drug therapy to regulate calcium and bone metabolism Flashcards
describe the parathyroid gland
- located on back of the thyroid gland
- produces parathyroid hormone (PTH)
- regulates calcium levels (norm is 8.5-10.5)
- indirectly regulates phosphorus bc Ca+ and phos have an inverse relationship
what three hormones are involved in calcium regulation
- parathyroid hormone
- calcitonin
- vitamin D
hormones alter absorption of calcium from GI tract, bones, and kidney
what happens when calcium levels are low in the blood
- increased PTH released
- increased activation of vit D
this results in…
- decreased loss of Ca+ in urine
- increased GI absorption of Ca+
- increased Ca+ release from bones
- raise calcium in blood
what happens when calcium levels are high in the blood
- decreased secretion of PTH
- increased secretion of calcitonin
results in…
- increased loss of Ca+ in GI tract
- decresed release of Ca+ from bones
- decrease calcium in blood
describe hypoparathyroidism
- not enough PTH
- low calcium levels
- causes: accidental removal of parathyroid glands
describe hyperparathyroidism
- too much PTH
- high calcium levels
- causes: tumor or enlargement of glands and genetic disease (pagets disease)
what are some signs and symptoms of hypocalcemia
- hyperactive reflexes, paresthesias, positive chvostek and trousseau signs
- hypotension, prolonged QT interval, edema, and signs of cardiac insufficiency
- abdominal spasms and cramps
- tetany, skeletal muscle cramps, carpopedal spasm, laryngeal spasm
- bone pain, osteomalacia, bone deformities, fractures
what are some signs and symptoms of hypercalcemia
- lethargy, personality and behavior changes, stupor, coma
- hypertension, shortening QT interval, atriovntricular block
- anorexia, nausea, vomiting, constipation
- muscle weakness, muscle atrophy, ataxia, loss of mucle tone
- polyuria, flank pain, kidney stones, acute and/or chronic renal insufficiency
- oseopenia, osteoporosis
what is used for the treatment of hypocalcemia
calcium supplements like:
- calcium acetate
- calcium carbonate (tums)
- calcium citrate
- calcium gluconate
and vitamin D
descrieb the action of calcium supplements
provides supplemental calcium
what are calcium supplements used for
- treat and prevent hypocalcemia
- decrease bone loss and fractures
- treat high phosphorus levels
what are some adverse effects of calcium supplements
- GI upset: N/V, constipation
- EKG changes
- weakness
what are some contraindications of calcium supplements
- kidney stones
- cancer with bone involvement
- hyperclacemia
- hypophosphatemia
what are some nursing considerations for calcium supplements
- available PO and IV
- give PO after meals
- monitor IV closely, tissue toxic
- monitor lab values
- monitor for EKG changes (should be on tele for IV)
describe patient education for calcium supplements
- calcium carbonate (tums) most calcium OTC
- high calcium diet (milk, yogurt, cheese)
- take after meals
describe the action of vitamin D for hypocalcemia
increases Ca+ and phos absorption in GI tract, pulls Ca+ and phosphorus from bones and decreases Ca+ loss in kidneys
what is vitamin D used for
- vitamin D deficiency
- treatment of hypoparathyroidism
what are some adverse effects of vitamin D
- high vitamin D (fat soluble)
- high calcium
what are some contraindications of vitamin D
- high calcium
- vitamin D toxicity
what are some nursing considerations for vitamin D
- monitor lab values
- many combination med available
describe patient education for vitamin D
- high vitamin D diet (fish, eggs, milk)
- sunlight good source of vitamin D
- may be taken without regard to meals
what drug is used for the treatment of hypercalcemia
bisphosphonates
like alendronate
describe the action of alendronate
bind to bone and block calcium release, suppress osteoclasts
what is alendronate used for
treat and prevent osteoporosis (post menopausal and steroid induced)
what are some adverse effects of alendronate
- esophageal irritation/erosion
- bone pain
what are some contraindications of alendronate
- inability to sit upright for 30mins
- esophageal disorders
what are some nursing considerations for alendronate
- give first thing in the morning
- give with full glass of water
- nothing to eat or drink for 30mins before
- remain sitting upright for 30mins
- if unable to sit upright for 30mins will need to take calcitonin salmon instead
describe patient education for alendronate
- proper administration
- report esophageal pain, heartburn, and difficulty swallowing to MD
the nurse is giving calcium IV, what is most important for the nurse to monitor?
1) cardiac rhythm
2) urine output
3) hearing changes
4) musculoskeletal pain
1) cardiac rhythm
calcium is going to effect the heart, both high and low calcium levels have cardiac effects. muscle and bone pain can be a side effect but monitoring the cardiac rhythm would be MOST important
