bone resorption inhibitors – Flashcards
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what are bone resorption inhibitors?
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drugs that inhibit osteoclast activity used a lot for osteoporosis bc they prevent the breakdown of bone
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2 classifications
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biphosphonates miscell.
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biphosphonates ex
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alendronate ibandronate risedronate
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miscellaneous ex
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denosumab raloxifene
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biphosphonates indications
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postmenopausal osteoporosis corticosteroid induced osteoporosis paget's disease
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biphosphonates contraindications
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esophageal probs inability to stand/sit up straight for 30 min renal failure hypocalcemia pregnant - cat c
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paget's disease
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rapid osteoclast activity (breakdown of bone) followed by rapid osteoblast activity (new bone forming) causes lots of skeletal deformities highly vascularized with new bone - may be tender, warm, painful
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hallmark of paget's disease
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pt stating my hat doesn't fit anymore skull affected
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alendronate indications
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postmenopausal osteoporosis corticosteroid induced osteoporosis pagets disease
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alendronate rout
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PO
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alendronate SE
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musculokeletal and abd pain (affecting bones) diarrhea N HA dyspepsia/esophageal ulcers osteonecrosis (rare, jaw becomes necrotic)
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all biphosphonates cause musculoskeletal
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and abdominal pain, diarrhea, dyspepsia/esophageal ulcers, and possibly osteonecrosis
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different SE for alendronate
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N and HA
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risedronate indications
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postmenopausal osteoporosis corticosteroid induced osteoporosis paget's disease
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risedronate route
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po
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risedronate SE
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musculoskeletal and abd pain diarrhea rash arthralgia dyspepsia/esophageal ulcers osteonecrosis
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PPI's and H2 antagonists cause
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Risedronate to release faster (increased drug level - toxicity)
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risedronate different Se
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rash and arthralgia
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ibandronate indications
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postmenopausal osteoporosis
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ibandronate route
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po and iv
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ibandronate SE
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musculoskeletal and abd pain diarrhea arm and leg pain anaphylaxis (IV) dyspepsia/esophageal ulcers osteonecrosis IV - acute renal failure PO - esophageal ulcer
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with IV admin, monitor for anaphylaxis with
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ibandronate
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ibandronate admin
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take in morning 60 min before food and other meds and and sit upright for 60 min after taking
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milk can decrease absorption
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of ibandronate
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different SE for ibandronate
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arm/leg pain anaphylaxis
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nursing implications and education for all biphosphonates... interactions
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calcium supplements, antacids, and other meds decrease absorption food, caffeine, and OJ decrease absorption NSAIDS increase gi SE's
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nursing implications and education for all biphosphonates... implications
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monitor bone density and calcium before and during tx
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nursing implications and education for all biphosphonates... education
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take in morning 30 min before food and other meds take with water only sit upright 30 min after - promotes drug going down esophagus exercise, calcium, and vit D to promote strong bones notify MD of new/worse heartburn (esophageal ulcer), pregnancy, and dental surgery
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risedronate... PPI's and h2 antagonists
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can cause this med to release faster (increased drug level = toxicity)
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ibandronate.... specific to this med
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take in morning 60 min before food/other meds and sit upright 60 min after milk can decrease absorption IV admin monitor for anaphylaxis
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dental sx
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could cause osteonecrosis
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heart burn
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could indicate esophageal ulcer
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pregnancy
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cat c drug need to get off of
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alendronate pic
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take on empty stomach with plenty of water. dont lie down or eat for 30 min watch for hypocalcemia , vomitting, constipation, and abd pain your days of breaking down bones are numbered. ill be interferring with your medicated bone reabsorption while helping the bone increase its calcium uptake by interferring with osteoclast activity
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miscellaneous category ex
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denosumab and raloxifene
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mis. indications
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postmenopausal osteoporosis
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denosumab contra
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renal failure hypocalcemia pregnant cat x
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raloxifene contra
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hx of thrombolytic events, stroke, afib pregnant cat x
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denosumab info
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monoclonal antibody also known to increase bone mass in women receiving adjuvant therapy for breast cancer (anastrozole) - this med blocks estrogen production in postmenopausal women
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raloxifene info
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selective estrogen receptor modulator - has estrogen like effects also known to decrease risk of breast cancer
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denosumab route
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subcut (arm, thigh, abd)
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denosumab SE's
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musculoskeletal or back pain cystitis (inflammation of the bladder) hypocalcemia, hypophosphatemia dyspepsia *serious = pancreatitis, anaphylaxis, osteonecrosis
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interactions denosumab
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immunosuppressants increase risk of infection no steroids
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denosumab considerations
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monitor bone density, calcium, and for anaphylaxis
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denosumab education
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exercise daily, calcium and vit d adequate intake notify MD of possible pregnancy- need highly effective contraception during and 5 months after therapy notify MD of spasms/twitches (hypocalcemia) or dental sx do not handle grey need cap on prepacking syringe if latex allergy let solution warm in room temp for 15-30 min - do not warm any other way it is refrigerated. it can affect particles
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raloxifene route
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po
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raloxifene SE's
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leg cramps and hot flashes *serious = stroke, thromboembolism
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raloxifene interactions
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cholestyramine (cholesterol med) decreases absorption can alter effects of warfarin (makes blood thicker, lowers INR)
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raloxifene considerations
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monitor bone density, calcium, and cholesterol
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raloxifene education
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can be taken without regard to meals exercise, calcium, vit D discontinue 72 hrs prior to sx and during recovery avoid prolonged sitting or travel - increase risk of clots notify MD of possible pregnancy... or leg pain/warmth/sudden chest pain/or SOB
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discontinue raloxifene
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72 hrs prior to and after sx and avoid prolonged travel bc of increased risk of clots
