Paricalcitol

INTRODUCTION

Indications

Prevention and treatment of secondary hyperparathyroidism in patients with Stage 3 or 4 (PO) or Stage 5 (IV) chronic kidney disease.

Action

Paricalcitol is a synthetic analogue of calcitriol (the active form of vitamin D₃. Promotes the absorption of calcium and decreases parathyroid hormone concentrations. Therapeutic Effects: Improved calcium and phosphorus homeostasis in patients with chronic kidney disease.

Adverse Reactions/Side Effects

Seen primarily as manifestations of toxicity (hypercalcemia)

CNS: dizziness, headache, somnolence, weakness. EENT: conjunctivitis, photophobia, rhinorrhea. CV: arrhythmias, edema, hypertension, palpitations. GI: anorexia, constipation, diarrhea, dry mouth, liver function test elevation, metallic taste, nausea, PANCREATITIS, polydipsia, vomiting, weight loss. GU: albuminuria, azotemia, decreased libido. Derm: pruritus, rash. Endo: gout. F and E: hypercalcemia. Metab: hyperthermia. MS: bone pain, metastatic calcification, muscle pain.

PHYSICAL THERAPY IMPLICATIONS^*

Examination and Evaluation

• Be alert for signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, oily stools. Report these signs to the physician or nursing staff immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any muscle or bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems. Request additional tests for suspicious bone pain that may indicate metastatic calcification.

• Monitor signs of electrolyte imbalances such as high calcium levels (hypercalcemia). Neuromuscular signs include muscle pain and weakness, joint pain, confusion, and lethargy. Notify physician because severe cases can lead to life-threatening arrhythmias and paralysis.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Because of the risk of arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• 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 ...