Mosby's 2014 Nursing Drug Reference (75 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(kal-sih-toh′nin)
Fortical
Miacalcin
Func. class.:
Parathyroid agents (calcium regulator)
Chem. class.:
Polypeptide hormone
Decreases bone resorption, blood calcium levels; increases deposits of calcium in bones; opposes parathyroid hormone
Paget’s disease, postmenopausal osteoporosis, hypercalcemia
Unlabeled uses:
Bone/neuropathic pain, diabetic neuropathy, osteolytic metastases, osteoporosis prophylaxis, phantom limb pain
Hypersensitivity to this product, fish
Precautions:
Pregnancy (C), breastfeeding, children, renal disease, osteogenic sarcoma, pernicious anemia
Calculator
• Adult:
SUBCUT
0.5 mg/day initially; may require 0.5 mg bid × 6 mo, then decrease until symptoms reappear
• Adult:
SUBCUT/IM
100 international units every other day;
INTRANASAL
200 international units (1 spray) daily alternating nostrils daily, activate pump before 1st dose
• Adult:
SUBCUT/IM
100 international units/day, maintenance 50 international units daily, every other day or 3 × per wk
• Adult:
SUBCUT/IM
4 international units/kg q12hr, increase to 8 international units/kg q12hr if response is unsatisfactory
• Adult:
IV/SUBCUT
100-200 international units/day for phantom limb pain
IV
200 international units over 20 min and 2nd inf given
• Adult:
SUBCUT
50-100 international units/day or
INTRANASAL
200 international units in 1 nostril/day
Available forms:
Inj 200 international units/ml; nasal spray 200 international units/actuation
•
By SUBCUT route only; rotate inj sites; use within 6 hr of reconstitution;
give
at bedtime to minimize nausea, vomiting, rotate sites
•
After test dose of 10 international units/ml, 0.1 ml intradermally; watch for 15 min;
give
only with epinephrine, emergency meds available
•
IM inj slowly into deep muscle mass; rotate sites; preferred route if volume is >2 ml
CNS:
Headache, tetany, chills, weakness, dizziness, fever, tremors
CV:
Chest pressure
EENT:
Nasal congestion, eye pain
GI:
Nausea, diarrhea, vomiting, anorexia, abdominal pain, salty taste, epigastric pain
GU:
Diuresis, nocturia, urine sediment, frequency
INTEG:
Rash, flushing, pruritus of earlobes, edema of feet, reaction at inj site
MS:
Swelling, tingling of hands, backache
RESP:
Dyspnea
SYST:
Anaphylaxis
IM/SUBCUT:
Onset 15 min, peak 4 hr, duration 8-24 hr, metabolized by kidneys, excreted as inactive metabolites via kidneys
Decrease:
lithium effect
Decrease:
effect of nasal spray—biphosphonates (Paget’s disease)
Anaphylaxis, hypersensitivity reaction
(rash, fever, inability to breathe); emergency equipment should be nearby
•
GI symptoms, polyuria, flushing, head swelling, tingling, headache; may indicate hypercalcemia
•
Nutritional status; diet for sources of vit D (milk, some seafood), calcium (dairy products, dark green vegetables), phosphates
•
Urinalysis (calcium should be kept at 9-10 mg/dl, vit D 50-135 international units/dl), alk phos baseline, q3-6mo; monitor urine hydroproline with Paget’s disease, biochemical markers of bone formation/absorption, radiologic evidence of fracture; bone density (osteoporosis)
•
Toxicity (can occur rapidly),
increased drug level; have parenteral calcium on hand if calcium level drops too low; check for tetany (irritability, paresthesia, nervousness, muscle twitching, seizures, tetanic spasms)
•
Storage at <77° F (25° C); protect from light
•
Therapeutic response: calcium levels 9-10 mg/dl, decreasing symptoms of Paget’s disease
•
About the method of inj if patient will be responsible for self-medication
•
To report difficulty swallowing, any changes in side effects to prescriber immediately
•
To use alternating nostrils for nasal spray; use after allowing to warm to room temp; prime to get full spray
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
3
(Rx)
(kal-sih-try′ole)
Calcijex, Rocaltrol, Vectical
Func. class.:
Parathyroid agent (calcium regulator)
Chem. class.:
Vit D hormone
Do not confuse:
calcitriol
/Calciferol
Increases intestinal absorption of calcium, provides calcium for bones, increases renal tubular resorption of phosphate
Hypocalcemia with chronic renal disease, hyperparathyroidism pseudohypoparathyroidism
Unlabeled uses:
Osteopetrosis, osteoporosis, osteoporosis prophylaxis, rickets, familial hypophosphatemia
Hypersensitivity, hyperphosphatemia, hypercalcemia, vit D toxicity
Precautions:
Pregnancy (C), breastfeeding, renal calculi, CV disease
Calculator
• Adult and child ≥6 yr:
PO
0.25 mcg/day
IV
0.5 mcg tid initially; may increase by 0.25 every other day q4-8wk
• Child 1-5 yr:
PO
0.25-2 mcg/day
• Adult and child ≥3 yr:
PO
0.25 mcg/day, may increase to 0.5 mcg/day
• Child <3 yr:
PO
0.01-0.015 mcg/kg/day
• Adult and child ≥6 yr:
PO
0.25 mcg/day, may increase q2-4wk, maintenance 0.5-2 mcg/day
• Child 1-5 yr:
PO
0.25-0.75 mcg daily
• Child <1 yr:
PO
0.04-0.08 mcg/kg/day
• Adult and child:
PO
1 mcg/day
• Adult:
PO
2 mcg/day
• Child:
PO
0.015-0.02 mcg/kg/day, maintenance 0.03-0.06 mcg/kg/day; max 2 mcg/day
• Adult:
PO
0.25 mcg bid, adjust to serum calcium levels
• Child:
PO
high-dose calcitriol 1-2 mcg/kg/day given in 4-6 divided doses
• Adult:
PO
0.5-1 mcg/day
Available forms:
Caps 0.25, 0.5 mcg; inj 1 mcg/ml, 2 mcg/ml; oral sol 1 mcg/ml; top 3 mcg/g
•
Do not break, crush, chew caps
•
Give without regard to meals
•
Give by direct IV over 1 min
CNS:
Drowsiness, headache, vertigo, fever, lethargy, hallucinations
CV:
Palpitations, hypertension
EENT:
Blurred vision, photophobia
GI:
Nausea, diarrhea, vomiting, jaundice, anorexia, dry mouth, constipation, cramps, metallic taste
GU:
Polyuria, hypercalciuria, hyperphosphatemia, hematuria, thirst
MS:
Myalgia, arthralgia, decreased bone development, weakness
SYST:
Anaphylaxis
PO:
Absorbed readily from GI tract, peak 10-12 hr, duration 3-5 days, half-life 3-6 hr, undergoes hepatic recycling, excreted in bile
•
Hypercalcemia: thiazide diuretics, calcium supplements
•
Cardiac dysrhythmias: cardiac glycosides, verapamil
•
Hypermagnesemia: magnesium antacids
•
Toxicity: other vit D products
Increase:
metabolism of vit D—phenytoin
Decrease:
absorption of calcitriol—cholestyramine, mineral oil, fat-soluble vitamins
•
Large amounts of high-calcium foods may cause hypercalcemia
False increase:
cholesterol
Interference:
alk phos, electrolytes
•
BUN, urinary calcium, PTH, creatinine, chloride, magnesium, electrolytes, phosphate; may increase calcium; should be kept at 9-10 mg/dl, vit D 50-135 international units/dl, phosphate 70 mg/dl; toxic reactions may occur rapidly
•
Hypercalcemia:
dry mouth, metallic taste, polyuria, bone pain, muscle weakness, headache, fatigue, change in level of consciousness, dysrhythmias, increased respirations, anorexia, nausea, vomiting, cramps, diarrhea, constipation; paresthesia, twitching, dysrhythmias, Chvostek’s sign, Trousseau’s sign
(hypocalcemia)
•
Renal status: decreased urinary output (oliguria, anuria), edema in extremities, weight gain 5-7 lb, periorbital edema
•
Nutritional status, diet for sources of vit D (milk, some seafood); calcium (dairy products, dark green vegetables), phosphates (dairy products) must be avoided
•
Storage protected from light, heat, moisture
•
Restriction of sodium, potassium if required; restriction of fluids if required for chronic renal failure
•
Therapeutic response: calcium 9-10 mg/dl; decreasing symptoms of hypocalcemia, hypoparathyroidism
•
About symptoms of hypercalcemia: renal stones, nausea, vomiting, anorexia, lethargy, thirst, bone or flank pain
•
To avoid products with sodium: cured meats, dairy products, cold cuts, olives, beets, pickles, soups, meat tenderizers with chronic renal failure; products with potassium: oranges, bananas, dried fruit, peas, dark green leafy vegetables, milk, melons, beans
•
To avoid OTC products that contain calcium, potassium, sodium with chronic renal failure
•
To monitor weight weekly; to maintain fluid intake