alendronate (Fosamax) – Flashcards

bone-resorption inhibitor; bisphosphonate (chemical class)

decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone; inhibits osteoclast activity (decrease number and action of osteoclasts)

treatment and prevention of osteoporosis in postmenopausal women, treatment of osteoporosis in men, Paget's disease, treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving estrogen and in men who are on continuing corticosteroid treatment with low bone mass

CNS: headache GI: abdominal pain, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia, ESOPHAGEAL PERFORATION, diarrhea, ESOPHAGEAL CANCER - eye pain and vision changes META: Hypophosphatemia, hypocalcemia MS: Bone pain, osteonecrosis of the jaw, bone fractures SYST: ANGIOEDEMA, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

Hypersensitivity to bisphosphonates, delayed esophageal emptying, inability to sit or stand for 30 minutes, hypocalcemia, renal insufficiency Precautions: - pregnancy, breastfeeding, children, CCr < 35 ml/min, esophageal disease, ulcers, gastritis, poor dental health, increased esophageal cancer risk

increase: GI adverse reactions - NSAIDs, salicylates, H2 blockers, proton pump inhibitors, gastric mucosal agents decrease: absorption - antacids, calcium supplements, aminoglycosides DRUG/FOOD: - decrease: absorption when used with caffiene, orange juice, food DRUG/LAB: - decrease: calcium, phosphate

PO

ASSESS FOR: - SERIOUS REACTIONS: ANGIOEDEMA, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, ATRIAL FIBRILLATION - hormonal status in women, before treatment - for osteoporosis: bone density test before and during treatment - for Paget's disease: increased skull size, bone pain, headache, decreased vision, hearing - Electrolytes, BUN/creatinine; calcium, phosphorous, magnesium, potassium - For hypercalcemia: paresthesia, twitching, laryngospasm, Chvostek's, Trousseau's signs - Alk phos levels, baseline and periodically, 2 x upper limit of normal is indicative of Paget's disease - dental status: regular dental exams should be performed; dental extractions (cover with antiinfectives before procedure)

teach client to: - remain upright for 30 minutes after dose to prevent esophageal irritation; if dose is missed, skip dose, do not double doses or take later in day; to take in AM before food, other meds; to take with 6-8 oz of water only (no mineral water). - *dont eat or drink anything other than water 30 minutes after taking the drug - to take calcium, vitamin D if instructed by healthcare provider - to perform weight-bearing exercise to increase bone density - to let health-care provider know if pregnant or if pregnancy is planned or if breastfeeding; to inform dentist of the use of this product - to maintain good oral hygiene

- therapeutic response: increased bone mass, absence of fractures