NCLEX Pharmacology Question: Calcitonin and Osteoporosis

This is a pharmacology NCLEX practice question on Calcitonin used to treat osteoporosis. This question provides a scenario about a patient taking Calcitonin for the treatment of osteoporosis, and you must determine which of the following options may represent an adverse side effect caused by this medication.

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NCLEX Pharmacology Question on Calcitonin for the Treatment for Osteoporosis

Your patient, who has osteoporosis, is prescribed to take Calcitonin. Which assessment finding below is a possible adverse reaction of this medication and requires you notify the physician immediately?

A. Constipation

B. Abdominal pain that is found a one-third distance between the belly button and anterior superior iliac spine.

C. Carpopedal spasm while assessing the patient’s blood pressure

D. Absent reflexes

To answer this question, we have to think back to how Calcitonin works to treat osteoporosis.

First, what is osteoporosis? It’s a disease process that thins the bones to a point that the bones are not strong enough to withstand everyday stress and it breaks/fractures.

Therefore, what happens is that the spongy bone matrix starts to become MORE porous (remember it is already naturally porous), which decreases the bone’s density.

How does this happen? Residing inside the spongy bone matrix are osteoCLASTS and osteoBLASTS. These cells either build-up or break down the matrix inside the spongy bone.

OsteoCLASTS: Consumes the bone matrix by taking the calcium inside the bone matrix and puts it back into the blood (helps maintain our electrolyte balance of calcium).

OsteoBLASTS: Build-up the bone matrix by taking the calcium in the blood and creates new bone matrix.

What is Calcitonin? It’s a hormone released by the thyroid gland that plays a role in bone health (it is prescribed in an inhaled form, which is from salmon).

How does Calcitonin work? When calcium levels are too high, the thyroid gland secretes calcitonin to decrease the activity of the osteoclasts and causes the kidneys to excrete more calcium. By decreasing the activity of the osteoclasts, the osteoblasts, in a sense, outwork the osteoclasts by building up the bones faster than they are being broken down. Hence, stronger bones!

Now ask yourself…..if our osteoCLASTS are dramatically decreased in their activity of consuming bone matrix (less calcium entering our blood) and the kidneys are starting to waste more calcium in the urine….what is going to happen to our blood levels of calcium??? They’re going to DECREASE!

So, the patient is at risk for HYPOcalcemia while taking Calcitonin and the nurse should monitor the patient for the signs and symptoms.

Therefore, when analyzing the options you must look for an option that presents in HYPOcalcemia.

Now let’s eliminate our options:

A. Constipation: ELIMINATED– this is found in HYPERcalcemia because the GI system starts to slow down and the stool stays longer in the system. This causes the stool to become hard and difficult to pass.

B. Abdominal pain that is found a one-third distance between the belly button and anterior superior iliac spine. : ELIMINATED- this is found in appendicitis and is known as McBurney’s Point. This is not found as an adverse effect with Calcitonin. If this was a GI question, yes this would be the answer (watch out for those distractor options).

C. Carpopedal spasm while assessing the patient’s blood pressure: CORRECT! – This is describing Trousseau’s Sign. It occurs in HYPOcalcemia and is found when there is occlusion on the upper arm’s brachial artery. It can be elicited with a blood pressure cuff or tourniquet. The wrist will start to INVOLUNTARY flex, thumb will adduct, and the fingers will extend. The patient may complain of tingling and is unable to correct this involuntary action.

D. Absent reflexes: ELIMINATED– Absent reflexes can be found in HYPERcalcemia. Reflexes in HYPOcalcemia will be hyperactive, not absent.

Answer to this question is C.

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