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PTx 2 > Calcium > Flashcards

Calcium Flashcards

1
Q

Calcium is essential for . . .

A
  1. cell membranes
  2. neuromuscular activity
  3. endocrine/exocrine secretory activities
  4. blood coagulation
  5. bone metabolism
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2
Q

99% of calcium is stored in the _____

A

bone

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3
Q

what is the normal range for total serum calcium?

A

8.5-10.5 mEq/L

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4
Q

What percentage of calcium is bound to albumin?

A

40%

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5
Q

ionized calcium is regulated by:

A
  1. PTH
  2. phos
  3. vit D
  4. calcitonin
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6
Q

What is the equation for corrected calcium?

A

[(4.0 - albumin) x 0.8] + Serum calcium

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7
Q

When a patient has metabolic ________, more calcium binds to albumin and there is less ionized calcium.

A

alkalosis

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8
Q

When a patient has metabolic ________, less calcium binds to albumin and there is more ionized calcium.

A

acidosis

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9
Q

How does PTH increases serum calcium?

A

increasing bone resorption
increasing renal retention of calcium
increasing renal excretion of phosphate
increasing renal formation of active vitamin D (which indirectly increases calcium absorption)

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10
Q

review pathophysiology bone notes!!

A

:)

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11
Q

How is hypocalcemia classified?

A

< 8.5 mg/dL

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12
Q

When are symptoms usually seen with hypocalcemia?

A

< 6.5 mg/dL

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13
Q

What are some causes of hypocalcemia?

A 
Drug induced
Low Mag
Dietary deficiency
alkalosis (less ionized calcium)
hypoparathyroidism 
TLS  (tumor lysis syndrome)
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14
Q

What are some drugs that can cause hypocalcemia?

A

diuretics (loops, acetazolamide), phenytoin, phenobarb, steroids, aminoglycosides, phosphate replacement products, bisphosphates

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15
Q

How does low mag cause low calcium?

A

it impairs PTH secretion and induces resistance at the organ level
(to fix this, just replace the magnesium)

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16
Q

Why does tumor lysis syndrome (TLS) cause low calcium?

A

when you decrease phosphorus, you decrease Ca2+

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17
Q

What is the clinical presentation of hypocalcemia?

A 
tetany, muscle spasms
anxiety, hallucinations
hypotension, MI
seizures, lethargy, stupor
\+Trousseau's/Chvostek's sign
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18
Q

How do you treat hypocalcemia?

A
  1. treat life-threatening symptoms (CALCIUM 10% chloride or gluconate)
  2. Fix other electrolyte abnormalities (Mag)
  3. Correct Vitamin D deficiency
  4. Chronic hypocalcemia: give Calcium + Vit D products
    usually 1-3 g daily elem calcium
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19
Q

What is the side effect of Calcium + D products?

A

constipation

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20
Q

How is hypercalcemia classified?

A

total serum calcium > 10.5 mg/dL

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21
Q

How is severe hypercalcemia classified?

A

> 13 mg/dL

22
Q

What are some causes of hypercalcemia?

A 
drug induced
malignancy (lung or breast cancer)
hyperparathyroidism 
TB
sarcoidosis (allusive respiratory disease inflammatory problem breathing trouble usually treated with steroids)
hyperthyroidism 
acidosis
23
Q

What are some drugs that can cause hypercalcemia?

A 
thiazide diuretics
estrogens
lithium 
vitamin A & D
tamoxifen
calcium supplements
24
Q

how can hyperthyroidism cause hypercalcemia?

A

it can cause bones to breakdown which releases Ca2+ into the bloodstream

25
Q

What is the clinical presentation of hypercalcemia?

A

mild-moderate hypercalcemia may be asymptomatic
severe (> 13 mg/dL)
• anorexia, N/V, constipation
• EKG changes: shortened QT interval, wide T wave
• Arrhythmias, bradycardia

26
Q

What is the clinical presentation of hypercalcemia in a crisis state?

A

acute renal insufficiency
AMS
sudden death

27
Q

What are some chronic complications caused by hypercalcemia?

A
  1. kidney stones
  2. calcification in organs
  3. acceleration of CAD
  4. calcification of arteries
28
Q

Why can acute renal insufficiency occur due to hypercalcemia?

A

buildup of Ca2+ in tubules of nephron can lead to renal problems

29
Q

How do you treat hypercalcemia?

A
  1. treat life-threatening complications
  2. reverse signs/symptoms, prevent complications
  3. normalize calcium
  4. treat underlying cause
    fluids: NS at 200-300 mL/hr (higher rate than normal which is approx. 125 mL/h)
30
Q

What are the 2 first line treatments for hypercalcemia?

A
  1. Fluids

2. Loops

31
Q

Use caution when using a lot of fluid in what patients?

A

. . . .

32
Q

What is the dose for furosemide given to treat hypercalcemia?

A

furosemide 40-80 mg IV q 1-4 h

33
Q

How does furosemide treat hypercalcemia?

A

increases renal excretion of calcium and helps offset large amount of fluids

34
Q

Fluids + Loops will decrease calcium by ___ to ___ mg/dL in 24 hours (pretty quick drop)

A

2-3

35
Q

How do you treat hypercalcemia in renal failure patients?

A

hemodialysis

36
Q

What are some other options for treating hypercalcemia caused by cancer?

A

bisphosphonates

others: last line– gallium nitrate, mithramycin

37
Q

When using bisphosphonates, the calcium levels will decline in __ days and will hit the lowest point in ____ days.

A

2 days

7 days

38
Q

What are some adverse drug effects caused by bisphosphonates?

A

fever
headache
nausea/volume
renal toxicity

39
Q

When are bisphosphonates contraindicated?

A

when CrCl < 30 mL/min

40
Q

How do bisphosphonates work?

A

decrease bone resorption (breakdown) which keeps serum Ca2+ from increasing

41
Q

What are some drug names of bisphosphonates?

A

Pamidronate 30-90 mg IV over 2-24 h
Zolendronic acid 4 mg IV over 15 min
Ibandronate 2-4 mg IV over 2 hours

42
Q

Oral bisphosphonates are usually used to treat _____________.

A

osteoporosis

43
Q

What are some ADRs of oral bisphosphonates?

A

cause esophageal irritation, not great GI absorption

44
Q

What is the dose of calcitonin?

A

4-8 units/kg SQ/IM q 12 h

45
Q

How does calcitonin work?

A

Calcitonin is the shut off button or negative feedback product that is released when the Ca2+ level gets too high (can give as a drug to decrease Ca2+)

46
Q

How is calcitonin usually given if the volume exceeds 2 mL?

A

IM

47
Q

Calcitonin causes a rapid reduction in calcium, but . . .

A

it has an unpredictable duration (1-2 mg/dL)

48
Q

Why should you test a small dose of calcitonin before giving it to patients?

A

because it is made from salmon and some people have a seafood allergy

49
Q

Can the intranasal prep (Miacalcin) work to treat hypercalcemia?

A

NO

50
Q

What are the last line agents to treat patients with hypercalcemia and cancer?

A

Gallium nitrate

Mithracmycin

51
Q

What drugs do you use to treat chronic hypercalcemia?

A 
Steroids 
• slow onset 
• prednisone 40-60 mg daily (HIGH dose)
Cinacalcet (Sensipar) 30 mg po BID
• specifically used in pts with secondary hyperparathyroidism (CKD)

PTx 2 (6 decks)

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