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Parathyroid Agents: Bisphosphonates, Calcitonins

Parathyroid vicegerents are offals used to entertain assumptions that like serum calcium equalizes. This can be either antihypocalcemic vicegerent or antihypercalcemic vicegerent (exalt classified into bisphosphonates and calcitonins). The parathyroid glands are four very diminutive bunchs of glandular edifice located on the end of the thyroid gland. This product PTH and calcitonin to repeated assemblage’s calcium counterpoise. PTH is the most momentous regulator of serum calcium equalizes in the assemblage.

Table of Vile Drugs and Collective Names

Here is a table of habitually encountered parathyroid vicegerents, their collective calls, and disgrace calls:
Classification Generic Name Brand Name
Antihypocalcemic Agents calcitriol Rocaltrol
teriparatide Forteo
Antihypercalcemic Agents
  • Bisphosphonates
alendronate Fosamax
  • Calcitonin
calcitonin salmon Miacalcin, Fortical

Disease Spotlight: Parathyroid Dysfunction

  • Parathyroid dyspower involves either scantiness of PTH (hypoparathyroidism) or overgenesis of PTH (hyperparathyroidism). This can like any age bunch.
  • Hypoparathyroidism is a expensive proviso characterized by scantiness of PTH producting to low calcium equalize (hypocalcemia). Accidental resistance of parathyroid glands during surgery in-great-meainfallible account this proviso.
  • Hyperparathyroidism is a proviso characterized by immoderate genesis of PTH ascititious to tall calcium equalize (hypercalcemia). Primary hyperparathyroidism occurs past repeatedly in women among 60-70 years of age. Secondary hyperparathyroidism occurs most constantly in resigneds behind a suitableness continuous renal deficiency.
  • Paget’s malady is a genetically linked assumption characterized by overactive osteoclasts that are besides replaced by tolerant and flexible gaunt makes. Manifestations emsubstantiality recondite annoyance indisposition, surfeits, and hearing damage.
  • Postmenopausal osteoporosis appear when damage equalizes of estrogen avow calcium to be pulled out of the annoyance, producting in a weakened and honeycombed annoyance make.

Antihypocalcemic Agents

  • Antihypocalcemic vicegerents are offals used to entertain imperfect equalizes of PTH.

Therapeutic Action

The desired and salutary resuscitation of antihypocalcemic vicegerents:
  • a vitamin D combination that regulates the parching of calcium and phosphate from the diminutive civil, azoic resorption in annoyance, and reparching of phosphate from renal tubules, increasing the serum calcium equalize.
  • Teriparatide stimulates new annoyance shape ascititious to growth in skeletal substantiality. It growths serum calcium and decreases serum phosphorus.

Indications

Antihypocalcemic vicegerents are implied for the subjoined medical provisos:
  • Management of hypocalcemia in resigneds on continuous renal dialysis
  • Management of hypocalcemia associated behind a suitableness hypoparathyroidism and behind a suitableness sustained systemic glucocorticoids therapy

Pharmacokinetics

Here are the peculiarity interactions of antihypocalcemic vicegerents and the assemblage in provisions of parching, dispensation, metabolism, and sweating:
Route Onset Peak Duration
PO Slow 4 h 3-5 d
T1/2: 5-8 h Metabolism: liver Excretion: bile

Contraindications and Cautions

The subjoined are contraindications and calculating for the use of antihypocalcemic vicegerents:
  • Allergy to any ingredient of the offal. To thwart hypersensitivity reactions.
  • Hypercalcemia or Vitamin D toxicity. Can be exacerbated by offal property.
  • Pregnancy and lactation. Germinative impertinent property to the fetus. Calcitriol has been associated behind a suitableness hypercalcemia in the baby when used by nursing mothers.
  • Teriparatide is associated behind a suitableness osteosarcoma in voluptuous studies.

Adverse Effects

Use of antihypocalcemic vicegerents may product to these impertinent property:
  • CNS: feebleness, surfeit, somnolence, irritability
  • GI: sonorous delicacy, nausea, vomiting, dry mouth, constipation

Interactions

The subjoined are offal-offal interactions confused in the use of antihypocalcemic vicegerents:
  • Magnesium-containing antacids. Occasion for hypermagnesemia.
  • Cholestyramine or azoic oil. Reduced parching of antihypocalcemic vicegerents; austered for at meanest two hours.

Nursing Considerations

Here are momentous nursing considerations when transfering antihypocalcemic vicegerents:

Nursing Assessment

These are the momentous things the nurse should emsubstantiality in conducting rate, narrative accidental, and examination:
  • Assess for contraindications or calculating (e.g. narrative of allergy, renal stone, pregnancy, etc.) to shirk impertinent property.
  • Assess bark lesions; orientation and like; liver evaluation; serum calcium, magnesium, and alkaline phosphate equalizes; and radiographs of bones as misapply, to particularize baseline foothold anteriorly prelude therapy and for any germinative impertinent property.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be makeulated in the use of this offal for therapy:

Implementation behind a suitableness Rationale

These are animate nursing interventions executed in resigneds who are accidental antihypocalcemic vicegerents:
  • Monitor serum calcium strain anteriorly and occasionalally during entertainment to avow for compromise of dose to repeated calcium equalizes behind a suitablenessin recognized stipulation.
  • Provide supportive measures (e.g. analgesics, diminutive and repeated meals, acceleration behind a suitableness activities of daily buttress) to acceleration resigned traffic behind a suitableness CNS and GI property of the offal.
  • Arrange for nutritional consultation if GI property are austere to fix nutritional counterpoise.
  • Provide resigned counsel about offal property and premonition signs to narration to augment resigned instruction and to raise consent.

Evaluation

Here are aspects of caution that should be evaluated to particularize energy of offal therapy:
  • Monitor resigned rejoinder to therapy (repay of serum calcium equalizes to recognized).
  • Monitor for impertinent property (weakness, surfeit, GI property).
  • Evaluate resigned construction on offal therapy by question resigned to call the offal, its demonstration, and impertinent property to wake for.
  • Monitor resigned consent to offal therapy.

Antihypercalcemic Agents

  • Antihypercalcemic vicegerents are offals used to entertain PRH extravagance or hypercalcemia. These vicegerents emsubstantiality bisphosphonates and calcitonin salmon.
  • These offals act on the serum equalizes of calcium and do not restrain the parathyroid gland or PTH.

Therapeutic Action

The desired and salutary resuscitation of antihypercalcemic vicegerents:
  • Bisphosphonates slow recognized and abrecognized annoyance resorption behind a suitablenessout inhibiting annoyance shape and azoicization.
  • Calcitonin inhibits annoyance resorption and lowers tall serum calcium. It besides growths the sweating of filtered phosphate, calcium, and sodium by the kidney.

Indications

Antihypercalcemic vicegerents are implied for the subjoined medical provisos:
  • Bisphosphonate is used to entertain and thwart osteoporosis in postmenopausal women and in men. It is besides used to entertain glucocorticoid-induced osteoporosis as well-mannered-mannered as to entertain Paget’s malady.
  • Calcitonin is used for entertainment of Paget’s malady, postmenopausal osteoporosis, and difficulty entertainment of hypercalcemia.

Pharmacokinetics

Here are the peculiarity interactions of biphosphonates and the assemblage in provisions of parching, dispensation, metabolism, and sweating:
Route Onset Peak Duration
PO Slow Days
T1/2: >10 days Metabolism: not metabolized Excretion: urine
Here are the peculiarity interactions of calcitonin and the assemblage in provisions of parching, dispensation, metabolism, and sweating:
Route Onset Peak Duration
IM, subcutaneous 15 min 3-4 h 8-24 h
Nasal Rapid 31-39 min 8-24 h
T1/2: 1.43 h Metabolism: kidneys Excretion: urine

Contraindications and Cautions

The subjoined are contraindications and calculating for the use of antihypercalcemic vicegerents:
  • Allergy to any ingredient of the offal. To thwart hypersensitivity reactions.
  • Hypocalcemia. Worsened by calcium-lowering goods of bisphosphonates
  • Pregnancy and lactation. Germinative impertinent property to fetus or neonate
  • Renal dysfunction. Can vary offal sweating.
  • Upper GI malady. Can be thoughtful by bisphosphonates. Offal should be fascinated behind a suitableness a liberal glass of instil and resigned should arrive honest for 30 minutes beaccount significant esophageal erosion can appear.
  • Allergy to salmon or fish products. To thwart hypersensitivity reresuscitation behind a suitableness accidental calcitonin
  • Pernicious anemia. Can be worsened by calcitonin

Adverse Effects

Use of antihypercalcemic vicegerents may product to these impertinent property:
  • Bisphosphonates: headache, loathing, diarrhea
  • Calcitonins: flushing of the countenance and hands, bark precipitate, loathing and vomiting, urinary abundance, and topical inflammation at the plight of insertion

Interactions

The subjoined are offal-offal interactions confused in the use of antihypercalcemic vicegerents:
  • Bisphosphonates. Decreased parching if behind a suitableness sinewy, antacids, or multiple vitamins so austered by at meanest 30 minutes; GI vex behind a suitableness aspirin.
  • Tless is no clinically momentous offal-offal interresuscitation behind a suitableness calcitonin.

Nursing Considerations

Here are momentous nursing considerations when transfering antihypercalcemic vicegerents:

Nursing Assessment

These are the momentous things the protect should emsubstantiality in conducting rate, narrative accidental, and examination:
  • Assess for contraindications or calculating (e.g. narrative of allergy to offal or to fish products behind a suitableness salmon calcitonin, renal dysfunction, pregnancy and lactation, etc.) to shirk impertinent property.
  • Assess bark lesions; orientation and like; abdominal examination; serum electrolytes; and renal power tests, to particularize baseline foothold anteriorly prelude therapy and for any germinative impertinent property.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be makeulated in the use of this offal for therapy:
  • Acute indisposition cognate to GI and bark property
  • Imbalanced nutrition: short than assemblage requirements cognate to GI property

Implementation behind a suitableness Rationale

These are animate nursing interventions executed in resigneds who are accidental antihypercalcemic vicegerents:
  • Eninfallible courteous hydration behind a suitableness any of these vicegerents to impair occasion of renal complications.
  • Arrange for accompanying vitamin D, calcium supplements, and hormone re-establishment therapy if used to entertain postmenopausal osteoporosis.
  • Rotate insertion plights and mentor for inflammation if using calcitonins to thwart edifice breakdown and irritation.
  • Monitor serum calcium anteriorly and occasionalally during entertainment to avow for dose compromise.
  • Arrange for occasional blood tests of renal power if using gallium to mentor for renal dysfunction.
  • Provide self-approval measures to acceleration resigned vie behind a suitableness offal property.
Provide resigned counsel about offal property and premonition signs to narration to augment resigned instruction and to raise consent.

Evaluation

Here are aspects of caution that should be evaluated to particularize energy of offal therapy:
  • Monitor resigned rejoinder to therapy (repay of calcium equalizes to recognized equalize; thwartions of complications of osteoporosis; moderate of Paget’s malady).
  • Monitor for impertinent property (bark precipitate, loathing and vomiting, renal dysfunction).
  • Evaluate resigned construction on offal therapy by question resigned to call the offal, its demonstration, and impertinent property to wake for.
  • Monitor resigned consent to offal therapy.

Practice Quiz: Parathyroid Agents

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Text Mode: All questions and exculpations are fond on a one page for lection and exculpationing at your own step. Be infallible to grab a pen and article to transcribe down your exculpations. 1. Hyperparathyroidism A. Leads to low serum equalize of calcium has a chief make which is past vile in elderly men B. Has a chief make which is past vile in patriarchal men C. Benefits from antihypercalcemic vicegerents D. Secondary make is vile in resigneds behind a suitableness continuous liver deficiency 1. Answer: C. Benefits from antihypercalcemic vicegerents Hyperparathyroidism is a proviso characterized by immoderate genesis of PTH ascititious to tall calcium equalize (hypercalcemia). Therefore, it allure use from antihypercalcemic vicegerents. Chief hyperparathyroidism appears past repeatedly in women among 60-70 years of age. Secondary hyperparathyroidism appears most constantly in resigneds behind a suitableness continuous renal deficiency. 2. A resigned accidental calcitriol is besides prescribed behind a suitableness a magnesium-containing antacid. Which of the subjoined should be embodyd in the protect’s mentoring? A. Color of stool B. Signs of bleeding C. Liver power test D. Serum electrolyte equalize 2. Answer: D. Serum electrolyte equalize Antihypocalcemic vicegerents collectively behind a suitableness magnesium-containing antacids growth the occasion for hypermagnesemia. Therefore, it is momentous to mentor serum magnesium equalize. 3. Which of the subjoined should be embodyd in resigned training of resigneds accidental bisphosphonates? A. Arrive honest 30 minutes behind accidental the offal. B. Take offal on leiinfallible stomach. C. Chew offal instead of absorption. D. Both B and C 3. Answer: A. Stay honest 30 minutes behind accidental the offal. Drug should be fascinated behind a suitableness a liberal glass of instil and resigned should arrive honest for 30 minutes beaccount significant esophageal erosion can appear. 4. Vile impertinent property of calcitonin embody: A. Headache B. Flushing of the countenance and hands C. Abdominal tenderness D. Diarrhea 4. Answer: B. Flushing of the countenance and hands Calcitonin is serviceable in IM, subcutaneous, and nasal makes. Other impertinent property emsubstantiality bark precipitate, loathing and vomiting, urinary abundance, and topical inflammation at the plight of insertion. Surfeit and diarrhea are vile in bisphosphonates. 5. This is a genetically-linked proviso behind a suitableness parathyroid dyspower characterized by recondite annoyance indisposition, surfeits, and hearing damage. A. Tay-Sachs malady B. Paget’s malady C. Gaucher assumption D. Marfan Syndrome 5. Answer: B. Paget’s malady Paget’s malady is a genetically linked assumption characterized by overactive osteoclasts that are besides replaced by tolerant and flexible gaunt makes. Manifestations emsubstantiality recondite annoyance indisposition, surfeits, and hearing damage.

References and Sources

References and sources for this pharmacology conduct for Parathyroid Agents:
  • Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
  • Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
  • Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing caution.
  • Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.

See Also

Here are other nursing pharmacology con-over conducts: Gastrointestinal System Drugs Respiratory System Drugs Endocrine System Drugs Autonomic Nervous System Drugs Immune System Drugs Chemotherapeutic Agents Reproductive System Drugs Nervous System Drugs Cardiovascular System Drugs

Further Lection and External Links

Recommended media and regard books. Disclosure: Includes Amazon annex links.
  1. Focus on Nursing Pharmacology - Easy to thrive conduct for Pharmacology
  2. NCLEX-RN Offal Guide: 300 Medications You Need to Know for the Exam - Great if you're reviewing for the NCLEX
  3. Nursing 2017 Offal Handbook (Nursing Offal Handbook) - Reliable nursing offal handbook!
  4. Lehne's Pharmacology for Nursing Care - Provides key inshape on habitually used offals in nursing
  5. Pharmacology and the Nursing Process - Learn how to transfer offals set-rightly and safely!
  6. Pharm Phlash Cards!: Pharmacology Flash Cards - Flash Cards for Nursing Pharmacology

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