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INTRODUCTION

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calcitriol (ointment) (kal-si-trye-ole)

Vectical ointment

Classification

Therapeutic: antipsoriatics

Pharmacologic: vitamin D analogues

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Indications
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Mild-to-moderate plaque psoriasis.

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Action
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Exact mechanism is unknown, but may affect keratinocyte proliferation and differentiation and decrease the action of proinflammatory cytokines. Therapeutic Effects: Decreased severity of plaque psoriasis.

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Adverse Reactions/Side Effects
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GU: hypercalcuria. Derm: pruritus, skin discomfort.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess the area being treated to help document whether drug therapy is successful in decreasing skin plaques and other psoriatic skin lesions.

  • Monitor any new or increased reactions at the site of application, including pain, irritation, burning, swelling, and rash. Report severe or prolonged skin reactions to the physician.

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Interventions
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  • Implement ultraviolet light therapy when indicated to help treat psoriasis and augment the effects of drug therapy.

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Patient/Client-Related Instruction
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  • Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.

  • Instruct patient to report signs of excess calcium in the urine (hypercalcuria). Signs include increased urination, painful urination, increased nighttime urination, and increased thirst.

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Pharmacokinetics
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Absorption: Although intended action is skin, some systemic absorption follows topical use.

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Distribution: Unknown.

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Metabolism and Excretion: Absorbed calcitriol undergoes enterohepatic recycling and is excreted in bile.

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Half-life: 5–8 hr.

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TIME/ACTION PROFILE: improvement in psoriatic lesions

ROUTE ONSET PEAK DURATON
topical unknown within 8 wk unknown

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Contraindications/Precautions
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Contraindicated in: No contraindications noted.

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Use Cautiously in: Concurrent use of medications known to ↑ serum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D; Exposure of the treated areas to natural or artificial sunlight, including tanning booths, sun lamps, or phototherapy; use should be limited or avoided; OB: Use during pregnancy only if potential benefit to patient justifies risk to fetus; Lactation: Use cautiously; Pedi: Safety and effectiveness in patients <18 yr has not been established.

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Interactions
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Drug-Drug: Concurrent use with medications known toserum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D may additively ↑ serum calcium levels; use cautiously.

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Route/Dosage
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Topical (Adults 18 yr): Apply twice daily; use should not exceed 200 g/wk.

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Availability
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Ointment: 3 mcg/g in 5- and 100-g tubes.

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