Calcitonin

INTRODUCTION

Indications

IM, SC: Treatment of Paget's disease of bone. Adjunctive therapy for hypercalcemia. IM, SC, Intranasal: Management of postmenopausal osteoporosis.

Action

Inhibits osteoclastic bone resorption and promotes renal excretion of calcium. Therapeutic Effects: Decreased rate of bone turnover. Lowering of serum calcium.

Adverse Reactions/Side Effects

CNS: nasal only—headaches. EENT: nasal only—rhinitis, epistaxis, nasal irritation. GI: IM, SC: nausea, vomiting. GU: IM, SC: urinary frequency. Derm: rashes. Local: injection site reactions. MS: nasal—arthralgia, back pain. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, facial flushing, swelling.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Be alert for signs of hypocalcemic tetany, especially during the first several doses of calcitonin. Signs include nervousness, irritability, paresthesia, muscle twitching, tetanic spasms, and seizures. Report these signs to the physician immediately.

• Assess bone pain periodically to document whether drug therapy can help reduce symptoms of Paget's disease.

• Assess any new episodes of joint pain or back pain, especially during intranasal use. Attempt to determine if pain is drug related rather than caused by musculoskeletal lesions.

• Monitor IM or SC injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Institute weight-bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low-impact or aquatic programs in patients with extensive demineralization or preexisting lesions, and increase exercise intensity slowly to prevent fractures.

• Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.), and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

• Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage at the injection site; these interventions can alter drug absorption from subcutaneous tissues.

Patient/Client-Related Instruction

• Advise patient about the benefits of proper diet in sustaining bone mineralization and plasma calcium levels. If necessary, refer patient for nutritional counseling about supplemental calcium and vitamin D.

• Encourage patient to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).

• Instruct patient to report problems related to intranasal administration, including severe or prolonged headache, nasal irritation, or nosebleeds.

• Instruct patient to report other troublesome side effects, including facial swelling/flushing, urinary frequency, skin rash, or GI problems (nausea, vomiting).

Pharmacokinetics

Absorption: Completely absorbed ...