Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (76 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(
PO-OTC
)
AcidFree, Alka-Mints, Amitone, Apo-Cal
, Calcarb, Calci-Chew, Calci-Mix, Calcite, Cal-Gest, Caltrate, Equaline Calcium, Leader Calcium, Maalox Antacid, Os-Cal 500, Rolaids Extra Strength Softchew, Tums, Tums E-X, Walgreens Calcium
OTC
)
(kal′see-um ass′e-tate)
Calphron, Eliphos, PhosLo
Func. class.:
Antacid, calcium supplement
Chem. class.:
Calcium product
Do not confuse:
Os-Cal
/Asacol
Neutralizes gastric acidity
Antacid, calcium supplement; not suitable for chronic therapy, hyperphosphatemia, hypertension during pregnancy, osteoporosis, prevention, treatment of hypocalcemia, hypoparathyroidism
Unlabeled uses:
Duodenal ulcer, PMS, stress gastritis
Hypersensitivity, hypercalcemia, hyperparathyroidism, bone tumors
Precautions:
Pregnancy (C), breastfeeding, geriatric patients, fluid restriction, decreased GI motility, GI obstruction, dehydration, renal disease
Calculator
• Adult ≥51 yr:
PO
1000-1500 mg/day elemental calcium (2500-3750 mg/day calcium carbonate)
• Adult 19-50 yr:
PO
1000 mg/day elemental calcium (2500 mg/day calcium carbonate)
• Adult:
PO
2-4 g/day elemental calcium (5-10 g/day calcium carbonate) in 3-4 divided doses
• Child:
PO
45-65 mg/kg/day elemental calcium (112.5-162.5 mg/kg/day calcium carbonate) in 4 divided doses
• Neonate:
PO
50-150 mg/kg/day elemental calcium (125-375 mg/kg/day in 4-6 divided doses, max 1 g/day)
• Adolescent and child 9-18 yr:
PO
1300 mg elemental calcium (3250 mg calcium carbonate)
• Child 4-8 yr:
PO
800 mg/day elemental calcium (2000 mg/day calcium carbonate)
• Child 1-3 yr:
PO
500 mg/day elemental calcium (1250 mg/day calcium carbonate)
• Infant 6-12 mo:
PO
270 mg/day elemental calcium based on total intake
• Neonates and infants <6 mo:
PO
210 mg/day elemental calcium based on total intake
• Adult:
PO
Individualized on response
• Adult:
PO
1-2 tabs q2hr, max 9 tabs/24 hr (Alka-mints); chew 2-4 tab q1hr prn, max 16 tabs (Tums regular strength); chew 2-4 tab q1hr prn, max 10 tabs (Tums E-X); chew 2-3 tabs q1hr prn, max 10 tabs/24 hr (Tums Ultra); chew 2 tabs q2-3hr, max 19 tabs/24 hr (Titralac Extra Strength)
• Adult:
PO
80-140 mEq q1-3hr
• Adult:
PO
(Tums EX, Tums Calcium for Life PMS) Chew 2 tabs bid
Available forms:
Calcium carbonate:
chewable tabs 350, 420, 450, 500, 750, 1000, 1250 mg; tabs 500, 600, 650, 667, 1000, 1250, 1500 mg; gum 300, 450, 500 mg; susp 1250 mg/5 ml; caps 1250 mg; powder 6.5 g/packet;
calcium acetate:
tabs 250 mg (65 mg Ca), 667 mg (169 mg Ca), 668 mg (169 mg Ca), 1 g (250 mg Ca); caps 500 mg (125 mg Ca)
•
Do not give enteric-coated within 1 hr of calcium carbonate
•
For ulcer treatment (adjunct): give 1 and 3 hr after meals and at bedtime
•
For a phosphate binder: give 1 hr after each meal or snack and at bedtime
•
For supplement: give 1-1½ hr after meals; avoid oxalic acid foods (spinach, rhubarb), phytic acid (brans, cereals) or phosphorus (milk, dairy), may decrease calcium absorption
•
Suspension: shake well, use calibrated measuring device
•
Laxatives or stool softeners if constipation occurs
GI:
Constipation
, anorexia, nausea, vomiting, flatulence, diarrhea, rebound hyperacidity, eructation
GU:
Calculi, hypercalciuria
1/3 of dose absorbed by small intestine, onset 20 min, duration 20-180 min, excreted in feces and urine, crosses placenta, must have adequate vit D for absorption
Increase:
digoxin toxicity—hypercalcemia
Increase:
plasma levels of quiNIDine, amphetamines
Increase:
hypercalcemia—thiazide diuretics
Decrease:
levels of salicylates, calcium channel blockers, ketoconazole, iron salts, tetracyclines, fluoroquinolones, phenytoin, etidronate, risedronate, atenolol
False increase:
chloride
False positive:
benzodiazepines
False decrease:
magnesium, oxylate, lipase
•
Calcium (serum, urine), calcium should be 8.5-10.5 mg/dl, urine calcium should be 150 mg/day, monitor weekly; serum phosphate
Milk-alkali syndrome:
nausea, vomiting, disorientation, headache
•
Constipation; increase bulk in the diet if needed
•
Hypercalcemia:
headache, nausea, vomiting, confusion; hypocalcemia: paresthesia, twitching colic, dysrhythmias, Chvostek’s sign, Trousseau’s sign
•
Those taking digoxin for toxicity
•
Antacid—for abdominal pain, heartburn, indigestion before, after administration
•
Therapeutic response: absence of pain, decreased acidity; decreased hyperphosphatemia with renal failure
•
To increase fluids to 2 L unless contraindicated; to add bulk to diet for consti
pation; to notify prescriber of constipation
•
Not to switch antacids unless directed by prescriber; not to use as antacid for >2 wk without approval by prescriber
•
That therapeutic dose recommendations are figured as elemental calcium
•
To avoid excessive use of alcohol, caffeine, tobacco
•
To avoid spinach, cereals, dairy products in large amounts
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert