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39 Cards in this Set
- Front
- Back
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What are the 3 types of symptoms associated with Hypocalcemia?
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-Neuromuscular
-Behavioral -Cardiovascular |
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What neuromuscular symptoms are seen in hypocalcemia?
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-Neuromusc excitability
-Tetany -Parasthesia |
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What are 2 behavioral symptoms that can develop in hypocalcemia?
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Psychosis and depression
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What are 3 cardiovascular symptoms associated with hypocalcemia?
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-Vasodilation
-Hypotension -Congestive heart failure |
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What is the most common cause of hypocalcemia?
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Iatrogenic - removal of the parathyroids resulting in no/low PTH.
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What are 4 other causes of hypocalcemia?
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DRIP
-Deficiency of Vit D -Renal insufficiency -Iatrogenic - drugs -Pancreatitis |
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What 2 electrolyte abnormalities will be seen in Pancreatitis induced hypocalcemia?
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-Hypocalcemia (obviously)
-HYPERphosphatemia |
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What are 3 drugs that can induce hypocalcemia?
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-Phenobarbital
-Phenytoin -Furosemide |
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What are 5 types of treatment for hypocalcemia?
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-PTH
-Vit D -Calcium -Phosphate binders -Mg supplements |
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What are 2 specific calcium formulations and how is each administered for hypocalcemia?
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-Calcium gluconate - IV
-Calcium carbonate - Oral |
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Why isn't PTH given very often for hypocalcemia?
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Because its very expensive
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What effect do Phosphate binders have in treating hypocalcemia?
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They increase free calcium in the serum.
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What are the symptoms of Hypercalcemia USUALLY?
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Asymptomatic
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What are symptoms that can present with Hypercalcemia?
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-N/V/Constipation
-Lethargy/depression -Calcium deposition in soft tissues (CARS - CNS/arrythmia/renal/STC) |
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What organ is susceptible to damage in hypercalcemia?
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The kidney
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What are the 2 major causes of Hypercalcemia?
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-Hyperparathyroidism
-Hypercalcemia of malignancy |
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4 less common causes of hypercalcemia:
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-Vit D intoxication
-Immobilization -Sarcoidosis -Thiazide diuretics |
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So how is serum Ca changed by:
-loop diuretics -thiazide diuretics |
Loops - hypocalcemia
Thiazides - hypercalcemia! |
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What are 4 mechanisms that drugs can use for decreasing serum Ca levels in hypercalcemia?
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-Decrease GI absorption
-Increase renal excretion -Decrease bone resorption -Complex w/ free Ca in blood |
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What could you do to accomplish the first three of those mechanisms all at the same time?
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Inhibit PTH secretion
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What drug inhibits PTH secretion? How?
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Cinacalcet - its a calcium mimetic so inhibits the parathyroid glands.
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What 2 conditions of hypercalcemia are treated with CINACALCET?
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-2ndry hyperPTism due to chronic renal disease
-Parathyroid Carcinoma causing hypercalcemia |
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And what is the mechanism of Cinacalcet?
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1. Decreases PTH secretion
2. Decreases bone resorption 3. Increases renal Ca excretion |
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What is the half-life of Cinacalcet like?
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LONG - 30-40 hrs!
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How is Cinacalcet metabolized and eliminated?
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Metabolized: by multiple liver p450's
Eliminated: by the kidney |
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What is the major side effect of Cinacalcet?
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Hypocalcemia
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What are 4 treatments for ACUTE hypercalcemia?
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-Saline rehydration
-Loop diuretics (furosemide) -Calcitonin -Plicamycin |
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How does saline rehydration work to treat hypercalcemia?
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It expands the plasma volume thus reduces the Ca concentration
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How do the loop diuretics work to treat hypercalcemia?
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By increasing Ca excretion
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Which loop diuretic?
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Furosemide
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What is Calcitonin's role in treating hypercalcemia? Why?
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Ancillary - bc refractoriness develops over time.
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What specific type of Acute Hypercalcemia is Calcitonin useful in treating?
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Hyperparathyroidism with hypophosphatemia
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What is Plicamycin?
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A potent cytotoxic antibiotic
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What is Plicamycin's mechanism in treating acute hypercalcemia?
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It inhibits bone resorption.
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How long does it take to see the effects of Cinacalcet in treating chronic hyperCa?
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2-4 hours
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How long does it take to see the effects of Plicamycin in treating acute hyperCa?
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24-48 hrs
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How long do the effects of Plicamycin last?
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Several days
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What are 2 major toxic side effects of Plicamycin?
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-Sudden Thrombocytopenia
-Liver toxicity |
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What are 2 other agents that can be used for treating hypercalcemia, and which one is a last option?
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-Bisphosphonates
-Inorganic Phosphate - last option |
