Osteoporosis-Bisphosphonates- Chapter 34.pptx

Chapter 34 Women’s Health Drugs  Osteoporosis  Low bone mass  Increased risk of fractures  Affects 25% of women & 5% of men in the U.S. over age 65 years 2  Osteoporosis: Risk Factors  European or Asian de...

Chapter 34 Women’s Health Drugs  Osteoporosis  Low bone mass  Increased risk of fractures  Affects 25% of women & 5% of men in the U.S. over age 65 years 2  Osteoporosis: Risk Factors  European or Asian descent  Slender body build  Early estrogen deficiency  Smoking  Alcohol consumption  Low-calcium diet  Sedentary lifestyle  Family history 3  Drug Therapy for Prevention of Osteoporosis  Calcium supplements and vitamin D are thought to help with prevention of osteoporosis  Current recommendations are that women, especially those older than age 60 years, consider taking calcium and vitamin D supplements for bone health. 4  Audience Response System Question #1 While taking a history of a 68-year-old female patient who is receiving estrogen therapy as part of palliative treatment for advanced breast cancer, which assessment finding would be of most concern to the nurse? A. The patient is on transdermal opioids for cancer pain. B. The patient smokes 1 pack of cigarettes a day. C. The patient drinks a glass of wine one evening a week. D. The patient has a history of osteoporosis. NOTE: No input is required to proceed. 5  Answer to System Question #1 ANS: B Smoking should be avoided during estrogen therapy because it adds to the risk for thrombosis. 6  Drug Therapy for Osteoporosis  Bisphosphonates  Alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), zoledronic acid (Reclast)  Selective estrogen receptor modifiers (SERMs)  Raloxifene (Evista)  Tamoxifen (Nolvadex)  Hormones  Calcitonin (Calcimar)  Teriparatide (Forteo): stimulates bone formation  Denosumab (Prolia): prevents bone resorption 7  Drug Therapy for Osteoporosis (Cont.)  Bisphosphonates  Work by inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density  Strong clinical evidence indicates the bisphosphonates can reverse lost bone mass and reduce facture risk.  Selective estrogen receptor modulators (SERMs)  Stimulate estrogen receptors on bone and increase bone density 8  Drug Therapy for Osteoporosis (Cont.)  Calcitonin (Calcimar)  Directly inhibits osteoclastic bone resorption  Teriparatide (Forteo)  Only drug that stimulates bone formation  Derivative of parathyroid hormone (PTH)  Action similar to natural PTH 9  Drug Therapy for Osteoporosis (Cont.)  Denosumab (Prolia)  Monoclonal antibody that blocks osteoclast activation, thereby preventing bone resorption  It is given as a subcutaneous injection once every 6 months along with daily calcium and vitamin D.  Romoszumab (Evenity)  New  Sclerostin inhibitor monoclonal antibody 10  Drug Therapy for Osteoporosis: Indications  Raloxifene  Primary use: 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 & denosumab: treatment of osteoporosis 11  Drug Therapy for Osteoporosis: Contraindications  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 12  Drug Therapy for Osteoporosis: Contraindications (Cont.)  Calcitonin: drug allergy or allergy to salmon  Teriparatide: drug allergy  Denosumab: hypocalcemia, renal impairment and infection 13  Drug Therapy for Osteoporosis: Adverse Effects  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 14  Drug Therapy for Osteoporosis: Adverse Effects (Cont.)  Calcitonin:  Flushing of the face, nausea, diarrhea, and reduced appetite  Teriparatide:  Chest pain, dizziness, hypercalcemia, nausea, and arthralgia  Denosumab:  Infections 15  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 in postmenopausal women as well as treatment of glucocorticoid- induced osteoporosis in men and for the treatment of Paget disease in women 16  Raloxifene (Evista)  SERM  Use: prevention of postmenopausal osteoporosis  Adverse effect: hot flashes 17  Audience Response System Question #2 A 60-year-old woman is taking a bisphosphonate. She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. Which instruction is most appropriate for the nurse to provide? A. Take the medication with milk. B. Take the medication with breakfast. C. Remain upright in a sitting position for at least 10 minutes after taking the medication. D. Stop the medication and come in for an evaluation. NOTE: No input is required to proceed. 18  Answer to System Question #2 ANS: D Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions. 19  Nursing Implications (Cont.)  For bisphosphonates, ensure that patients have no esophageal abnormalities and can remain upright or in a sitting position for 30 minutes after the dose. 20  Nursing Implications (Cont.)  Bisphosphonates  Instruct patients to take medication 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. 21  Nursing Implications (Cont.)  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). 22  Nursing Implications (Cont.)  Monitor for therapeutic responses.  Monitor for adverse effects. 23