NURS 3210 CH 34 PPT
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Questions and Answers

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?

  • 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?

  • 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?

    <p>At least 6 to 8 oz of water</p> Signup and view all the answers

    What should patients do if they experience esophageal irritation, dysphagia, severe heartburn, or retrosternal pain while taking bisphosphonates?

    <p>Report the symptoms to the prescriber immediately</p> Signup and view all the answers

    Why should patients be monitored while taking bisphosphonates?

    <p>To monitor for both therapeutic responses and adverse effects</p> Signup and view all the answers

    What instruction should be given to patients taking SERMs regarding prolonged immobility?

    <p>They should stop taking the medication 72 hours before and during prolonged immobility</p> Signup and view all the answers

    What is the primary concern when taking bisphosphonates?

    <p>Esophageal and GI adverse effects</p> Signup and view all the answers

    How should patients take bisphosphonates according to the nursing implications?

    <p>With a full glass of water, and 30 minutes before eating</p> Signup and view all the answers

    What should the nurse emphasize to patients taking bisphosphonates?

    <p>The importance of remaining upright for at least 30 minutes after taking the medication</p> Signup and view all the answers

    Which of the following medications is classified as a bisphosphonate?

    <p>Alendronate</p> Signup and view all the answers

    Which medication is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?

    <p>Raloxifene</p> Signup and view all the answers

    Which drug class directly targets the RANK ligand, inhibiting bone resorption?

    <p>Monoclonal antibodies</p> Signup and view all the answers

    What is the primary mechanism of action of Teriparatide in treating osteoporosis?

    <p>Stimulation of bone formation</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing osteoporosis?

    <p>High body mass index (BMI)</p> Signup and view all the answers

    Which medication is most likely to be used in cases of severe osteoporosis with a high risk of fractures?

    <p>Teriparatide</p> Signup and view all the answers

    What is a potential side effect associated with bisphosphonate therapy?

    <p>All of the above</p> Signup and view all the answers

    Which medication is considered a sclerostin inhibitor?

    <p>Romosozumab</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with Teriparatide therapy?

    <p>Hypercalcemia</p> Signup and view all the answers

    Which medication is most likely to be used as a first-line treatment for postmenopausal osteoporosis?

    <p>Raloxifene</p> Signup and view all the answers

    What is the primary use of Raloxifene?

    <p>Prevention of postmenopausal osteoporosis</p> Signup and view all the answers

    Which of the following is a common adverse effect of SERM medications?

    <p>Hot flashes</p> Signup and view all the answers

    What is a contraindication for the use of Denosumab?

    <p>Hypocalcemia</p> Signup and view all the answers

    Which condition is Teriparatide primarily used to treat?

    <p>High-risk osteoporosis</p> Signup and view all the answers

    What is the mechanism of action of bisphosphonates?

    <p>Inhibits osteoclast-mediated bone resorption</p> Signup and view all the answers

    Which of the following drugs is a monoclonal antibody that acts as a sclerostin inhibitor?

    <p>Romoszumab</p> Signup and view all the answers

    Which adverse effect is associated with bisphosphonates?

    <p>Headache and gastrointestinal upset</p> Signup and view all the answers

    What is a contraindication specifically associated with Calcitonin?

    <p>Allergy to salmon</p> Signup and view all the answers

    Which of the following drugs is effective for the treatment of osteoporosis in men as well as postmenopausal women?

    <p>Alendronate</p> Signup and view all the answers

    What adverse effect is specifically associated with Teriparatide?

    <p>Hypercalcemia</p> Signup and view all the answers

    Which drug works by inhibiting osteoclast-mediated bone resorption?

    <p>Alendronate</p> Signup and view all the answers

    What is the primary action of Denosumab in osteoporosis treatment?

    <p>Blocking osteoclast activation</p> Signup and view all the answers

    Which medication directly stimulates estrogen receptors on bone and increases bone density?

    <p>Raloxifene</p> Signup and view all the answers

    Which drug is the only one that stimulates bone formation?

    <p>Teriparatide</p> Signup and view all the answers

    How often is Denosumab administered?

    <p>Once every 6 months</p> Signup and view all the answers

    What is the mechanism of action of Calcitonin in treating osteoporosis?

    <p>Inhibiting osteoclastic bone resorption</p> Signup and view all the answers

    Which bisphosphonate is known for its effectiveness in reversing lost bone mass?

    <p>Alendronate</p> Signup and view all the answers

    Which medication is derived from parathyroid hormone (PTH)?

    <p>Teriparatide</p> Signup and view all the answers

    Which of the following is NOT a drug used to treat osteoporosis?

    <p>Slerostin</p> Signup and view all the answers

    What is the main benefit of using bisphosphonates in osteoporosis?

    <p>They reduce fracture risk</p> Signup and view all the answers

    What is the mechanism of action of bisphosphonates in treating osteoporosis?

    <p>Inhibit osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density</p> Signup and view all the answers

    Which of the following medications is a selective estrogen receptor modulator (SERM) used to prevent osteoporosis?

    <p>Raloxifene</p> Signup and view all the answers

    What is the mechanism of action of Calcitonin in treating osteoporosis?

    <p>Directly inhibit osteoclastic bone resorption</p> Signup and view all the answers

    Which medication is the only one that stimulates bone formation?

    <p>Teriparatide</p> Signup and view all the answers

    How often is Denosumab administered?

    <p>Once every 6 months</p> Signup and view all the answers

    What is the primary action of Denosumab in osteoporosis treatment?

    <p>Blocks osteoclast activation, thereby preventing bone resorption</p> Signup and view all the answers

    Which medication is derived from parathyroid hormone (PTH)?

    <p>Teriparatide</p> Signup and view all the answers

    What is the mechanism of action of Raloxifene in treating osteoporosis?

    <p>Stimulates estrogen receptors on bone and increases bone density</p> Signup and view all the answers

    What should patients be instructed to do when taking bisphosphonates?

    <p>Take at least 30 minutes before any food.</p> Signup and view all the answers

    Which instruction is crucial for patients taking SERMs before surgery?

    <p>Discontinue the medication at least 72 hours prior.</p> Signup and view all the answers

    Which statement is true regarding the use of denosumab in osteoporosis treatment?

    <p>It inhibits the action of RANK ligand.</p> Signup and view all the answers

    In the treatment of osteoporosis, teriparatide is primarily used for what purpose?

    <p>To stimulate bone formation.</p> Signup and view all the answers

    What must patients avoid to prevent adverse effects when taking bisphosphonates?

    <p>Laying down for 30 minutes post-dose.</p> Signup and view all the answers

    Calcitonin is primarily used to treat which condition?

    <p>Osteoporosis.</p> Signup and view all the answers

    Which medication is indicated for the prevention of postmenopausal osteoporosis, but is contraindicated in women who are or may become pregnant?

    <p>Raloxifene</p> Signup and view all the answers

    Which of the following is NOT a possible side effect associated with bisphosphonates?

    <p>Liver toxicity.</p> Signup and view all the answers

    Which action is important for monitoring patients on bisphosphonates?

    <p>Monitoring for signs of esophageal irritation.</p> Signup and view all the answers

    Which medication has a risk of causing osteonecrosis of the jaw as a potential adverse effect?

    <p>Bisphosphonates</p> Signup and view all the answers

    Which medication is considered a sclerostin inhibitor and is a new treatment option for osteoporosis?

    <p>Romoszumab</p> Signup and view all the answers

    Which medication is administered via subcutaneous injection and is primarily used to treat osteoporosis in patients at high risk of fractures?

    <p>Denosumab</p> Signup and view all the answers

    Which medication is derived from parathyroid hormone (PTH) and is used to stimulate bone formation in patients with severe osteoporosis?

    <p>Teriparatide</p> Signup and view all the answers

    Which medication is contraindicated in patients with hypocalcemia, renal impairment, and infection?

    <p>Denosumab</p> Signup and view all the answers

    Which medication can be administered intravenously, subcutaneously, or orally and is used for the prevention and treatment of osteoporosis in both men and women?

    <p>Bisphosphonates</p> Signup and view all the answers

    Which medication is contraindicated in patients with drug allergy or allergy to salmon?

    <p>Calcitonin</p> Signup and view all the answers

    Which medication is known to cause hot flashes as a common adverse effect?

    <p>Raloxifene</p> Signup and view all the answers

    Which medication is contraindicated in patients with a history of venous thromboembolic disorders?

    <p>Raloxifene</p> Signup and view all the answers

    A patient taking a bisphosphonate complains of severe jaw pain. Which of the following is the most likely cause of this pain?

    <p>Osteonecrosis of the jaw</p> Signup and view all the answers

    Which of the following medications is MOST LIKELY to be used for a patient with a history of osteoporosis and a recent vertebral fracture?

    <p>Teriparatide</p> Signup and view all the answers

    A patient is prescribed Calcitonin for osteoporosis. Which of the following is a common adverse effect that should be monitored for?

    <p>Nausea and diarrhea</p> Signup and view all the answers

    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?

    <p>SERMs</p> Signup and view all the answers

    A patient with severe renal impairment is being evaluated for osteoporosis treatment. Which medication would be MOST LIKELY to be CONTRAINDICATED?

    <p>Denosumab</p> Signup and view all the answers

    Which medication is indicated for the treatment of Paget's disease in women?

    <p>Alendronate</p> Signup and view all the answers

    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?

    <p>Calcium levels</p> Signup and view all the answers

    Which of the following medications is a monoclonal antibody that directly inhibits the RANK ligand, thereby reducing bone resorption?

    <p>Denosumab</p> Signup and view all the answers

    A patient is prescribed a bisphosphonate. Which of the following instructions should be given to the patient regarding medication administration?

    <p>Take the medication on an empty stomach with a full glass of water</p> Signup and view all the answers

    Which of the following medications is primarily used for the prevention of postmenopausal osteoporosis?

    <p>Raloxifene</p> Signup and view all the answers

    What is the recommended protocol for taking bisphosphonates to avoid gastrointestinal complications?

    <p>Remain upright for at least 30 minutes after taking.</p> Signup and view all the answers

    How should patients who are taking SERMs manage their medication in relation to periods of immobility?

    <p>Discontinue the medication for 72 hours before and during prolonged immobility.</p> Signup and view all the answers

    What should be the primary action taken if a patient experiences severe heartburn while on bisphosphonate therapy?

    <p>Immediately report it to the prescriber.</p> Signup and view all the answers

    Which of the following instructions is essential for a patient taking Calcitonin for osteoporosis?

    <p>Administer via subcutaneous injection as prescribed.</p> Signup and view all the answers

    What is a significant benefit of using Denosumab in osteoporosis treatment?

    <p>It acts as a sclerostin inhibitor to promote bone density.</p> Signup and view all the answers

    Which mechanism of action does Teriparatide primarily utilize in osteoporosis therapy?

    <p>Stimulation of bone formation.</p> Signup and view all the answers

    What is a key nursing implication when administering bisphosphonates?

    <p>Monitor for signs of esophageal abnormalities.</p> Signup and view all the answers

    What is an important observation for patients receiving treatment with bisphosphonates?

    <p>They should report any signs of dysphagia or heartburn.</p> Signup and view all the answers

    What is a unique characteristic of Teriparatide among osteoporosis treatments?

    <p>It stimulates bone formation.</p> Signup and view all the answers

    Which mechanism describes how Denosumab works in the treatment of osteoporosis?

    <p>Blocks osteoclast activation to prevent bone resorption.</p> Signup and view all the answers

    What is a primary action of Calcitonin in osteoporosis management?

    <p>Inhibiting osteoclastic bone resorption.</p> Signup and view all the answers

    What is the key role of Selective Estrogen Receptor Modulators (SERMs) in osteoporosis treatment?

    <p>Stimulating estrogen receptors to increase bone density.</p> Signup and view all the answers

    Which of the following bisphosphonates is particularly noted for effectively reversing lost bone mass?

    <p>Alendronate (Fosamax)</p> Signup and view all the answers

    How often is Denosumab administered for osteoporosis treatment?

    <p>Once every six months.</p> Signup and view all the answers

    Which statement accurately describes the action of bisphosphonates?

    <p>They inhibit osteoclast-mediated bone resorption.</p> Signup and view all the answers

    What distinguishes Raloxifene from other medications used for osteoporosis?

    <p>It is a selective estrogen receptor modulator.</p> Signup and view all the answers

    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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    Osteoporosis-Bisphosphonates- Chapter 34.pptx

    Description

    This quiz covers various drug therapies used to treat osteoporosis, including bisphosphonates, selective estrogen receptor modifiers, hormones, and more. Test your knowledge of these medications and their effects on bone health.

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