Question

The client with hypoparathyroidism is admitted with a calcium level of \(7.6 \mathrm{mg} / \mathrm{dL}\). The nurse should anticipate an order for which of the following medications? A. Furosemide (Lasix) B. Levothyroxin (Synthyroid) C. PTH (Forteo) D. Propanolol (inderal)

Short answer

Answer: C. PTH (Forteo)

Step-by-step solution

Understand hypoparathyroidism

Hypoparathyroidism is a condition characterized by decreased parathyroid hormone production. As PTH is responsible for regulating calcium levels in the blood, low PTH production results in low calcium levels, which can manifest as muscle cramps, seizures, and other issues.

Evaluate medication options

The next step is to understand the given medication options and their effects on the body: A. Furosemide (Lasix) - a diuretic that removes excess fluid from the body, causing decreased blood calcium levels. B. Levothyroxine (Synthroid) - a thyroid hormone replacement drug, not helpful in regulating calcium levels. C. PTH (Forteo) - a synthetic hormone that helps regulate calcium levels by increasing its levels in blood. D. Propanolol (Inderal) - a beta-blocker that is used for treating high blood pressure and heart-related issues, not helpful in regulating calcium levels.

Identify the appropriate medication

Keeping hypoparathyroidism and the medication options in mind, the appropriate medication for a client with low calcium levels due to hypoparathyroidism should be the one that helps in regulating or raising blood calcium levels. In this case, the suitable medication would be: C. PTH (Forteo) - it is a synthetic hormone that aids in regulating calcium levels, which would be helpful for a client with hypoparathyroidism and low blood calcium levels.

Key concepts

Hypoparathyroidism Treatment

When it comes to hypoparathyroidism, a condition where decreased production of the parathyroid hormone (PTH) leads to low levels of calcium in the blood, the treatment goals focus on normalizing these levels.

Calcium supplements and vitamin D analogs are usually the cornerstone of managing hypoparathyroidism. These help increase the amount of calcium in the blood and also make it easier for the body to absorb calcium from food. Sometimes, diet modifications are recommended to increase calcium intake through nutrition.

In addition to oral supplements, a healthcare provider may prescribe PTH injections, such as recombinant human parathyroid hormone (rhPTH), to replace the missing hormone and further assist in maintaining calcium-phosphorus metabolism.

Close monitoring is essential to avoid hypercalcemia, a condition where the calcium levels become too high, which can be just as dangerous as hypocalcemia, the low calcium condition associated with hypoparathyroidism.

Calcium Level Management

Effective management of calcium levels in patients with hypoparathyroidism is crucial to minimize symptoms and prevent complications. This involves a delicate balance, as both high and low calcium levels can have serious health implications.

Generally, treatment targets maintaining calcium levels in the low-normal range to avoid kidney problems while reducing symptoms of hypocalcemia. This is achieved through administration of calcium supplements, often taken multiple times throughout the day to ensure a steady supply, and active forms of vitamin D, such as calcitriol, which enhance calcium absorption from the gut and retention by the kidneys.

Monitoring and Adjustment

Frequent blood tests are required to monitor the levels of calcium and related minerals, and dosages of supplements might need to be adjusted based on these results. Additionally, patients are often advised to recognize the signs of low or high calcium for immediate intervention to adjust their treatment as needed.

Parathyroid Hormone Replacement

Parathyroid hormone replacement is a treatment option designed to replicate the function of natural PTH in patients with hypoparathyroidism.

The synthetic version, known as recombinant human PTH or rhPTH (like Forteo), handles multiple functions, such as: facilitating the absorption of calcium from the foods we eat, prompting the release of calcium from bones, and regulating the excretion of calcium by the kidneys.

Administration

Typically administered via injection, PTH replacement requires a careful dosing schedule to mimic the natural pulsatile release of the hormone. This helps avoid potential side effects, like an increased risk of osteosarcoma seen in rats, though this hasn't been proven in humans.

Long-term Benefits and Considerations

Over the long term, PTH replacement can potentially offer better quality of life and decrease in complications. However, because this is a relatively newer treatment modality, long-term studies are still assessing its comprehensive benefits and risks.