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What is the action/use of BIOPHOSPHANATES ?
*inhibits osteoclastic bone resorption to increase BMD & total bone mass
*used for prevention & tx of postmenopausal osteoporosis, steroid induced osteoporosis, paget's dx, osteoporosis in men
What assessments should be done before administering BIOPHOSPHANATES?
- serum Ca & Vit D
- evidence of esophageal irritation
- difficulty swallowing
- visual disturbances
***contraindicated in renal insufficiency
What are the expected outcomes for BIOPHOSPHANATES?
- prevention of or decrease in progression of osteoporosis
- decrease in progression of Paget's dx
- improvement in BMD from corticostreoid-induced osteoporosis (zoledronic acid (Reclast))
What interventions for administration of BIOPHOSPHANATES?
- take 1st thing in the am, 30 mins before other meds, food or beverages
- take with H2O
- remain upright for at least 30 mins
What evaluation for administration of BIOPHOPHANATES?
- no evidence of esophageal irritation
- decrease incidence of fractures
- evidence of improvement in BMD
Name 4 types of biophopahantes medications.
- alendronate (Fosamax)
- risedronate (Actonel)
- ibandronate (Boniva)
- zoledronic acid (Reclast)
What is the action/use of CALCITONIN?
thyroid hormonse used to treat osteoporosis in women at least 5 yrs postmenopausal and Paget's disease by inhibiting osteoclastic bone resorption & decreasing bone turnover
What assessments should be done before administering CALCITONIN?
- nasal mucosa: rhinitis, *epistaxis
- SE of N/V
- monitor serum Ca (watch for s/s of hypocalcemia=nervousness, muscle twitching, paresthesia)
- assess for hypersensitivity=rash, flushing, fever, hives)
What are the expected outcomes for CALCITONIN?
- slowed progression of postmenopausal osteoporosis
- decreased boen pain
What interventions should be done for CALCITONIN?
- available in subQ, IM, & intranasal spray forms
- alternate nostrils daily to prevent dryness
- store in refrigerator
- discard 30 days after 1st use
What evaluation for CALCITONIN?
- evidence of BMD increase
- no evidence of nasal irritaion or any injection site irritation
Name 3 types of CALCITONIN?
Calcitonin is derived from?
What secretes CALCITONIN?
***calcitonin decrease calcium serum concentration if its high above its normal levels
What is the role of estrogen ?
stimulates osteoblastic and inhibit PTH; it decreases at menopause=Ca level to decrease which leads to osteoporosis
What is the action/use of ESTROGEN/HORMONE THERAPY?
hormone used to replace estrogen for relief of vasomotor symptoms and for tx & prevention of postmenopausal osteoporosis
What assessments for ESTROGEN/HORMONE THERAPY?
monitor s/s thromboembolism, MI, edema, HTN, wt gain, nausea, h/a
may cause increase in HDL, glucose triglycerides, & Na
What are the expected outcomes for ESTROGEN/HORMONE THERAPY?
- prevention of vetebral and hip fx's
- increase in BMD
- relief of postmenopausal symptoms
What are the interventions for ESTROGEN/HORMONE THERAPY?
- should be usd in lowest effective dose of shortest duration to meet goals
- HRT use not recommended solely or osteoporosis prevention, other meds should be considered first
What evaluation for ESTROGEN/HORMONE THERAPY?
- decrease incidence of fx
- normalization of estrogen levels
Name 3 types of ESTROGEN/HORMONE THERAPY.
- estrogen therapy (Climara)
- estradoil (Estrace)
- Hormone therapy (Prempro)
Name 1 type of Estrogen Antagonist.
What action/use for ESTROGEN ANTAGONIST?
- synthetic estrogen that inhibits bone resoprtion used in tx and prevention of postmenopausal osteoporosis
- produces estrogen-like effects on bone without breast ot uterus involvement
What assessments for ESTROGEN ANTAGONIST?
- BMD before and periodically during use
- monitor SE of leg cramps & hot flashes
- ***contraindicated if thromboembolic hx
What are the expected otcomes for ESTROGEN ANTAGONIST?
- prevention of osteoporosis
- increases BMD by reducing bone resorption
What are the interventions for ESTROGEN ANTAGONIST?
- teach pt importance of Ca & vitD intake
- no smoking or alcohol
- wt bearing ecercises
- administed po without regards to meals
What evaluation for ESTROGEN ANTAGONIST?
decrease incidence of osteoporotic spine fx
Name 1 type of PARATHYROID HORMONE.
What action/use for PARATHYROID HORMONE?
- PTH regulates Ca & P metabolism
- it stimulates osteoblastic activity & increases BMD used for tx of osteoporosis in postmenopausal women at high risk for fx
- most useful for those who failed osteoporosis therapies
*** when Ca levels decreases, PTH increases & stimulate bone to promote osteoclastic activity & release Ca in the blood
What assessments for PARATHYROID HORMONE?
- check BMD
- increases Ca & decreases P
- monitor for *orthostatic hypoTN during 1st several doses, leg cramping
What expected outcomes for PARATHYROID HORMONE?
increase bone mineral density with reduce risk of fx in spine, hip, & wrist
What interventions for PARATHYROID HORMONE?
- should not be used for more than 2 yr
- daildy subQ injection into thigh or abd wall
- store pen in refrigerator, use STAT then return
- Forteo pen can be used for 28 days then discarded
What evaluation for PARATHYROID HORMONE?
- increase BMD
- decrease incidence of fx
Name 2 types of CALCIUM SUPPLEMENTS.
- Calcium carbonate (Caltrate, Os-Cal)
- Calcium citrate (Citracal)
What action/use for CALCIUM SUPPLEMENTS?
- increase Ca intake
- osteoporosis prevention to build bone health
What assessments for CALCIUM SUPPLEMENTS?
- monitor serum Ca level to prevent hypercalcemia
- hx of urinary stones
What expected outcomes for CALCIUM SUPPLEMENTS?
serum calcium levels WNL
What intervention for CALCIUM SUPPLEMENTS?
- Caltrate=take with food & H2O
- Citracal=empty stomach is fine
What evaluation for CALCIUM SUPPLEMENTS?
- decrease incidence of osteoporosis
- increased or normal serum calcium levels
What does DMARD's stands for ?
disease-modifying antirheumatic drugs
Name 3 types of DMARD's.
- methotrexate (Rheumatrex)
- hydroxychloroquine (Plaqeunil)
- sulfasalazine (Azulfidine)
What action/sue for DMARD's?
immunosuppressive activity used for tx of RA unresponsive to other tx
What assessment for DMARD's?
- abd pain
- CBC for decreased WBC's/platelets
- increased liver enzymes(avoid alcohol)
- CXR for s/s of pneumonitis
- joint pain, ROM, hair loss, mouth sores
- Plaquenil can cause retinal damage (need eye exam q6-12mo)
What expected outcomes for DMARD's?
- reduced inflammation & pain w/t adverse drug effects or infections
- slows progression of mild RA
What interventions for DMARD's?
- adminitered weekly
- slow acting taking 4-6wks to work
- instruct to avoid crowds
- bleeding precautions
- avoid OTC and herbals
- push fluids
- use SPF30
- pregnancy not recommended d/t birth defects
What evaluation for DMARD's?
improved mobility & decreased joint pain/swelling
What does BRD's stands for?
biologic response modifiers
Name 3 types of BRD's.
- etanercept (Enbrel)
- infliximab (Remicade)
- Adalimumab (Humira)
What action/use for BRD's?
used to treat moderate to severe RA by disrupting the inflammatory process & delaying dx progression (also used to tx Crohn's dx)
What assessment for BRD's?
- assess for infusion related reactions such as fever, urticaria, pruritis during & after infusion
- assess for latent TB
- monitir liver fx
- CBC for leucopenia & thrombocytopenia
- joint pain & ROM
What expected outcome for BRD's?
decreased pain & swelling with decreased rate of joint destruction & improved physical fx
What interventions for BRD's?
- administered IV
- advise of AE of myalgia, rash, fever may occur 3-12 days after infusion
- watch for dizziness
What evaluation for BRD's?
- report decrease in pain & swelling of joints
- no evidence of AE or infusion related reactions