Vitamin D + Secondary Hyperparathyroidism Medications Flashcards

1
Q

What causes hyperparathyroidism?

A

Hyperphosphatemia and the kidney’s inability to activate vitamin D leads to a decrease in calcium serum concentrations. This triggers the parathyroid gland to secrete more PTH to increase calcium mobilization from the bone.

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2
Q

Which forms of Vitamin D require activation?

A

Ergocalciferol (Calciferol) -Vitamin D2

Cholecalciferol -Vitamin D3

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3
Q

What is the dosing of Ergocalciferol (Calciferol)?

A

One 50,000 IU capsule per month

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4
Q

What is the dosing of Cholecalciferol?

A

1000 IU po daily

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5
Q

What forms of Vitamin D do not require activation?

A

Calcitriol (Rocaltrol and Calcijex)

Paricalcitol (Zemplar)

Doxercalciferol (Hectorol) **must be activated by liver

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6
Q

What are important considerations for using Calcitriol (Rocaltrol and Calcijex)

A

-Approved for pediatric use
-Greatest risk of hypercalcemia
-Cheapest

Monitor: Ca, iPTH

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7
Q

What are important considerations for using Paricalcitol (Zemplar)?

A

30% reduction in iPTH
-Most favorable adverse drug reaction profile
-Less calcemic activity than calcitriol

Monitor: Ca, iPTH

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8
Q

What are some important considerations for using Doxercalciferol (Hectorol)?

A

-It is a prodrug that must be activated by the liver!!
-Lets the patient’s body activate it as it needs it
-Produces more even serum concentration that calcitriol
-30% reduction in iPTH
-Lower incidence of hypercalcemia compared to calcitriol
-Higher incidence of hyperphosphatemia

*Do not use in patients with both kidney and liver failure
*Mainly used when phosphorus is not high and we just want to bring the PTH down

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9
Q

What are the two calcimimetic drugs?

A

Cinacalcet (Sensipar)

Etelcalcetide (Parsabiv)

*Cinacalcet is prefered since Etelcalcetide is an IV drug

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10
Q

What is the mechanism of action for Cinacalcet (Sensipar)?

A

Type II calcimimetic agent

-Mimics the action of calcium by binding to the calcium sensing receptor (CaR) and inducing a conformational change to the receptor. This triggers the parathyroid gland to decrease PTH secretion.

-Binds irreversibly, when calcium drops below 7.5 mg/dL we must stop the drug and wait for new receptors to form

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11
Q

What is the dosing of Cinacalcet (Sensipar)?

A

30mg po once daily

-Increase dose to achieve desired PTH serum concentrations
-MAX DOSE: 180mg

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12
Q

When are calcimimetics contraindicated?

A

Contraindicated in hypocalcemia

If Ca < 7.5mg/dL, withhold calcimimetics until Ca = or > 8mg/dL

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13
Q

Which of the following vitamin D products DOES NOT require activation by a body organ prior to activation?
A. calcitriol
B. doxercalciferol
C. cholecalciferol
D. ergocalciferol

A

A. calcitriol

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14
Q

Mrs. Jenkins is an 82 year old hemodialysis patient who presented to the clinic today with persistent secondary hyperparathyroidism. Her most current labs are as follows:

Ca 7.2 mg/dL (L)
Phos 4.0 mg/dL
PTH 1300 pg/mL (H)
Vitamin D 35 ng/mL

Which of the following medications should be recommended for treating her secondary hyperparathyroidism?

A. cholecalciferol
B. ergocalciferol
C. cinacalcet (Sensipar)
D. paricalcitol (Zemplar)

A

D. paricalcitol (Zemplar)

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