoms
dehydration
confusion
N/V
lethargu
severe hypercalcemia sx
decreased GFR
seizures
arrythmias
normal calcium level
8.5-10
corrected calcium equation
serum calcium + 0.8 (4-serum albumin)
mild hypercalcemia 10-12 treatment
no sx: hydration
moderate sx: 200-400 ml/hr NS + bisphosphonate
(either zolendronic acid or pamidronate)
moderate hypercalcemia tx 12-14
hydration
zolendronic acid
severe hypercalcemia tx 14+
hydration - 200ml/hr
zolendronic acid or pamidronate
calcitonin 3rd line
2nd line if refractory hypercalcemia
denosumab
chronic hypercalcemia tx
zolendronic acid
pamidronate
MONTHLY
what do bisphosphonates do
decrease osteoclast activity
decrease bone resorption
build up the bone
cancers with affinity to bone
breast
prostate
myeloma
lung
kidney
treatment of bony mets overview
radiation
radioisotopes
bisphosphonates
bisphosphonates in bony mets with consdierations
zolendronic acid - quicker , more expensive
pamidronate - slower, cheaper
need to renal adjust!!
for what disease state do we renally adjust bisphosphonates
bony mets (NOT Hypercalcemia)
supplments for pts taking bisphosphonates
vit D and calcium
denosumab renal considerations
no renal adjustments
refractory to bisphosphonates in bony mets tx
denosumab
adverse effects of bisphosphonates
osteonecrosis of jaw
hypocalcemia
denosumab side effects
hypocalcemia
need vit d and ca supplement
