Elizabeth Snow - Pharmacology 1.docx

Osteoporosis Medications: Group 3: Carmen, Olga, Farhana, and AstrydBiophosphonates : OlgaTrade/ Generic NameClassificationActionRoute/ DoseSide effects and Nursing Implication

Trade name: FosamaxGeneric name:AlendronateTrade name:DidrocalGeneric name: Etidronate Trade name: Actonel Generic name: Risedronate Trade name:AclastaGeneric name: Zoledronic AcidCan be classified into one or more drug classes Enzyme-resistant analogues of pyrophosphateInhibit resorption of the bone by blocking the action of osteoclasts and promote osteoclast cell apoptosis: this action leads to decreased release of calcium from bone and decreased serum calcium levelIndications:Treatment of osteoporosisRoute: Oral Dosage:Alendronate PO 5-10 mg/day Etidronate -5-10 mg/kg/day for 6 more or 11-20 mg/kg/day for 3 more Risedronate PO 30 mg/day at least 30 min before the first drink or meal of the daySide Effects:CNS: Headache, dizzinessCV: Hypertension, chest painGI: Nausea, diarrhea, altered taste, metallic taste, abdominal pain, anorexia, esophageal erosionHematologic: Elevated blood urea nitrogen, serum creatinine, hypophosphatemia, hypokalemia, hypomagnesemia, hypocalcemiaRespiratory: Dyspnea, coughing, pleural effusionSkeletal increased or recurrent bone pain, focal osteomalacia, arthralgiaOther: Infections, fever, progression of cancer AssessmentHistory of allergy to bisphosphonates, renal failure, upper gastrointestinal disease Physical assessment of muscle tone, bone pain, bowel sounds, urinalysis, serum calcium, renal function testsInterventionsAdminister of oral drug with a full glass of water, 30 min to 1 h before meals or any other medication; make sure that the patient stays upright for at least 30 min after administration Monitor serum calcium levels before, during, and after therapy

Calcitonin: CarmenTrade/ Generic NameClassificationActionRoute/ DoseSide effects and Nursing Implication

Generic in Canada: Calcitonin-salmon Trade: Calcimar, Caltine, MiacalcinParathyroid (PTH)

PTH controls calcium, phosphorus, and vitamin D levels in the blood. Directly inhibits osteoclastic bone resorption, altering the function and/or number of osteoclasts.

Osteoclasts are responsible for the demineralization of the bone. Piagets Disease Sub-Q IMInitial dose 100 units (0.5mL daily)

Maintenance 50 units (0.25mL daily)

**A higher dosage of 100 units is suitable in patients with serious deformities or neurological problems.

Hypercalcemia Sub-Q IMInitially, 4 units/kg every 12 hours

May increase dosage in 1-2 days if initial dosage is ineffective to 8 units/kg every 6 hours

Postmenopausal osteoporosis Sub-Q IMMinimum dose not determined, however 100 units every second day can preserve Bone Mineral Density (BMD) Intranasal200 units (1 spray) dailyCommon side effectsSub-Q & IM

Nausea, vomitting, injection site reaction, flushing of the face, ears, hands and feet

Intranasal

Rhinitis, back pain

Allergic reactions

Calcitonin-salmon contains the same sequence of amino acids that is of salmon origin. Serious allergic reactions have been reported in patients receiving calcitonin injections due to fish allergies.

Pregnant women

Inhibits lactation in animals. It is unknown if calcitonin is distributed in human milk.

Geriatric patients

Intranasal spray effects include rhinitis, irritation and congestion in adults older than 65 years of age.

Nursing Implications

-Providing clear and specific methods of taking the medication

-In women, stressing the importance of informing a clinician in case of possibility/certainty of a pregnancy.

-Discussing and understanding interactions with any current illness or usage of over-the-counter drugs.

Hormone Therapy: OlgaTrade/ Generic NameClassificationActionRoute/ DoseSide effects and Nursing Implication

Trade names: C. E. S., Premarin,Senestin, Enjuvia. Generic name: conjugated estrogens

EstrogenHormoneEstrogen plays an important role in maintaining bone, therefore hormone therapy is an option to consider to treat osteoporosis Conserve calcium and phosphorous Encourage bone formation.

Indications: To retard progression Route: OralDosage: Start with lowest dose, 0.3 mg/day PO given continuously or cyclically (25 days on/ 5 days off)Side Effects:CNS: Steepening of the corneal curvature with a resultant change in visual activity and intolerance to contact lenses, headache, dizziness, mental depression, seizures. CV: Increased risk of blood clots and stroke, increased blood pressure Dermatologic: Photosensitivity, peripheral edema, chloasma, erythema nodosum or multiforme, hemorrhagic eruption, loss of scalp hair, hirsutism, urticarial, dermatitis GI: Gallbladder disease, hepatic adenoma, nausea,vomiting, abdominal cramps, bloating, jaundice, colitis, acute pancreatitis GU: Increased risk of endometrial cancer, vaginal candidiasis, cystitis-like syndrome, endometrial cystic hyperplasia Hematologic: Hypercalcemia, decreased glucose tolerance Other: weight changes, reduced carbohydrate tolerance, aggravation of porphyria, edema, breast tenderness Increased risk of endometrial cancer (only if a woman still has her uterus and is not taking a progestin along with estrogen). Treatment can consist of estrogen alone or estrogen and progesterone in combination in order to reduce the risk of developing uterine cancer if a women still has her uterus. Nursing Implication:This medication should be combined with diet, calcium, and exercise. Increased risk of endometrial cancer: pre-treatment and periodic (at least annual) history and physical assessment which should include: BP, breasts, abdomen, pelvic organs, and a Pap test. Do not use to prevent CV events or dementia: may increase risk of thrombophlebitis, pulmonary embolism, stroke, myocardial infarction

Selective Estrogen Receptor Modulators: FarhanaTrade/ Generic NameClassificationActionRoute/ DoseSide effects and Nursing Implication

Generic: Raloxifene Hydrochloride

Trade: Evista

Generic:Bazedoxifene/ Conjugated estrogens

Trade: DuaveePharmacotherapeutic:

Selective estrogen receptor modulator

Estrogen Agonists- Antagonist

Clinical:

Osteoporosis preventative

They bind to the estrogen receptors which decreases the bone resorption and bone turnover which in turn prevents bone loss.

Route: Oral

Indications:Prevention and treatment of Osteoporosis in postmenopausal women. Also may reduce the risk of breast cancer in postmenstrual women.

(Safety and usage not evaluated in men).

Dose: 1 tablet, 60 mg once a day without regard to food.Side Effects

Frequent: Hot flashes, flu-like symptoms, sinusitis.

Occasional:Nausea, weight gain, cough, leg cramps, rash, depression.

Rare: Vomit, fever, migraines, peripheral edema, flatulence, vaginitis.

Nursing Implications:

Assessment- Bone mineral density, urine bone turnover markers (ex: collagen breakdown products)

Implementation- PO (adults) 60 mg daily. Calcium supplements and Vitamin D are also encouraged.

Evaluation- Prevention of osteoporosis. Increased bone mineral density.

Considerations- Allergies, pregnancy, smoking, history of pulmonary embolism, venous thrombosis, risk of myopathy, drug-drug interactions

Bone Metabolism Regulators: Astryd Trade/ Generic NameClassificationActionRoute/ DoseSide effects and Nursing Implication

Prolia, Xgeva/DenosumabBone resorption inhibitorsSpecifically binds and acts as an inhibitor on RANKL and prevents reception with RANK. Inhibits formation of osteoclasts through formation, function, survival. Increases BMD in both postmenopausal women and men undergoing androgen deprivation therapy. Osteoclasts of giant cell tumours of bone are prevented from being activated with use of Denosumab.Route: Sub-Q into upper arm, upper thigh, abdomen. Must not be injected into muscle or blood vessels.

Dose: Pediatric patients (with giant cell tumour of bone): 120 mg once every four weeks for one month, on days 8 and 15 administer extra 120 g.

AdultsWomen/ men at high risk for fracture (includes postmenopausal women and men undergoing androgen deprivation therapy): 60 mg once every 6 months.

For prevention of SREs: 120 mg once every 4 weeks.Common side effects: Back, extremity, joint, and musculoskeletal pain, hypercholesterolemia, cystitis in postmenopausal women and nasopharyngitis (men).

Other possible side effects: Hypocalcemia, mineral metabolism, osteonecrosis of jaw, atypical subtrochanteric and diaphyseal femoral fracture, suppression of bone turnover, immunogenicity and antibody formation, increased risk of serious infections (cellulitis, endocarditis, abdominal, UTI, dermatologic reactions (rash, dermatitis, eczema).

Nursing implications:Important to correct hypocalcemia prior to starting Denosumab. Pregnant or lactating women are not advised to take Denosumab1. Patients may be sensitive to Denosumab/ components of Denosumab. Medical professionals with latex sensitivities should exercise caution in administering Denosumab.

Recommended daily supplementation of Ca ( 500 mg) and vitamin D (400 IU) to patients.

Bone mineral density test every 1-3 years to monitor response to Denosumab.

REFERENCES

American Society of Health-System Pharmacists, Inc., DynaMed. (2013, January 18). Calcitonin. Ipswich, MA:EBSCO Information Services. Retrieved January 13, 2015, from http://search.ebscohost.com.login.ezproxy.library.ualberta.ca/login.aspx?direct=true&site=DynaMed&id=233015

American Society of Health-System Pharmacists, Inc., DynaMed. (2013, June 13). Denosumab. Ipswich, MA:EBSCO Information Services. Retrieved January 12, 2015, from http://web.b.ebscohost.com/dynamed/detail?vid=6&sid=9696f877-0521-4334-a22f-d135ccb398d0%40sessionmgr112&hid=116&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=900410&anchor=r3100251

American Society of Health-System Pharmacists, Inc., DynaMed. (2014, May 27).Raloxifene. Ipswich, MA:EBSCO Information Services. Retrieved January 13, 2015 from http://web.a.ebscohost.com/dynamed/detail?vid=4&sid=c5054e77-0441-4fad 8aca9b1e5fb95e97%40sessionmgr4001&hid=4206&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=233547 Hodgson, B., & Kizior, R. (2009).Saunders nursing drug handbook 2009. Philadelphia, Pa.: Elsevier Saunders.

Karch, A. (2011). Lippincott's nursing drug guide. 2012. Ambler, PA: Lippincott Williams & Wilkins.

Spratto, G., & Woods, A. (2003). PDR nurse's drug handbook: The information standard for prescription drugs and nursing considerations (2003 ed.). Clifton Park, NY: Delmar Learning.

Vallerand, A., & Sanoski, C. (2014). Davis's drug guide for nurses: Canadian version. (Fourteenth ed.). S.l.: F A Davis.