Parathyroid Hormone (PTH)

--Activates osteoclasts increasing serum calcium

--increases intestinal absorption of calcium by activating the kidneys to metabolize vitamin D to active form

--increases calcium reabsorption and decreases phosphate reabsorption

Non-Pharmocological Therapy

Dietary interventions

(hypoparathyroidism)

Foods rich in calcium (brocholi)

Low in phosphorus rich foods (meats)

Calcium Therapy

(hypoparathyroidism)

Calcium

--titrate dose to minimize vitamine D dose

--contraindications--renal stones,hypercalcemia

--interations--decrease tetracycline, quinilones, and iron (dietary fiber may decrease absorption)

---CONSTIPATION

--maintaint adequate fluid intake

Vitamin D Therapy

(hypoparathyroidism)

Vitamin D2(ergocalciferol)  Vitamin D3 (calciferol)

--Stimulates Absorption of calcium and phosphate

--Adverse Effects--hypercalcemia, arrythmias, muscle and bone pain

--Contraindications--hercalcemia, hypervitaminosis

--Pregnancy--may use if benifits outweigh risks

--Interactions--Bile-acid resins, thiazides, antacids(can cause hypermagnesemia)

--Precautions--renal stones, hyperphosphatemia

--

Calcitriol

(hypoparathyroidism)

--Natural for of vitamin D from kidney

--Promotes absorption of calcium in the intestines

--Adverse effects--Hypercalcemia, hyperphosphatemia, vitamin D toxicity

--Pregnancy--C

--Interactions--Bile-acid resinss, Thiazide Diuretics, antacids

--Precautions--maintain adequate fluid intake

Thiazide therapy

(hypoparathyroidism)

Hydrochlorothiazide and low salt diet--promting calcium retention (preventing or controlling hypercalciuria)

--Precautions--renal impairment

--Contraindications--hypersensitivity, anuria

--Preganancy--B

--Interactions--increases litium levels, NSAIDS, attenuate effects of diuretics

--Adverse effects--hypokalemia, hyperglycemia, hypomagnesemia

--excess secretion of PTH

--Leads to hypercalcemia and decreaed phosphate levels

Non-pharmalogical Therapy

(Hyperparathyroidism)

--Surgery

--Avoid dehydration

--Keep Calcium intake below 1000 mg/day

Bisphosphonates

(Hyperparathyroidism)

--Inhibitions of osteoclast activity

*not recomended if CrCl <35ml/min

--Adverse effects--osteonecrosis (of jaw), acid regurge, esophagitis

--Interactions--antacids decrease efficacy

--Precautions--take with 6-8oz of O2 30 minutes before food and do not lay down for 30 minutes.

--Contraindications--inability to stand or sit upright for 30 minutes, Hypocalcemia

Estrogens

(Hyperparathyroidism)

--reduce bone reabsorption (no or little effect on calcium)

--Contraindications--Breast Cancer, history of VTE

--Adverse Effects--MI,stroke, HTN, Breast Cancer

--Calcium (ionized)

--Albumin(calcium binds here)

--Magnesium

--PTH

--Phosphorus

--25-hydroxyvitamine D

(think campp 25...when you are camping you get hypothermia)

Measured Total Calcium + 0.8 (4-Serum Albumin)

--PTH

--Calcium

--25-hydroxyvitamin D

--Phosophorous

(think pcp 25....pcp makes you hyper)

• Insulin resistance and progressive beta cell failure
• Starts as hyperinsulinemia
• relative lack of insulin