Podcast
Questions and Answers
What is the recommended time frame for taking bisphosphonates in relation to food and beverages?
What is the recommended time frame for taking bisphosphonates in relation to food and beverages?
- At least 30 minutes before the first morning beverage (correct)
- Immediately after eating a meal
- At least 1 hour after the first morning beverage
- With the first morning meal
Why is it important for patients to remain upright after taking bisphosphonates?
Why is it important for patients to remain upright after taking bisphosphonates?
- To promote bone growth
- To prevent esophageal and GI adverse effects (correct)
- To reduce the risk of osteoporosis
- To increase the absorption of the medication
What instruction should be given to patients taking bisphosphonates regarding esophageal abnormalities?
What instruction should be given to patients taking bisphosphonates regarding esophageal abnormalities?
- They should report esophageal abnormalities to the prescriber immediately (correct)
- They should stop taking the medication if they experience esophageal abnormalities
- They can ignore esophageal abnormalities
- Esophageal abnormalities are not a concern
What is the recommended amount of water to take with bisphosphonates?
What is the recommended amount of water to take with bisphosphonates?
What should patients do if they experience esophageal irritation, dysphagia, severe heartburn, or retrosternal pain while taking bisphosphonates?
What should patients do if they experience esophageal irritation, dysphagia, severe heartburn, or retrosternal pain while taking bisphosphonates?
Why should patients be monitored while taking bisphosphonates?
Why should patients be monitored while taking bisphosphonates?
What instruction should be given to patients taking SERMs regarding prolonged immobility?
What instruction should be given to patients taking SERMs regarding prolonged immobility?
What is the primary concern when taking bisphosphonates?
What is the primary concern when taking bisphosphonates?
How should patients take bisphosphonates according to the nursing implications?
How should patients take bisphosphonates according to the nursing implications?
What should the nurse emphasize to patients taking bisphosphonates?
What should the nurse emphasize to patients taking bisphosphonates?
Which of the following medications is classified as a bisphosphonate?
Which of the following medications is classified as a bisphosphonate?
Which medication is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?
Which medication is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?
Which drug class directly targets the RANK ligand, inhibiting bone resorption?
Which drug class directly targets the RANK ligand, inhibiting bone resorption?
What is the primary mechanism of action of Teriparatide in treating osteoporosis?
What is the primary mechanism of action of Teriparatide in treating osteoporosis?
Which of the following is NOT a risk factor for developing osteoporosis?
Which of the following is NOT a risk factor for developing osteoporosis?
Which medication is most likely to be used in cases of severe osteoporosis with a high risk of fractures?
Which medication is most likely to be used in cases of severe osteoporosis with a high risk of fractures?
What is a potential side effect associated with bisphosphonate therapy?
What is a potential side effect associated with bisphosphonate therapy?
Which medication is considered a sclerostin inhibitor?
Which medication is considered a sclerostin inhibitor?
Which of the following is a common adverse effect associated with Teriparatide therapy?
Which of the following is a common adverse effect associated with Teriparatide therapy?
Which medication is most likely to be used as a first-line treatment for postmenopausal osteoporosis?
Which medication is most likely to be used as a first-line treatment for postmenopausal osteoporosis?
What is the primary use of Raloxifene?
What is the primary use of Raloxifene?
Which of the following is a common adverse effect of SERM medications?
Which of the following is a common adverse effect of SERM medications?
What is a contraindication for the use of Denosumab?
What is a contraindication for the use of Denosumab?
Which condition is Teriparatide primarily used to treat?
Which condition is Teriparatide primarily used to treat?
What is the mechanism of action of bisphosphonates?
What is the mechanism of action of bisphosphonates?
Which of the following drugs is a monoclonal antibody that acts as a sclerostin inhibitor?
Which of the following drugs is a monoclonal antibody that acts as a sclerostin inhibitor?
Which adverse effect is associated with bisphosphonates?
Which adverse effect is associated with bisphosphonates?
What is a contraindication specifically associated with Calcitonin?
What is a contraindication specifically associated with Calcitonin?
Which of the following drugs is effective for the treatment of osteoporosis in men as well as postmenopausal women?
Which of the following drugs is effective for the treatment of osteoporosis in men as well as postmenopausal women?
What adverse effect is specifically associated with Teriparatide?
What adverse effect is specifically associated with Teriparatide?
Which drug works by inhibiting osteoclast-mediated bone resorption?
Which drug works by inhibiting osteoclast-mediated bone resorption?
What is the primary action of Denosumab in osteoporosis treatment?
What is the primary action of Denosumab in osteoporosis treatment?
Which medication directly stimulates estrogen receptors on bone and increases bone density?
Which medication directly stimulates estrogen receptors on bone and increases bone density?
Which drug is the only one that stimulates bone formation?
Which drug is the only one that stimulates bone formation?
How often is Denosumab administered?
How often is Denosumab administered?
What is the mechanism of action of Calcitonin in treating osteoporosis?
What is the mechanism of action of Calcitonin in treating osteoporosis?
Which bisphosphonate is known for its effectiveness in reversing lost bone mass?
Which bisphosphonate is known for its effectiveness in reversing lost bone mass?
Which medication is derived from parathyroid hormone (PTH)?
Which medication is derived from parathyroid hormone (PTH)?
Which of the following is NOT a drug used to treat osteoporosis?
Which of the following is NOT a drug used to treat osteoporosis?
What is the main benefit of using bisphosphonates in osteoporosis?
What is the main benefit of using bisphosphonates in osteoporosis?
What is the mechanism of action of bisphosphonates in treating osteoporosis?
What is the mechanism of action of bisphosphonates in treating osteoporosis?
Which of the following medications is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?
Which of the following medications is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?
What is the mechanism of action of Calcitonin in treating osteoporosis?
What is the mechanism of action of Calcitonin in treating osteoporosis?
Which medication is the only one that stimulates bone formation?
Which medication is the only one that stimulates bone formation?
How often is Denosumab administered?
How often is Denosumab administered?
What is the primary action of Denosumab in osteoporosis treatment?
What is the primary action of Denosumab in osteoporosis treatment?
Which medication is derived from parathyroid hormone (PTH)?
Which medication is derived from parathyroid hormone (PTH)?
What is the mechanism of action of Raloxifene in treating osteoporosis?
What is the mechanism of action of Raloxifene in treating osteoporosis?
What should patients be instructed to do when taking bisphosphonates?
What should patients be instructed to do when taking bisphosphonates?
Which instruction is crucial for patients taking SERMs before surgery?
Which instruction is crucial for patients taking SERMs before surgery?
Which statement is true regarding the use of denosumab in osteoporosis treatment?
Which statement is true regarding the use of denosumab in osteoporosis treatment?
In the treatment of osteoporosis, teriparatide is primarily used for what purpose?
In the treatment of osteoporosis, teriparatide is primarily used for what purpose?
What must patients avoid to prevent adverse effects when taking bisphosphonates?
What must patients avoid to prevent adverse effects when taking bisphosphonates?
Calcitonin is primarily used to treat which condition?
Calcitonin is primarily used to treat which condition?
Which medication is indicated for the prevention of postmenopausal osteoporosis, but is contraindicated in women who are or may become pregnant?
Which medication is indicated for the prevention of postmenopausal osteoporosis, but is contraindicated in women who are or may become pregnant?
Which of the following is NOT a possible side effect associated with bisphosphonates?
Which of the following is NOT a possible side effect associated with bisphosphonates?
Which action is important for monitoring patients on bisphosphonates?
Which action is important for monitoring patients on bisphosphonates?
Which medication has a risk of causing osteonecrosis of the jaw as a potential adverse effect?
Which medication has a risk of causing osteonecrosis of the jaw as a potential adverse effect?
Which medication is considered a sclerostin inhibitor and is a new treatment option for osteoporosis?
Which medication is considered a sclerostin inhibitor and is a new treatment option for osteoporosis?
Which medication is administered via subcutaneous injection and is primarily used to treat osteoporosis in patients at high risk of fractures?
Which medication is administered via subcutaneous injection and is primarily used to treat osteoporosis in patients at high risk of fractures?
Which medication is derived from parathyroid hormone (PTH) and is used to stimulate bone formation in patients with severe osteoporosis?
Which medication is derived from parathyroid hormone (PTH) and is used to stimulate bone formation in patients with severe osteoporosis?
Which medication is contraindicated in patients with hypocalcemia, renal impairment, and infection?
Which medication is contraindicated in patients with hypocalcemia, renal impairment, and infection?
Which medication can be administered intravenously, subcutaneously, or orally and is used for the prevention and treatment of osteoporosis in both men and women?
Which medication can be administered intravenously, subcutaneously, or orally and is used for the prevention and treatment of osteoporosis in both men and women?
Which medication is contraindicated in patients with drug allergy or allergy to salmon?
Which medication is contraindicated in patients with drug allergy or allergy to salmon?
Which medication is known to cause hot flashes as a common adverse effect?
Which medication is known to cause hot flashes as a common adverse effect?
Which medication is contraindicated in patients with a history of venous thromboembolic disorders?
Which medication is contraindicated in patients with a history of venous thromboembolic disorders?
A patient taking a bisphosphonate complains of severe jaw pain. Which of the following is the most likely cause of this pain?
A patient taking a bisphosphonate complains of severe jaw pain. Which of the following is the most likely cause of this pain?
Which of the following medications is MOST LIKELY to be used for a patient with a history of osteoporosis and a recent vertebral fracture?
Which of the following medications is MOST LIKELY to be used for a patient with a history of osteoporosis and a recent vertebral fracture?
A patient is prescribed Calcitonin for osteoporosis. Which of the following is a common adverse effect that should be monitored for?
A patient is prescribed Calcitonin for osteoporosis. Which of the following is a common adverse effect that should be monitored for?
A patient with a history of deep vein thrombosis (DVT) is being considered for treatment of osteoporosis. Which medication class would be CONTRAINDICATED due to the patient's history?
A patient with a history of deep vein thrombosis (DVT) is being considered for treatment of osteoporosis. Which medication class would be CONTRAINDICATED due to the patient's history?
A patient with severe renal impairment is being evaluated for osteoporosis treatment. Which medication would be MOST LIKELY to be CONTRAINDICATED?
A patient with severe renal impairment is being evaluated for osteoporosis treatment. Which medication would be MOST LIKELY to be CONTRAINDICATED?
Which medication is indicated for the treatment of Paget's disease in women?
Which medication is indicated for the treatment of Paget's disease in women?
A patient is receiving Teriparatide therapy. Which of the following laboratory values should be monitored closely due to a potential adverse effect of this medication?
A patient is receiving Teriparatide therapy. Which of the following laboratory values should be monitored closely due to a potential adverse effect of this medication?
Which of the following medications is a monoclonal antibody that directly inhibits the RANK ligand, thereby reducing bone resorption?
Which of the following medications is a monoclonal antibody that directly inhibits the RANK ligand, thereby reducing bone resorption?
A patient is prescribed a bisphosphonate. Which of the following instructions should be given to the patient regarding medication administration?
A patient is prescribed a bisphosphonate. Which of the following instructions should be given to the patient regarding medication administration?
Which of the following medications is primarily used for the prevention of postmenopausal osteoporosis?
Which of the following medications is primarily used for the prevention of postmenopausal osteoporosis?
What is the recommended protocol for taking bisphosphonates to avoid gastrointestinal complications?
What is the recommended protocol for taking bisphosphonates to avoid gastrointestinal complications?
How should patients who are taking SERMs manage their medication in relation to periods of immobility?
How should patients who are taking SERMs manage their medication in relation to periods of immobility?
What should be the primary action taken if a patient experiences severe heartburn while on bisphosphonate therapy?
What should be the primary action taken if a patient experiences severe heartburn while on bisphosphonate therapy?
Which of the following instructions is essential for a patient taking Calcitonin for osteoporosis?
Which of the following instructions is essential for a patient taking Calcitonin for osteoporosis?
What is a significant benefit of using Denosumab in osteoporosis treatment?
What is a significant benefit of using Denosumab in osteoporosis treatment?
Which mechanism of action does Teriparatide primarily utilize in osteoporosis therapy?
Which mechanism of action does Teriparatide primarily utilize in osteoporosis therapy?
What is a key nursing implication when administering bisphosphonates?
What is a key nursing implication when administering bisphosphonates?
What is an important observation for patients receiving treatment with bisphosphonates?
What is an important observation for patients receiving treatment with bisphosphonates?
What is a unique characteristic of Teriparatide among osteoporosis treatments?
What is a unique characteristic of Teriparatide among osteoporosis treatments?
Which mechanism describes how Denosumab works in the treatment of osteoporosis?
Which mechanism describes how Denosumab works in the treatment of osteoporosis?
What is a primary action of Calcitonin in osteoporosis management?
What is a primary action of Calcitonin in osteoporosis management?
What is the key role of Selective Estrogen Receptor Modulators (SERMs) in osteoporosis treatment?
What is the key role of Selective Estrogen Receptor Modulators (SERMs) in osteoporosis treatment?
Which of the following bisphosphonates is particularly noted for effectively reversing lost bone mass?
Which of the following bisphosphonates is particularly noted for effectively reversing lost bone mass?
How often is Denosumab administered for osteoporosis treatment?
How often is Denosumab administered for osteoporosis treatment?
Which statement accurately describes the action of bisphosphonates?
Which statement accurately describes the action of bisphosphonates?
What distinguishes Raloxifene from other medications used for osteoporosis?
What distinguishes Raloxifene from other medications used for osteoporosis?
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Study Notes
Drug Therapy for Osteoporosis
- Bisphosphonates:
- Examples: alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), zoledronic acid (Reclast)
- Work by inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density
- Strong clinical evidence indicates that bisphosphonates can reverse lost bone mass and reduce fracture risk
- Selective estrogen receptor modifiers (SERMs):
- Examples: raloxifene (Evista), tamoxifen (Nolvadex)
- Stimulate estrogen receptors on bone and increase bone density
- Hormones:
- Calcitonin (Calcimar): directly inhibits osteoclastic bone resorption
- Teriparatide (Forteo): stimulates bone formation, derivative of parathyroid hormone (PTH), action similar to natural PTH
- Denosumab (Prolia): monoclonal antibody that blocks osteoclast activation, thereby preventing bone resorption, given as a subcutaneous injection once every 6 months along with daily calcium and vitamin D
- Romoszumab (Evenity): new, sclerostin inhibitor monoclonal antibody
Indications for Drug Therapy
- Raloxifene: primary use is prevention of postmenopausal osteoporosis
- Bisphosphonates: prevention and treatment of osteoporosis
- Teriparatide: subset of osteoporosis patients at highest risk of fracture (e.g., those with prior fracture)
- Calcitonin and denosumab: treatment of osteoporosis
Contraindications for Drug Therapy
- Bisphosphonates: drug allergy, hypocalcemia, esophageal dysfunction, and the inability to sit or stand upright for at least 30 minutes after taking the medication
- SERMs: women with known allergy to these drugs, who are or may become pregnant, with a venous thromboembolic disorder, including deep vein thrombosis (DVT), PE, and retinal vein thrombosis or with a history of such a disorder
- Calcitonin: drug allergy or allergy to salmon
- Teriparatide: drug allergy
- Denosumab: hypocalcemia, renal impairment, and infection
Adverse Effects of Drug Therapy
- SERMs:
- Hot flashes, leg cramps
- Increased risk of venous thromboembolism
- Teratogenic
- Leukopenia, leading to infection
- Bisphosphonates:
- Headache, gastrointestinal (GI) upset, joint pain
- Risk of esophageal burns if medication lodges in esophagus before reaching the stomach
- Risk of osteonecrosis of the jaw
- Possible severe (incapacitating) bone, joint, or muscle pain
- Calcitonin:
- Flushing of the face, nausea, diarrhea, and reduced appetite
- Teriparatide:
- Chest pain, dizziness, hypercalcemia, nausea, and arthralgia
- Denosumab:
- Infections
Nursing Implications
- For bisphosphonates, ensure that patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose
- Instruct patients to take bisphosphonates upon rising in the morning, with a full glass of water, and 30 minutes before eating
- Emphasize that patients should sit upright for at least 30 minutes after taking the medication
- For SERMs, instruct patients that the medication will need to be discontinued 72 hours before and during any prolonged immobility (e.g., surgery or a long trip)
- Monitor for therapeutic responses and adverse effects
Drug Therapy for Osteoporosis
- Romoszumab (Evenity): a sclerostin inhibitor monoclonal antibody
Indications
- Raloxifene: primary use for prevention of postmenopausal osteoporosis
- Bisphosphonates: prevention and treatment of osteoporosis
- Teriparatide: for high-risk osteoporosis patients (e.g., those with prior fracture)
- Calcitonin and denosumab: treatment of osteoporosis
Contraindications
- Bisphosphonates: drug allergy, hypocalcemia, esophageal dysfunction, and inability to sit or stand upright for 30 minutes after taking the medication
- SERMs: women with known allergy, who are or may become pregnant, with a venous thromboembolic disorder, or with a history of such a disorder
- Calcitonin: drug allergy or allergy to salmon
- Teriparatide: drug allergy
- Denosumab: hypocalcemia, renal impairment, and infection
Adverse Effects
- SERMs: hot flashes, leg cramps, increased risk of venous thromboembolism, teratogenic, and leukopenia leading to infection
- Bisphosphonates: headache, GI upset, joint pain, risk of esophageal burns, risk of osteonecrosis of the jaw, and possible severe bone, joint, or muscle pain
- Calcitonin: flushing of the face, nausea, diarrhea, and reduced appetite
- Teriparatide: chest pain, dizziness, hypercalcemia, nausea, and arthralgia
- Denosumab: infections
Alendronate (Fosamax)
- Oral bisphosphonate
- First nonestrogen nonhormonal option for preventing bone loss
- Inhibits or reverses osteoclast-mediated bone resorption
- Indications: prevention and treatment of osteoporosis in men and postmenopausal women, and treatment of glucocorticoid-induced osteoporosis and Paget disease
Raloxifene (Evista)
- SERM
- Use: prevention of postmenopausal osteoporosis
- Adverse effect: hot flashes
Nursing Implications
- Bisphosphonates: ensure patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose
- Instruct patients to take bisphosphonates upon rising in the morning, with a full glass of water, and 30 minutes before eating, and to sit upright for at least 30 minutes after taking the medication
- SERMs: instruct patients to discontinue medication 72 hours before and during prolonged immobility
- Monitor for therapeutic responses and adverse effects
Drug Therapy for Osteoporosis
- Romoszumab (Evenity): a sclerostin inhibitor monoclonal antibody
Indications
- Raloxifene: primary use for prevention of postmenopausal osteoporosis
- Bisphosphonates: prevention and treatment of osteoporosis
- Teriparatide: for high-risk osteoporosis patients (e.g., those with prior fracture)
- Calcitonin and denosumab: treatment of osteoporosis
Contraindications
- Bisphosphonates: drug allergy, hypocalcemia, esophageal dysfunction, and inability to sit or stand upright for 30 minutes after taking the medication
- SERMs: women with known allergy, who are or may become pregnant, with a venous thromboembolic disorder, or with a history of such a disorder
- Calcitonin: drug allergy or allergy to salmon
- Teriparatide: drug allergy
- Denosumab: hypocalcemia, renal impairment, and infection
Adverse Effects
- SERMs: hot flashes, leg cramps, increased risk of venous thromboembolism, teratogenic, and leukopenia leading to infection
- Bisphosphonates: headache, GI upset, joint pain, risk of esophageal burns, risk of osteonecrosis of the jaw, and possible severe bone, joint, or muscle pain
- Calcitonin: flushing of the face, nausea, diarrhea, and reduced appetite
- Teriparatide: chest pain, dizziness, hypercalcemia, nausea, and arthralgia
- Denosumab: infections
Alendronate (Fosamax)
- Oral bisphosphonate
- First nonestrogen nonhormonal option for preventing bone loss
- Inhibits or reverses osteoclast-mediated bone resorption
- Indications: prevention and treatment of osteoporosis in men and postmenopausal women, and treatment of glucocorticoid-induced osteoporosis and Paget disease
Raloxifene (Evista)
- SERM
- Use: prevention of postmenopausal osteoporosis
- Adverse effect: hot flashes
Nursing Implications
- Bisphosphonates: ensure patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose
- Instruct patients to take bisphosphonates upon rising in the morning, with a full glass of water, and 30 minutes before eating, and to sit upright for at least 30 minutes after taking the medication
- SERMs: instruct patients to discontinue medication 72 hours before and during prolonged immobility
- Monitor for therapeutic responses and adverse effects
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