Module 5 meds Flashcards
Biphosphonates
Inhibit osteoclasts, causing decreased bone loss and increased bone mass
Key Nursing Considerations:
Adequate calcium and vitamin D intake is needed to assure maximum effect; however, these supplements should not be taken at the same time as the bisphosphonates
Side effects include gastrointestinal symptoms, including dyspepsia, nausea, flatulence, diarrhea, and constipation
Adverse effects may include esophageal or gastric ulcers, osteonecrosis of the jaw, and atypical femur fractures; these effects may be mitigated by instituting a 1–2 yr drug-free holiday in patients with mild osteoporosis after 4–5 yrs of treatment, and in patients with higher fracture risk after 10 yrs of treatment
(biphosphonates)
Alendronate
Risedronate
-treatment of osteoporosis in women who are postmenopausal
-treatment of osteoporosis in men, and in women and men taking corticosteroids
Key Nursing Considerations:
Administer PO, either daily or weekly
Advise patient to take in AM on empty stomach with 250 mL of water while sitting upright and to remain upright for at least 30 min
Effects of alendronate may be diminished in older adult patients who take proton pump inhibitors
(biphosphonates)
Ibandronate
treatment of osteoporosis in women who are postmenopausal
IV dosing may be good option for patients either intolerant of PO bisphosphonates or nonadherent to prescribed therapy
reatment of osteoporosis in women who are postmenopausal
IV dosing may be good option for patients either intolerant of PO bisphosphonates or nonadherent to prescribed therapy
(biphosphonates)
Zoledronic acid
Treatment of osteoporosis in women who are postmenopausal
*Treatment of osteoporosis in men and in both men and women taking corticosteroids for at least 12 mo
Administer IV once yearly for osteoporosis treatment or once every 2 yrs for osteoporosis prevention
This is the most potent bisphosphonate and is associated with acute kidney injury; therefore it is contraindicated in patients with creatinine clearances less than 35 mL/min or in patients with chronic kidney disease
(Estrogen Agonist/Antagonist (formerly called selective estrogen receptor modulator [SERM])
Raloxifene
Promotes estrogenic effects on bone, preserving BMD, with concomitant antiestrogenic effects on the uterus and breasts
*Prevention and treatment of osteoporosis in women who are postmenopausal, particularly those with breast cancer
*May also reduce the risk of breast cancer in patients at risk
Administer PO once daily. May be given in tandem with calcium and vitamin D
Side effects include hot flashes and leg cramps
Adverse effects include VTE formation
(RANKL Inhibitor)
Denosumab
Monoclonal antibody that increases BMD and reduces the porosity of cortical bone by inhibiting the effects of TNF on osteoclasts, inhibiting their activity
*Treatment of osteoporosis in men and women who are postmenopausal at high risk of fracture; also indicated for women with osteoporosis and breast cancer receiving aromatase inhibitors and for men with osteoporosis and prostate cancer receiving gonadotropin-reducing hormones
Given once every 6 mo SQ
Side effects include skin rashes
Adverse effects include hypocalcemia, cellulitis, osteonecrosis of the jaw, and atypical femur fracture
Note: when treatment with denosumab is stopped, loss of BMD can be rapid; other drugs should be started to mitigate this response
(PTH Analogue)
Teriparatide
Synthetic parathyroid hormone which increases bone strength and density
*Treatment of osteoporosis in men and women who are postmenopausal at high risk of fracture
Must be refrigerated
Daily self-administered SQ injections for up to 2 yrs
