ATI Pharm Medications for Bone Disorders Ch 34 (Exam 2)

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calcium supplements Prototypes:
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calcium citrate (Citracal) calcium chloride or calcium gluconate (iv)
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alcium citrate (Citracal) calcium chloride or calcium gluconate Therapeutic outcome
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maintain normal musculoskeletal, neurological, and cardiovascular function; hypocalcemia or deficiencies in the parathyroid hormone
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Ca supplement for intravenous infusion (very low levels)
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calcium chloride or calcium gluconate
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Adverse Effects: calcium citrate (Citracal) calcium chloride or calcium gluconate
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Hypercalcemia (10.5 mg/dL) – monitor for muscle weakness, constipation, N/V, lethargy, abdominal pain, arrhythmias Monitor for hypocalcemia – Chvostek’s (hyperexcitability of facial nerve) or Trousseau’s sign (hand spasms with hypoperfusion)
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Nursing Considerations calcium citrate (Citracal calcium chloride or calcium gluconate
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Don’t give with glucocorticoids and thyroid hormone (decreases absorption)- take 1 hour apart Monitor levels – normal 9.0-10.5 mg/dL Intravenous – warm solution and give between 0.5 – 2 mL/min (slowly)
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Selective Estrogen Receptor Modulator (SERM)(Agonist/Antagonist) Prototype:
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raloxifene (Evista)
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raloxifene (Evista) Therapeutic outcome
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decreases bone reabsorption; slows down bone loss and preserves mineral density in postmenopausal osteoporosis Also used to protect again breast cancer
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raloxifene (Evista) Adverse Effects:
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PE/DVT – monitor for symptoms – chest pain, shortness of breath, leg pain, itching, swelling, redness Increased risk of endometrial cancer – monitor for vaginal bleeding Hot flashes/mood changes/night sweats Vaginal discharge Pregnancy Category X
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raloxifene (Evista) Nursing Considerations
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Monitor bone density – scan every 12-18 months Encourage calcium intake (dairy products (and vitamin D) egg yolks Adverse effects hot flashes, swelling or redness in calf, (DVT), shortness of breath (Pulmonary embolism)
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Biphosphonates – Osteoporosis: Prototypes:
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alendronate sodium (Fosamax) ibandronate (Boniva)
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alendronate sodium (Fosamax) ibandronate (Boniva) Adverse Effects
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Abdominal pain, N/V Musculoskeletal pain – mild analgesic Risk for hyperparathyroidism – parathyroid stimulation from a decrease in calcium levels = monitor PTH levels Visual disturbances – monitor and report
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alendronate sodium (Fosamax) ibandronate (Boniva) Nursing Considerations
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Esophagitis, esophageal ulceration – encourage client to sit upright for 30 minutes and take with full glass of water Take first thing in the morning Monitor calcium levels
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alendronate sodium (Fosamax) ibandronate (Boniva) Patient Teaching
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-Take first thing in the morning – 30 minutes before meals and other food -Sit upright or ambulate for 30 minutes after taking this medication orally. -Take tablets with at least 8 oz of water -Pregnancy Cat C/D -Report difficulty swallowing, painful swallowing, or new, painful heartburn -Bone density scans every 12-18 months
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ibandronate (Boniva) Patient Teaching
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Don’t eat food or other medications for 1 hr after
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Calcitonin Prototype:
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calcitonin-salmon (Fortical)
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calcitonin-salmon (Fortical) Therapeutic response
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– inhibits bone reabsorption by decreasing action of osteoclasts; treat osteoporosis and hypercalcemia
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calcitonin-salmon (Fortical) most common route
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Most commonly given as a nasal spray.
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Current recommendations calcitonin-salmon (Fortical)
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limit its usage (risk of cancer)
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calcitonin-salmon (Fortical) Adverse effects
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-Nasal dryness and irritation – alternate nostrils daily, inspect nasal mucosa for ulceration -Monitor for hypocalcemia – Chvostek’s (hyperexcitability of facial nerve) or Trousseau’s sign (hand spasms with hypoperfusion)
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calcitonin-salmon (Fortical) Nursing Considerations Skin test must be done before starting this medication to check for allergies
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-Avoid in patients allergic to fish – perform skin test first! -Monitor bone density -Encourage clients to consume a diet high in calcium and vitamin D
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Nursing Considerations/Adverse Effects: calcium citrate (Citracal) calcium chloride or calcium gluconate
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