Bisphosphonates Flashcards
bisphosphonates pt. counseling
- all except Atelvia: take on an EMPTY stomach 30mins before breakfast
- Atelvia: take immediately after breakfast
- take with a full glass of water to minimize esophageal burning
- stay upright for 30mins after taking
bisphosphonates
Didronel Skelid Actonel Atelvia Fosamax Fosamax Plus D Boniva Reclast
osteoporosis
a decrease in bone density caused by bone resorption
resorption
loss of a substance
bone resorption
calcium moves from the bone into the blood and the bone becomes weaker
osteoblasts
cells that build bone
osteoclasts
cells responsible for bone resorption
cause of osteoporosis
osteoclasts always function, but osteoblast function decreases with age
bisphosphonate indications
osteoporosis
Paget’s Disease of the Bone
corticosteroid induced osteoporosis
Paget’s Disease of the Bone
- a.k.a. osteitis deformans
- episodes of time with increased bone resorption followed by excessive attempts at repair; repaired bone is weak
- affects longer bones e.g. arms and legs
- usually occurs in people over 50
corticosteroid induced osteoporosis
- occurs in pts. taking more than 7.5mg of prednisone daily
- corticosteroids decrease osteoblast function and increase osteoclast function when taken long-term
bisphosphonate MOA
work by becoming part of the bone structure making it resistant to resorption so calcium stays in the bone
Didronel
etidronate
-bisphosphonate
Skelid
tiludronate
-bisphosphonate
Actonel
risedronate
- bisphosphonate
- 35mg qweek or 150mg qmonth immediate-release tablets
Atelvia
risedronate
- bisphosphonate
- 35mg enteric-coated tablet qweek
Fosamax
alendronate 70mg (qweek) -bisphosphonate
Fosamax Plus D
alendronate, cholecalciferol
- bisphosphonate
- 70mg alendronate with either 70mcg or 140mcg cholecalciferol (4tabs/pk)(qweek)
cholecalciferol
vitamin D
- 70mcg=2800 units
- 140mcg=5600 units
- necessary for calcium absorption, if deficient you have increased osteoclast production
- also need weight-bearing exercise
vitamin D requirements
- pts. under 70yo need 600units/day
- pts. over 70yo need 800units/day
calcium requirements
- women under 50yo and men under 70yo need 1,000mg/day
- women over 50yo and men over 70yo need 1,200mg/day
Boniva
ibandronate
- bisphosphonate
- 150mg tablet (qmonth)
- parenteral IV (every 3 months)
Reclast
zoledronic acid
- bisphosphonate
- parenteral IV (qyear)
Forteo
teriparatide
- parathyroid hormone analog
- subQ injection (qdaily)
- ind. for osteoporosis
- stimulates osteoblast production and bone formation
- refrigerate always*
Prolia
denosumab
- monoclonal antibody
- subQ injection (every 6 months)
- ind. for osteoporosis in pts. with a high risk of fractures (not a first-line drug)
- decreases bone resorption
PTH
parathyroid hormone
