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What is the equation for corrected Calcium?
Ca + 0.8(4 - albumin)
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What is the tx for hypercalcemia of malignancy if there are no sx present and Ca < 14 mg/dL?
- Encourage oral fluids
- Increase Na intake
- Increase ambulation
- Monitor: Ca, Phos, K, BUN, SCr, Alb, fluid status
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What is the tx for hypercalcemia of malignancy if there are sx present or Ca > 14 mg/dL?
- NS + Calcitonin + Bisphosphonate
- Monitor: Ca, Phos, K, BUN, SCr, Alb, fluid status
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What is the MOA of NS in hypercalcemia?
- expands intracellular volume
- increases renal Ca excretion
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What is the MOA of diuretics in hypercalcemia?
inhibition of Ca reabsorption by the kidneys
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What is the MOA of Calcitonin in hypercalcemia?
- inhibits osteoclastic bone resorption
- increases renal excretion of Ca
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What is the MOA of bisphosphonates in hypercalcemia?
- inhibits osteoclastic bone resorption
- inhibits bone crystal dissolution
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What is the dosing schedule of Calcitonin for hypercalcemia?
SQ q 6h (8 dose max)
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What is the differince between the onset of action for Calcitonin and the onset of all other agents used for hypercalcemia?
- Calcitonin = a few hrs
- Others = 48hrs
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What is the DOA of NS for hypercalcemia?
48hrs
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What is the DOA of Calcitonin for hypercalcemia?
24hrs
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What is the DOA of bisphosphonates for hypercalcemia?
~30d
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What are the SE of NS in hypercalcemia?
- fluid overload (use +/- diuretics)
- decreases K
- decreases Mg
- hyponatremia
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What are the SE of Calcitonin for hypercalcemia?
- tachyphylaxis
- GI upset
- Rash/flushing
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What are the SE of bisphosphonates for hypercalcemia?
- decrease Ca
- increase Phos
- decrease Mg
- increase SCr (not really if you follow dir.)
- Rash
- Fever
- Thrombophlebitis
- Osteonecrosis of the jaw
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