How do I install the Es Hcm Prefer Dmab Over Bp skill?

Run npx skillmds@latest add dromlakhani/es-hcm-prefer-dmab-over-bp in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Es Hcm Prefer Dmab Over Bp free to use?

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Who published Es Hcm Prefer Dmab Over Bp?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Es Hcm Prefer Dmab Over Bp by dromlakhani

Name: Es Hcm Prefer Dmab Over Bp
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Hcm Prefer Dmab Over Bp

This skill suggests using denosumab rather than an intravenous bisphosphonate for adults with hypercalcemia of malignancy. It is triggered when a clinician questions which antiresorptive to choose first or seeks guidance on drug selection for HCM.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Prefer denosumab over intravenous bisphosphonate for HCM

STEP 1 — Gather Information

Confirm hypercalcemia of malignancy (elevated serum calcium with malignancy history). Collect serum calcium, albumin-adjusted calcium, renal function (eGFR, creatinine), vitamin D level, prior antiresorptive exposure, and assess for symptoms severity.

STEP 2 — Rule In / Rule Out

Rule out severe hypercalcemia (albumin-adjusted SCa >14 mg/dL) requiring initial combination therapy with calcitonin plus an antiresorptive. If severe, proceed to combination therapy per Recommendation 3; otherwise continue.

STEP 3 — Classify or Stratify

Assess for refractory/recurrent HCM after prior intravenous bisphosphonate. If refractory/recurrent, denosumab is still preferred per Recommendation 4. If not refractory, proceed to preference decision.

STEP 4 — Decide

Choose denosumab (120 mg subcutaneously) over an intravenous bisphosphonate (e.g., zoledronic acid 4 mg or pamidronate 60–90 mg) as the initial antiresorptive for HCM.

Clinical Guardrails / Mimics / Pitfalls

Monitor serum calcium, phosphorus, magnesium, and renal function before and after denosumab; correct vitamin D deficiency and hypocalcemia prior to dosing. Avoid denosumab in patients with eGFR <30 mL/min without dose adjustment and close calcium monitoring. Do not delay antiresorptive therapy while awaiting oncology consultation; hydration remains first-line. Be aware of rare osteonecrosis of the jaw and atypical femoral fractures with long-term use.

Concrete Clinical Example

A 58-year-old man with metastatic prostate cancer presents with fatigue and nausea; serum calcium 13.0 mg/dL (albumin-adjusted), eGFR 55 mL/min, vitamin D insufficient. He asks which antiresorptive to start. Following the skill, administer denosumab 120 mg subcutaneously, supplement vitamin D, recheck calcium in 48–72 hours, and continue monthly dosing.

Source: Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac621

---name: es-hcm-prefer-dmab-over-bpdescription: This skill suggests using denosumab rather than an intravenous bisphosphonate for adults with hypercalcemia of malignancy. It is triggered when a clinician questions which antiresorptive to choose first or seeks guidance on drug selection for HCM.---# Prefer denosumab over intravenous bisphosphonate for HCM## STEP 1 — Gather InformationConfirm hypercalcemia of malignancy (elevated serum calcium with malignancy history). Collect serum calcium, albumin-adjusted calcium, renal function (eGFR, creatinine), vitamin D level, prior antiresorptive exposure, and assess for symptoms severity.## STEP 2 — Rule In / Rule OutRule out severe hypercalcemia (albumin-adjusted SCa >14 mg/dL) requiring initial combination therapy with calcitonin plus an antiresorptive. If severe, proceed to combination therapy per Recommendation 3; otherwise continue.## STEP 3 — Classify or StratifyAssess for refractory/recurrent HCM after prior intravenous bisphosphonate. If refractory/recurrent, denosumab is still preferred per Recommendation 4. If not refractory, proceed to preference decision.## STEP 4 — DecideChoose denosumab (120 mg subcutaneously) over an intravenous bisphosphonate (e.g., zoledronic acid 4 mg or pamidronate 60–90 mg) as the initial antiresorptive for HCM.## Clinical Guardrails / Mimics / PitfallsMonitor serum calcium, phosphorus, magnesium, and renal function before and after denosumab; correct vitamin D deficiency and hypocalcemia prior to dosing. Avoid denosumab in patients with eGFR <30 mL/min without dose adjustment and close calcium monitoring. Do not delay antiresorptive therapy while awaiting oncology consultation; hydration remains first-line. Be aware of rare osteonecrosis of the jaw and atypical femoral fractures with long-term use.## Concrete Clinical ExampleA 58-year-old man with metastatic prostate cancer presents with fatigue and nausea; serum calcium 13.0 mg/dL (albumin-adjusted), eGFR 55 mL/min, vitamin D insufficient. He asks which antiresorptive to start. Following the skill, administer denosumab 120 mg subcutaneously, supplement vitamin D, recheck calcium in 48–72 hours, and continue monthly dosing.**Source:** Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, DOI: 10.1210/clinem/dgac621

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