chamberlain college nr 566 wk 1 completed study guide latest updated
Written for
NR 566
All documents for this subject (684)
Seller
Follow
ElonMusk
Reviews received
Content preview
Chamberlain College: NR 566 wk 1 Completed Study Guide LATEST
UPDATED
Chapter 21: Drugs Affecting the Endocrine System
Bisphosphonates
• Drugs: etidronate (Didronel), pamidronate (Aredia), risedronate (Actonel)
alendronate (Fosamax), tiludronate (Skelid), zoledronic acid (Zometa), ibandronate
(Boniva)
• Used for bone support, most commonly used
• Pharmacodynamics
▪ Adhere to bone, inhibit osteoclastic activity, potent inhibitors of both normal
and abnormal bone resorption
o Etidronate (Didronel): reduces both bone resorption and bone formation
because formation is coupled with resorption
o Pamidronate (Aredia) (available as IV only)
o and risedronate (Actonel): inhibit bone resorption with out inhibiting bone
formation and mineralization
o Alendronate (Fosamax): highly selective inhibitor of bone resorption 1
▪ 100 to 500 time more potent than the other drugs
▪ Does not interfere with osteoclastic recruitment or attachment but does
inhibit osteoclastic activity
o Tiludronate (Skelid): inhibits protein-tyrosine-phosphatease, results in detachment
of osteoclasts from the bone surface
▪ Inhibits the osteoclastic proton pump
o Zoledronic acid (Zometa): inhibits osteoclastic activity and induces osteoclast
apoptosis
▪ Also inhibits the increased osteoclastic activity and skeletal calcium
release induced by various stimulatory factors release by tumors
▪ Only available as IV formulation
o Ibandronate (Boniva): inhibits osteoclast activity and reduces bone resorption and
turnover based
on its affinity for hydroxyapatite (part of the bone matrix)
• All drugs in this class reduce vertebral fracture however,
o Only alendronate, risedronate, and zoledronic acid have demonstrated nonvertebral
fracture
reduction
o Pamidronate and zoledronic acid: only for parenteral use
• Pharmacotherapeutics
o Contraindication: uncorrected hypocalcemia, documented Barrett’s
esophagus, and renal insufficiency
o Caution: patient with GI disorders
o R/F severe esophageal adverse reactions is greater in patients who lie down after
taking these drugs or fail to take with a full glass of water
,o Etidronate has been withheld from patients with enterocolitis r/t diarrhea particularly at
high doses
▪ Associated with fracture in patients with Paget’s disease when given high
doses or when therapy lasted longer than 6 months
• Monitor with x-rays and lab work to assess for lesions
• Rare femur fracture in non-Paget’s patients using bisphosphonates
o IV formulations associated with higher renal toxicity risk especially with rapid infusion
▪ Check crt prior to every dose is required, force fluids before and after infusion
,• Clinical Use (Page 546 Dosing Chart)
o Osteoporosis
▪ Prevention and treatment of osteoporosis and its risk for fracture in men and
postmenopausal women (especially vertebral fractures)
▪ First line drugs: Alendronate, risedronate, and zolendronic acid with hip
fracture reductions, FDA approved for this indication
▪ Second-line drug: Ibandronate
▪ Ibandronate and zoledronic acid come in IV form
▪ Alendronate PO solution (Binosto) and PO tablets
▪ Zoledronic acid: only alternative form that shows evidence of hip fracture
reduction
▪ Prophylactic use in patients with early osteopenia r/t long term use of
medications that contribute to bone loss
• Includes (thyroid hormone, aromatase inhibitors, and glucocorticoids,
PPIs, SSRIs)
▪ It is recommended that all adults taking more than 7.5 mg of prednisone or its
equivalent for more than 3 weeks be given alendronate or risedrone
▪ In very high risk patients, maximum 2-year use of teriparatide (Forteo) (bone
mass benefit disappears after d/c) a parathyroid hormone, may be more
efficacious
• Bisphosphonates: bone mass benefit does not decline for 5 years
▪ Alendronate and risedronate initial doses for prevention of bone loss: 5mg/day or
35mg/week
▪ For existing osteoporosis: alendronate 10mg/day or 70mg/week
▪ Risedronate: 75mg for 2 days or 150mg once a month
o Paget’s Disease (Osteitis Deformans)
▪ All bisphosphonates are used to treat Paget’s disease when the alkaline
phosphatase is at least twice the upper limit of normal
▪ Asymptomatic or at risk for future complications from their disease
▪ Symptomatic Paget’s best treated with etidronate
▪ Etidronate slows accelerated bone turnover in pagetic lesions and to a lesser
extend in normal bone
▪ Reduced turnover causes symptomatic improvement: less bone pain and
decreased fractures
▪ 5-10 mg/kg daily for up to 6 months or 11 to 20 mg/kg daily for 3 months
▪ For all drugs indications for retreatment are evidence of active disease or failure
to normalize alkaline phosphatase levels
▪ Supplemental calcium and vitamin D if dietary intake is not adequate
▪ Space calcium supplements and bisphosphonates to prevent reduced
bioavailability
o Heterotopic Ossification
▪ Complications of THR
▪ Etidronate: first line
, ▪ Heterotopic ossification r/t spinal cord injury
▪ Use as soon as possible after injury
• Drug Interactions
o Adverse GI reactions, interact with drugs that affect the GI tract
▪ Histamine 2 blocking agents double alendronate bioavailability but the impact with unknow
o Calcium supplements and antacids interfere with bisphosphonate absorption when
taken within 1 hr
o R/F GI bleeding is increased when ASA and NSAIDs are concomitantly taken
o ASA may decrease the bioavailability of tiludronate by up to 50% when taken
2 hrs after the tiludronate
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ElonMusk. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $16.49. You're not tied to anything after your purchase.
