Contraindications: Hypercalcemia, ventricular fibrillation, metastatic bone cancer, renal calculi.
ALERT: When given through IV give slowly to avoid dysrhythmias and cardiac arrest.
Adverse effects: potential for dysrhythmias with any imbalance of calcium in blood. IV administration of Calcium can lead to a fast increase and higher risk of side effects.
Interactions: may increase dysrhythmias when administered with digoxin, may antagonize the effects of calcium channel blockers. Can decrease serum phosphate and potassium levels and magnesium levels.
fat soluble, over dose resulting in hypercalcemia
400 units normal dose
calcitriol (Calcijex, Rocaltrol)
Pharm Class: Bone resorption inhibitor
Therapeutic class: Vitamin D
MOA: active form of vitamin D, promotes intestinal absorption of calcium, elevates serum levels of calcium. Usually prescribed with a calcium supplement.
Preg. Cat: C
Indications: impaired kidney function or hypoparathyroidism, treatment of rickets.
Contraindications: Hypercalcemia, VItamin D Toxicity.
Adverse effects: Can cause hypercalcemia and lead to S&S of Hypercalcemia.
Interactions: Thiazide diuretics may enhance the effects of vitamin D causing hypercalcemia and leading to dysrhythmias.
*alendronate sodium (Fosamax)
Pharm Class: Bisphosphonate; bone resorption inhibitor.
Therapeutic Class: Drug for osteoporosis
MOA: Lowers serum alkaline phosphatase; enzyme associated with bone turnover. May take up to 1-3 months to reach therapeutic effect.
Preg Cat. C
Indications: Osteoporosis and Paget's disease.
Alert: Should be taken on empty stomach for max absorption, patient should remain in upright position for at least 30 mins after administration.
Contraindication: osteomalacia, esophagus abnormalities, caution: for renal impairment, heart failure, Hyperphosphatemia, liver disease, infections, GI problems, and pregnancy.
Adverse effects: GI upset, esophageal irritation, osteonecrosis of the jaw (ONJ), hypocalcemia, hypophosphatemia, dyspepsia, arthralgia, myalgia, headache- Pathologic fractures may occur if the drug is taken longer than 3 months.
Interactions: Calcium, iron, antacids can interfere with absorption.
MOA: Genetically engineered proteins derived from human genes, designed to either inhibit specific components of the immune system or suppressing inflammation
Adverse effects: Rare but serious – reactivation of TB, infections, neurological disorders such as MS, lymphoma, lupus like syndromes. Fewer side effects then DMRADS -GI upset, anorexia, alopecia, headache, ocular effects, blood dyscrasias
Corticoids and Glucocorticoids
Used to treat a wide variety of inflammatory disorders. Can be injected which is more effective. Many adverse effects-hyperglycemia, muscle weakness, bone thinning,gastric ulcers.