Medications for Bone Disorders Flashcards
What are some main functions of calcium?
proper muscle, nerve, bone function
blood coagulation
heart function
What is the therapeutic outcome for calcium supplement
Maintain normal musculoskeletal, neurological, and cardiovascular function in patients with hypocalcemia or a deficiency in the parathyroid hormone.
What should be tried before calcium supplementation, in patients primarily with hypocalcemia occuring from low dietary intake?
increases calcium in the diet (non-pharmacological techniques first)
What does parathyroid hormone do? If calcium is low? If calcium is high?
regulates calcium levels, so if calcium levels are low parathyroid hormone will increase which will increase the breakdown of bone resulting in the increase of serum calcium levels. If levels are low then PTH will decrease which will decrease the breakdown of bone and lower the serum calcium levels.
What are some nursing considerations/adverse effects for calcium supplements?
Hypercalcemia (>10.5 mg/dL) - monitor for weakness, constipation, n/v, lethargy, abdominal pain, arrythmias
Dont give with glucocorticoids and thyroid hormone (decreases absorption) - take them 1 hour apart
monitor calcium levels - 9.0-10.5 mg/dL
monitor for hypocalcemia - chvosteks (hyperexcitability of facial nerve) or trousseaus (hand spasms with hypoperfusion using BP cuff) sign.
IV - warm the solution and give between 0.5 - 2ml/min (slowly)
How far apart should calcium supplements be given from glucocorticoids and thyroid hormone?
1 hour apart (decreases absorption)
How fast should IV calcium supplements be given?
0.5-2.0 ml/min (slowly)
WARM SOLUTION
What is trousseaus sign? What is it used for?
This is where there will be spasms of the hand after perfusion is cut off with BP cuff
used to detect hypocalcemia
What is chvosteks sign? What is it used for?
this is when the the facial nerve is hyperexcitable when something taps it
this is used to detect hypocalcemia
What are some other signs of hypocalcemia? Contrast these with signs of hypercalcemia.
hypo - twitching (tetany), paresthesias, numbness/tingling of periorbital area, muscle cramps
hyper - muscle weakness, constipation, n/v, lethargy, abdominal pain, arrythmias
What is the therapeutic outcome for selective estrogen receptor modulator (agonist/antagonist)?
decreases bone reabsorption; slows down bone loss and preserves mineral density in postmenopausal osteoporosis.
ALSO USED TO PROTECT AGAINST BREAST CANCER
how does selective estrogen receptor modulator act as an agonist/antagonist?
endogenous estrogen in bone - slows the bone loss AGONIST
blocks estrogen receptors in breast and endometrial tissue ANTAGONIST - protects against breast cancer, INCREASES risk for endometrial cancer. (these are not intended effects of medication when used for purpose of bone health)
WE ALSO LOSE SOME CARDIOPROTECTIVE EFFECTS THAT ESTROGEN HAS
What are some adverse effects of SERMs?
DVT/PE
increased risk for endometrial cancer
hot flashes/ mood changes/ night sweats
vaginal discharge (make sure it doesnt appear bloody)
Pregnancy category X
What are some nursing considerations for SERMs?
Monitor for signs of DVT/PE - chest pain, SOA, leg pain, itching, swelling, redness….. REMEMBER THIS!!
monitor for vaginal bleeding (endometrial cancer)
encourage calcium intake (dairy products (and vitamin D), egg yolks) - helps maintain bone density by keeping PTH low which decreases breakdown of bone.
monitor bone density - scan every 12-18 months
What pregnancy category are SERMs?
Category X
What is the therapeutic action of biphosphonates?
inhibits bone reabsorption by decreasing the number and action of osteoclasts (bone breakdown and remodeling cells); used to treat and prevent osteoperosis, hypercalcemia from malignancy (some malignancies increase the breakdown of bone), and pagets disease of bone.
VERY POPULAR CLASS, NOT A LOT OF ADVERSE EFFECTS
What is pagets disease?
this is a disease where there is repeated breakdown and remodeling of bone, which may cause deformities of bone.
What are some adverse effects of biphosphonates?
esophagitis/ esophageal ulceration
abdmoninal pain, n/v
muscluloskeletal pain
risk for hyperparathyroidism - parathyroid stimulation from decrease in serum calcium levels
visual disturbances
What are some nursing considerations for biphosphonates?
esophagitis/ esophageal ulceration - encourage client to sit upright for 30 minutes (decreases reflux risk) and take medication with a full glass of water (ensures medication makes it past esophagus and into stomach) - REMEMBER THIS!!!
musculoskeletal pain - mild analgesic
hyperparathyroidism risk - monitor PTH levels (and calcium levels)
monitor and report visual disturbances, n/v, abdominal pain
monitor serum calcium levels
What are some main patient teaching points for biphosphonates?
take first thing in the morning - 30 minutes before meals and other food (increases absorption)
sit upright or ambulate for 30 minutes after taking medication orally (prevent reflux)
dont eat food or take other medications for 1 hour after taking (ibandronate - increases absorption)
take tablets with at least 8 ounces of water
report difficulty swallowing, or new, painful heartburn (esophagitis, esophageal ulceration
bone density scans every 12-18 months
What pregnancy category are biphosphonates?
C/D
What is the therapeutic action of calcitonin?
inhibits bone reabsorption by decreasing the action of osteoclasts; used to treat osteoperosis and hypercalcemia.
NOT USED OFTEN, HAS BEEN FOUND TO INCREASE RISK FOR CANCER AND ITS EFFICACY IT QUESTIONED
How is calcitonin most commonly given?
nasal spray
What are some adverse effects of calcitonin?
nasal dryness and irritation
hypocalcemia
What are some nursing considerations for calcitonin?
nasal dryness and irritation - use alternate nostrils daily and inspect nasal mucosa for ulceration - STOP IF THERE IS BREAKDOWN
monitor for hypocalcemia - chvosteks sign or trousseaus sign
avoid in patients allergic to fish (made from a salmon product) - perform skin test first!
monitor bone density
encourage high calcium and vitamin D diet
