drug therapy to regulate calcium and bone metabolism

Question 1

describe the parathyroid gland

Answer 1

• 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

Question 2

what three hormones are involved in calcium regulation

Answer 2

• parathyroid hormone
• calcitonin
• vitamin D

hormones alter absorption of calcium from GI tract, bones, and kidney

Question 3

what happens when calcium levels are low in the blood

Answer 3

• 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

Question 4

what happens when calcium levels are high in the blood

Answer 4

• 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

Question 5

describe hypoparathyroidism

Answer 5

• not enough PTH
• low calcium levels
• causes: accidental removal of parathyroid glands

Question 6

describe hyperparathyroidism

Answer 6

• too much PTH
• high calcium levels
• causes: tumor or enlargement of glands and genetic disease (pagets disease)

Question 7

what are some signs and symptoms of hypocalcemia

Answer 7

• 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

Question 8

what are some signs and symptoms of hypercalcemia

Answer 8

• 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

Question 9

what is used for the treatment of hypocalcemia

Answer 9

calcium supplements like:
- calcium acetate
- calcium carbonate (tums)
- calcium citrate
- calcium gluconate

and vitamin D

Question 10

descrieb the action of calcium supplements

Answer 10

provides supplemental calcium

Question 11

what are calcium supplements used for

Answer 11

• treat and prevent hypocalcemia
• decrease bone loss and fractures
• treat high phosphorus levels

Question 12

what are some adverse effects of calcium supplements

Answer 12

• GI upset: N/V, constipation
• EKG changes
• weakness

Question 13

what are some contraindications of calcium supplements

Answer 13

• kidney stones
• cancer with bone involvement
• hyperclacemia
• hypophosphatemia

Question 14

what are some nursing considerations for calcium supplements

Answer 14

• 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)

Question 15

describe patient education for calcium supplements

Answer 15

• calcium carbonate (tums) most calcium OTC
• high calcium diet (milk, yogurt, cheese)
• take after meals

Question 16

describe the action of vitamin D for hypocalcemia

Answer 16

increases Ca+ and phos absorption in GI tract, pulls Ca+ and phosphorus from bones and decreases Ca+ loss in kidneys

Question 17

what is vitamin D used for

Answer 17

• vitamin D deficiency
• treatment of hypoparathyroidism

Question 18

what are some adverse effects of vitamin D

Answer 18

• high vitamin D (fat soluble)
• high calcium

Question 19

what are some contraindications of vitamin D

Answer 19

• high calcium
• vitamin D toxicity

Question 20

what are some nursing considerations for vitamin D

Answer 20

• monitor lab values
• many combination med available

Question 21

describe patient education for vitamin D

Answer 21

• high vitamin D diet (fish, eggs, milk)
• sunlight good source of vitamin D
• may be taken without regard to meals

Question 22

what drug is used for the treatment of hypercalcemia

Answer 22

bisphosphonates
like alendronate

Question 23

describe the action of alendronate

Answer 23

bind to bone and block calcium release, suppress osteoclasts

Question 24

what is alendronate used for

Answer 24

treat and prevent osteoporosis (post menopausal and steroid induced)

Question 25

what are some adverse effects of alendronate

Answer 25

• esophageal irritation/erosion
• bone pain

Question 26

what are some contraindications of alendronate

Answer 26

• inability to sit upright for 30mins
• esophageal disorders

Question 27

what are some nursing considerations for alendronate

Answer 27

• 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

Question 28

describe patient education for alendronate

Answer 28

• proper administration
• report esophageal pain, heartburn, and difficulty swallowing to MD

Question 29

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

Answer 29

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