Name /bks_53161_deglins_md_disk/cholecalciferol 03/06/2014 08:10AM pg 1 # 1 hypertension. GI: anorexia, constipation, dry mouth,qliver enzymes, metallic taste, nausea, PANCREATITIS, polydipsia, vomiting, weight loss. GU: albuminuria, azotemia, polyuria. Derm: pruritus. F and E: hypercalcemia. MS: bone pain, muscle pain. 1 cholecalciferol (kol-e-kal-sif-e-role) vitamin D3 (inactive) Classification Therapeutic: vitamins Pharmacologic: fat-soluble vitamins Pregnancy Category C Interactions Drug-Drug: Cholestyramine, colestipol, or mineral oilpabsorption of vitamin D analogues. Use with thiazide diuretics may result in hypercalcemia. Corticosteroidspeffectiveness of vitamin D analogues. Concurrent use of magnesiumcontaining drugs may lead to hypermagnesemia. Calcium-containing drugs mayqrisk of hypercalcemia. Concurrent use of other vitamin D supplements (q risk of hypercalcemia). Drug-Food: Ingestion of foods high in calcium content may lead to hypercalcemia. Indications Treatment or prevention of vitamin D deficiency. Action Requires activation in the liver and kidneys to create the active form of vitamin D3 (calcitriol). Promotes the intestinal absorption of dietary calcium. Therapeutic Effects: Treatment and prevention of deficiency states, particularly bone manifestations. Pharmacokinetics Absorption: Unknown. Distribution: Extensively protein bound. Metabolism and Excretion: Undergoes activation in liver and kidneys to form calcitriol (active form of vitamin D3). Half-life: 14 hr. TIME/ACTION PROFILE (effects on serum calcium) ROUTE ONSET PEAK DURATION PO unknown unknown unknown Contraindications/Precautions Contraindicated in: Hypersensitivity; Hypercalcemia; Vitamin D toxicity; Concurrent use of magnesium-containing antacids or other vitamin D supplements; Malabsorption problems. Use Cautiously in: OB: Safety not established. Adverse Reactions/Side Effects Seen primarily as manifestations of toxicity (hypercalcemia) CNS: headache, irritability, somnolence, weakness. EENT: conjunctivitis, photophobia. CV: arrhythmias, ⫽ Canadian drug name. Plate # 0-Composite ⫽ Genetic Implication. Route/Dosage PO (Adults): 400– 1000 IU daily. PO (Infants): Exclusively or partially breast fed— 400 IU daily. NURSING IMPLICATIONS Assessment ● Assess for symptoms of vitamin deficiency prior to and periodically during ther- apy. ● Assess patient for bone pain and weakness prior to and during therapy. ● Observe patient carefully for evidence of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, and Chvostek’s or Trousseau’s sign). Protect symptomatic patient by raising and padding side rails; keep bed in low position. ● Lab Test Considerations: Monitor serum calcium, phosphorus, and alkaline phosphatase periodically. ● Serum calcium times phosphate product (Ca X P) should no exceed 70 mg2/dL2 (patients may be atqrisk of calcification). ● Toxicity and Overdose: Toxicity is manifested as hypercalcemia, hypercalciuria, and hyperphosphatemia. Assess patient for appearance of nausea, vomiting, anorexia, weakness, constipation, headache, bone pain, and metallic taste. Later symptoms include polyuria, polydipsia, photophobia, rhinorrhea, pruritus, and cardiac arrhythmias. Notify health care professional immediately if these signs of hypervitaminosis D occur. Treatment usually consists of discontinuation of chole- CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued. PDF Page #1 Name /bks_53161_deglins_md_disk/cholecalciferol 03/06/2014 08:10AM Plate # 0-Composite pg 2 # 2 2 PDF Page #2 calciferol, a low-calcium diet, or administration of a laxative. IV hydration and loop diuretics may be ordered to increase urinary excretion of calcium. Hemodialysis may also be used. Potential Nursing Diagnoses Imbalanced nutrition: less than body requirements (Indications) Implementation ● PO: May be administered without regard to meals. Patient/Family Teaching ● Advise patient to take medication as directed. Take missed doses as soon as re● ● ● ● ● ● membered that day, unless almost time for next dose; do not double up on doses. Advise parents to use calibrated measuring device or dropper with oral solution. Review diet modifications with patient. Encourage patient to comply with dietary recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the 4 basic food groups and the importance of sunlight exposure. Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses for treatment of various medical conditions is unproved and may cause side effects. Advise patient to avoid concurrent use of antacids containing magnesium. Review symptoms of overdose and instruct patient to report these promptly to health care professional. Emphasize the importance of follow-up exams to evaluate progress. Evaluation/Desired Outcomes ● Resolution or prevention of vitamin D deficiency. Why was this drug prescribed for your patient? 䉷 2015 F.A. Davis Company