PARATHYROID

AGENTS
Prepared by Rhodee Kristine Dona
Parathyroid Glands
are four very small
groups of glandular
tissue located on
the back of the
thyroid gland. It
produces PTH, an
important regulator
of calcium levels
PARATHYROID
HORMONE (PTH)
Stimulation of osteoclasts or bone cells to
release calcium from the bone
Increased intestinal absorption of calcium
Increased calcium reabsorption from kidneys
Stimulation of cells in the kidneys to produce
calcitriol, the active from of Vitamin D, which
stimulates intestinal transport of calcium into
the blood
 REGULATION OF
SERUM CALCIUM
Parathyroid hormone (PTH)and
calcitonin regulate normal serum
calcium. As serum calcium rises,
PTH is inhibited by calcitonin.
The kidney then excretes more
calcium, the gastrointestinal (GI)
system absorbs less, and a
reduction in bone resorption
occurs. As serum calcium falls,
PTH is secreted and raises the
calcium level by decreasing the
amount of calcium lost in the
kidney, increasing the amount
absorbed in the GI tract and
increasing bone resorption.
 HYPOPARATHYROIDISM

The absence of PTH results in a low calcium level

(hypocalcemia) and a relatively rare condition called
hypoparathyroidism. This is most likely to occur with
the accidental removal of the parathyroid glands
during thyroid surgery. Treatment consists in calcium
and vitamin D therapy to increase serum calcium
levels
The excessive production of PTH leads to an
elevated calcium level (hypercalcemia) and a
condition called hyperparathyroidism. This can occur
as a result of parathyroid tumor or certain genetic
disorders. The patient presents with signs of high
calcium levels

HYPERPARATHYROIDISM
 PARATHYROID
AGENTS
THE DRUGS USED TO TREAT DISORDERS
ASSOCIATED WITH PARATHYROID FUNCTION ARE
DRUGS THAT AFFECT SERUM CALCIUM LEVELS.
ANTIHYPOCALCEMIC AGENTS
ANTIHYPERCALCEMIC AGENTS
ANTIHYPOCALCEMIC
AGENTS
drugs used to treat deficient levels of PTH.
Calcitriol
Parathyroid
Hormone
Teriparatide
 THERAPEUTIC ACTIONS
A vitamin D compound that
regulates the absorption of
calcium and phosphate from the
small intestine, mineral resorption
in bone, and reabsorption of
phosphate from renal tubules,
increasing the serum calcium
level.
Teriparatide stimulates new
bone formation leading to
increase in skeletal mass. It
increases serum calcium and
decreases serum
phosphorus.strations, lectures,
speeches, reports, and more.
Parathyroid hormones is
only approved for
maintenance of calcium
levels in patients with
hypoparathyroidism
 INDICATIONS
MANAGEMENT OF MANAGEMENT OF
HYPOCALCEMIA IN HYPOCALCEMIA
PATIENTS ON ASSOCIATED WITH
CHRONIC RENAL HYPOPARATHYROIDISM
DIALYSIS AND WITH SUSTAINED
SYSTEMIC
GLUCOCORTICOIDS
THERAPY
PHARMACOKINETICS
ROUTE: PO
ONSET: Slow
PEAK: 4 h
DURATION: 3-5 d
T1/2: 5-8 h
Metabolism: Liver
Excretion: Bile
 CONTRAINDICATIONS AND
CAUTIONS
ALLERGY TO ANY HYPERCALCEMIA TERIPARATIDE
PREGNANCY AND

COMPONENT OF OR VITAMIN D AND

PARATHYROID
THE DRUG. TOXICITY LACTATION HORMONE
Associated with
To prevent Can be exacerbated by Potential adverse effects
osteosarcoma in animal
hypersensitivity reactions. drug effects. to the fetus. studies.
 ADVERSE EFFECTS
CENTRAL GASTROINTESTINAL
NERVOUS
metallic taste, nausea, vomiting,
SYSTEM
dry mouth,
weakness, headache, constipation
somnolence, irritability
 DRUG-DRUG INTERACTIONS
MAGNESIUM- CHOLESTYRAMINE
CONTAINING OR MINERAL OIL
ANTACIDS Reduced absorption of
antihypocalcemic agents;
Risk for
separate for at least two
hypermagnesemia. hours.
 IMPORTANT NURSING
CONSIDERATIONS WHEN
ADMINISTERING
ANTIHYPOCALCEMIC AGENTS:
ASSESSMENT
DIAGNOSES
IMPLEMENTATION
EVALUATION
 NURSING ASSESSMENT

Assess skin lesions; orientation and Assess for contraindications or

affect; liver evaluation; serum calcium, cautions (e.g. history of allergy, renal
magnesium, and alkaline phosphate stone, pregnancy, etc.) to avoid
levels; and radiographs of bones as adverse effects.
appropriate, to determine baseline
status before beginning therapy and
for any potential adverse effects.
NURSING DIAGNOSES
ACUTE PAIN RELATED
TO GI AND CNS
EFFECTS

IMBALANCED
NUTRITION: LESS THAN
BODY REQUIREMENTS
RELATED TO GI EFFECTS
 NURSING
IMPLEMENTATION
MONITOR SERUM PROVIDE ARRANGE FOR PROVIDE
CALCIUM SUPPORTIVE NUTRITIONAL PATIENT
CONCENTRATION MEASURES CONSULTATION EDUCATION
NURSING EVALUATION
MONITOR PATIENT MONITOR FOR EVALUATE MONITOR
RESPONSE TO ADVERSE PATIENT PATIENT
THERAPY EFFECTS UNDERSTANDING COMPLIANCE TO
ON DRUG DRUG THERAPY.
THERAPY
ANTIHYPERCALCEMIC
AGENTS
drugs used to treat PRH excess or hypercalcemia.
It act on the serum levels of calcium and do not suppress
the parathyroid gland or PTH.
Bisphosphonates
Calcitonin
 THERAPEUTIC ACTIONS
BISPHOSPHONATES CALCITONIN
slow normal and abnormal inhibits bone resorption and lowers
bone resorption without elevated serum calcium. It also
inhibiting bone formation increases the excretion of filtered
and mineralization phosphate, calcium, and sodium by
the kidney.
 INDICATIONS
BISPHOSPHONATES CALCITONIN
used to treat and prevent used for treatment of Paget’s
osteoporosis in
disease, postmenopausal
postmenopausal women and
osteoporosis, and emergency
in men. It is also used to treat
glucocorticoid-induced
treatment of hypercalcemia.
osteoporosis as well as to
treat Paget’s disease.
 PHARMACOKINETICS
BISPHOSPHONATES CALCITONIN
ROUTE: IM, Subcutaneous
ROUTE: PO ONSET: 15 min
ONSET: Slow PEAK: 3-4 h
PEAK: - DURATION: 8-24 h
DURATION: Days ROUTE: Nasal
ONSET: Rapid
T1/2: >10 days
PEAK: 31-39 min
METABOLISM: Not
DURATION: 8-24 h
metabolized
EXCRETIONS: Urine T1/2: >10 days
METABOLISM: Not metabolized
EXCRETIONS: Urine
 CONTRAINDICATIONS AND
CAUTIONS
ALLERGY TO
PREGNANCY AND
ANY HYPOCALCEMIA
LACTATION
COMPONENT
OF THE DRUG.
PERNICIOUS
ANEMIA

ALLERGY TO RENAL
UPPER GI DISEASE
SALMON OR DYSFUNCTION
FISH PRODUCTS
 ADVERSE EFFECTS
BISPHOSPHONATES CALCITONIN
flushing of the face and hands,
headache, nausea, diarrhea
skin rash, nausea and vomiting,
urinary frequency, and local
inflammation at the site of
injection
DRUG-DRUG INTERACTIONS
BISPHOSPHONATES CALCITONIN
Decreased absorption if with There is no clinically important
iron, antacids, or multiple drug-drug interaction
vitamins so separate by at
least 30 minutes; GI distress
with aspirin.
 IMPORTANT NURSING
CONSIDERATIONS WHEN
ADMINISTERING
ANTIHYPERCALCEMIC AGENTS:
ASSESSMENT
DIAGNOSES
IMPLEMENTATION
EVALUATION
 NURSING ASSESSMENT
Assess skin lesions; orientation and
affect; abdominal examination;
serum electrolytes; and renal function
tests, to determine baseline status
before beginning therapy and for any
potential adverse effects
Assess for contraindications or
cautions (e.g. history of allergy to
drug or to fish products with salmon
calcitonin, renal dysfunction,
pregnancy and lactation, etc.) to
avoid adverse effects
NURSING DIAGNOSES
ACUTE PAIN RELATED
TO GI AND SKIN
EFFECTS

IMBALANCED
NUTRITION: LESS THAN
BODY REQUIREMENTS
RELATED TO GI EFFECTS
 NURSING
IMPLEMENTATION
ENSURE ROTATE MONITOR SERUM ARRANGE FOR
ADEQUATE INJECTION CALCIUM PERIODIC BLOOD
HYDRATION SITES AND TESTS OF RENAL
MONITOR FOR FUNCTION
INFLAMMATION

ARRANGE FOR CONCOMITANT PROVIDE COMFORT

VITAMIN D, CALCIUM MEASURES
SUPPLEMENTS, AND
HORMONE REPLACEMENT
THERAPY
NURSING EVALUATION
MONITOR PATIENT MONITOR FOR EVALUATE MONITOR
RESPONSE TO ADVERSE PATIENT PATIENT
THERAPY EFFECTS UNDERSTANDING COMPLIANCE TO
ON DRUG DRUG THERAPY.
THERAPY
COM
PEND
IUM