Bone modifying agents

Question 1

Mild

Answer 1

Calcium level 10-12
polyuria, polydipsia, constipation, fatigue

Question 2

Moderate

Answer 2

Calcium levels 12-14
Dehydration, N/V, confusion/ditsy, muscle weakness, loss of deep tendon reflexes, shortened QT, widened T wave

Question 3

Severe

Answer 3

Calcium greater than 14
decreased EGFR
Seizure, stupor, coma, heart block arrhythmias, asystole

Question 4

Corrected calcium equation

Answer 4

Serum calcium + 0.8 (4- serum albumin) =
Normal calcium: 8.5-10 mg/dl

Question 5

Mild symptom treatments asymptomatic

Answer 5

calcium levels 10-12
hydration - fluids
D/C medications that increase serum calcium or decrease renal blood flow
repeat calcium levels in 4 weeks

Question 6

Moderate treatment

Answer 6

Calcium levels 12-14
Hydration - normal saline
Zoledronic Acid OR pamidronate
Can repeate after 7 days if needed

Question 7

Severe treatment

Answer 7

fluids
zoledronic acid
calcitonin - if needed

Question 8

If above treatment does not work this is second line

Answer 8

Phosphates OR
Denosumab - Xgeva SUBQ, No renal adjustment needed for this drug

Question 9

Chronic HCM treatment

Answer 9

Zoledronic Acid
Supplement with calcium

Question 10

Why are we giving bisphosphonates

Answer 10

These will inhibit osteoclast activity and stop break down of bown and decrease bone resorption

Question 11

Skeletal related events - cancers that put Pts at greater risk

Answer 11

Prostate cancer!
Breast
Myeloma
lung
Kidney

Question 12

Skeletal related events - symptoms

Answer 12

Bony pain or tenderness

Question 13

Risk factors for SRE

Answer 13

Smoking, older than 65, history of fracture, androgen deprivation therapy (MEN), BMI < 20

Question 14

IV treatment for SRE

Answer 14

Pamidronate - 2 hour IV and Zolendronic acid - 15 minute IV
(preferred is Zolendronic acid)

MUST RENAL ADJUST DOSING FOR SREs Not needed for HCM