Medications affecting the parathyroid glands: Nursing pharmacology

Parathyroid disorders affect the parathyroids, which are four small glands located on the thyroid gland. Now, the parathyroid glands produce parathyroid hormone, or PTH for short, in response to low levels of calcium in the bloodstream.

So parathyroid disorders include hypoparathyroidism, which is characterized by a decrease in PTH, and hyperparathyroidism, which is characterized by an increase in PTH.Let’s start with hypoparathyroidism, which is treated with the active form of vitamin D3 called calcitriol, which can be given orally or intravenously, as PTH replacement therapy.

Once administered, calcitriol acts by binding to PTH receptors and mimicking the actions of PTH. These include promoting the absorption of calcium from the gastrointestinal tract, as well as promoting the reabsorption of calcium from renal tubules, and to a certain extent, releasing calcium from bones into the bloodstream.

As a result, calcitriol causes an increase in blood calcium levels. This medication can also be given to treat secondary hyperparathyroidism or hypocalcemia associated with chronic kidney disease, as well as pseudohypoparathyroidism.Now, the most common side effects of calcitriol include headache and drowsiness, as well as a dry mouth and a metallic taste.

Clients can also experience abdominal pain, anorexia, nausea, vomiting, diarrhea or constipation. Calcitriol may also cause blurred vision and photophobia, as well as myalgia and arthralgia.

Other important side effects include hypertension, arrhythmias, hypercalcemia, pancreatitis, and anaphylactic reactions.Alright, now contraindications of calcitriol include hypercalcemia, hyperphosphatemia, and vitamin D toxicity, while precautions should be taken in clients with cardiovascular disease and renal calculi, as well as during pregnancy and breastfeeding.In contrast, hyperparathyroidism is treated using calcitonin, which can be administered subcutaneously, intramuscularly, and intranasally.

Once administered, this medication works by inhibiting the breakdown of bones by osteoclasts and promoting calcium deposition in bones, as well as increasing the renal excretion of calcium.

As a result, calcitonin causes a decrease in blood calcium levels. This medication can also be given to treat hypercalcemia, Paget disease, and postmenopausal osteoporosis.Side effects of calcitonin include headache, bronchospasm and flu-like symptoms, as well as anorexia, nausea, vomiting, and diarrhea.

Clients taking calcitonin may also experience myalgia and arthralgia. Lastly, calcitonin may cause a skin rash, flushing, and even anaphylactic reactions.Calcitonin is contraindicated in clients who are allergic to fish, since calcitonin is obtained from salmon.

In addition, precautions should be taken during pregnancy, breastfeeding, and in children. Finally, calcitonin should also be used with caution in clients with hypotension or hypocalcemia.Okay, when caring for a client with a parathyroid disorder, before administering any medication, be sure to conduct a focused assessment, noting signs of hypocalcemia like muscle cramps, hyperreflexia, paresthesias of the extremities or around the mouth, as well as positive Trousseau's and Chvostek’s signs; or signs of hypercalcemia, such as muscle weakness, depressed reflexes, and gait abnormalities.

Next, review your client’s most recent laboratory test results, including calcium, phosphorus, magnesium, alkaline phosphatase, vitamin D, and PTH levels, as well as urine calcium measurements.

Lastly, review diagnostic test results, including ECG and bone density tests.Now, if your client is diagnosed with hypoparathyroidism, before administering calcitriol, be sure to explain how the medication will help increase their blood calcium levels.

Then, instruct your client to store their medication away from light, heat, or moisture, and to take it once each day, with or without food.

Let them know about side effects they may experience, including a metallic taste, nausea, and headaches. Stress the importance of avoiding a calcium level that’s too high, so teach them to avoid over-the-counter supplements containing calcium, antacids that contain magnesium, or large amounts of high-calcium foods, and teach them to contact their healthcare provider right away if they notice signs of hypercalcemia, such as constipation, muscle weakness, or bone pain.On the other hand, if your client is diagnosed with hyperparathyroidism and hypercalcemia, and is prescribed a calcitonin nasal spray, first confirm they have no known allergy to salmon.

Then, explain how the medication will help reduce their excess blood calcium levels. Teach them to take their medication once daily, at bedtime, and instruct them to keep unopened medication in the refrigerator, while their opened medication can be kept at room temperature for no more than 30 days.

Remind them that the medication should always be at room temperature before administering.Be sure they know how to activate a new bottle of medication by holding it upright and depressing side arms down at least 5 times until a full spray is emitted from the bottle.

Then, teach them how to administer the medication. They should keep their head upright, place the tip of the bottle into one nostril, and press down to deliver the medication; be sure to remind them to not inhale the medication.

Also, advise them to alternate nostrils each day, and to notify their healthcare provider if significant irritation occurs.

Let them know they may experience certain side effects, such as headaches, and flushing of their face or hands. Stress the importance of recognizing symptoms of hypocalcemia, such as muscle twitching and paresthesia, and to seek emergency medical treatment immediately if these symptoms occur.

Lastly, be sure they understand how to adhere to the recommended dietary modifications to ensure adequate intake of calcium and vitamin D.Finally, during therapy, keep a close eye on your client’s calcium, phosphate, magnesium, and alkaline phosphatase levels.

Monitor them regularly for side effects such as hypo- or hypercalcemia, and evaluate for the desired therapeutic effect of calcium levels within a normal range.Alright, as a quick recap… The parathyroid glands secrete parathyroid hormone, or PTH, to help regulate blood calcium levels.

A decrease in the amount of PTH leads to hypoparathyroidism, which is treated with calcitriol, a replacement medication that mimics PTH in the body to increase calcium levels.

On the other hand, an increase in PTH leads to hyperparathyroidism, which is treated with calcitonin, a medication that antagonizes PTH in the body to decrease calcium levels.

When caring for a client with a parathyroid disorder, nursing considerations include assessing for signs of hypo- or hypercalcemia, close monitoring of serum electrolytes, especially calcium, and monitoring for side effects and the therapeutic effect of calcium levels within a normal range.

Client teaching is focused on safe self-administration and learning to recognize and report signs of altered calcium levels to a