Ati Joint And Bone Meds ( Bone Disorder Drugs)

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calcium supplements

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proto: calcium citrate (Citrical)
calcium carbonate (Tums, Rolaids)
calcium acetate (PhosLo)
IV: calcium chloride, calcium gluconate

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calcium supplements MOA

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maintenance of normal musculoskeletal, neurological, and cardiovascular function

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calcium supplements USE

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hypocalcemia
deficiencies of parthyroid hormone, Vitamin D, dietary calcium
IV meds are used for clients with critically low levels of calcium

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calcium supplements adverse

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hypercalcemia greater than (10.5 mg/dL)
tachycardia and elevatedBP leading to bradycardia and hypotension, muscle weakness and hypotonia, constipation, nausea, vomiting, abdominal pain, lethargy, confusion

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calcium supplements interventions

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calcium levels (9.0-10.5 mg/dL)

IV furosemide (Lasix), IV glucocorticoids galium (Ganite)
biophosphates ( alendronate (Fosamax), and oral inorganic phosphates are used to reverse hypercalcemia

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calcium supplements contraindicaitons

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hypercalcemia
bone tumors
hyperparathyroidism
kidney disease
GI function

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calcium supplements inteactions

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glucocorticoids- reduce absorption
calcium- decreases absorption of tetracyclines and thyroid hormone
thiazide diuretics increases risk of hypercalcemia
spinach, rhubarb, bran, whole grains may decrease calcium absorption
IV calcium preciptiates with phosphates, carbonates, sulfates, and tartrates
digoxin and parenteral calcium can lead to severe bradycardia

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calcium supplements admin

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1 hour apart from glucocorticoids, tetracyclines, and other thyroid hormones
warm IV infusions of calcium to body temperature
admin IV injections at 0.5-2 mL/min

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calcium supplements effectiveness

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serum calcium levels between (9.0-10.5 mg/dL

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selective estrogen receptor modulator

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proto: ralxifene (Evista)

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selective estrogen receptor modulator MOA

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endogenous estrogen in bone, lipid metabolism, and blood coagulation
decreases bone absorption (preservation of bone loss)
antagonist to estrogen on breast and endometrial tissue
decrease plasma levels of cholesterol

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selective estrogen receptor modulator use

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prevent and treat postmenopausal osteoporosis and prevent spinal fractures in female clients
protect against breast cancer

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selective estrogen receptor adverse

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increases risk for pulmonary embolism and DVT
hot flashes

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selective estrogen receptor contraindications

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history of venous thrombosis

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selective estrogen receptor interactions

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concurrent use with estrogen therapy is discouraged

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selective estrogen receptor admin

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consume adequate amounts of calcium and vit D
may be taken with or without food once a day
monitor bone density and serum calcium
LFT
weight bearing exercises daily

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selective estrogen receptor effectiveness

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increase in bone density
no fractures

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bisphosphates

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proto: alendronate (Fosamax)
other: ibandronate (Boniva)
risedronate (Actonel)
IV infusion- zoledronic (Reclast, Zometa)

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biophosphates MOA

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decrease number and action of osteoclasts, which thereby inhibits bone reabsorption

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biophosphates use

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prophylaxis and treatment of postmenopausal osteoporosis
prophylaxis and treatment of osteoporosis produced by long-term glucocorticoid use
clients who have Paget's disease of bone and hypercalcemia of malignancy

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biophosphates adverse

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esophagitis, esophageal ulceration
GI disturbances
musculoskeletal pain
visual disturbances
bisphosphate related osteonecrosis of the jaw with IV infusion
hyperparathyroidism at higher dose used for Paget's disease

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biphosphates contraindications

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lactation
esophageal stricture, disorders, difficulty swallowing
renal impairment, hypocalcemia
cannot sit upright or stand or at least 30 min after taking med
liver impairment
femoral fractures are greater risk for older adult

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bisphosphate interactions

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Aldendronate absorption decreases when taken with calcium supplements, orange juice, antacids, and caffeine

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bisphosphate interventions

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empty stomach with at least 8oz of water
30 min after admin to take antacids or calcium

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bisphosphate admin

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take med first thing in morning after getting out of bed
sit or ambulate for 30 min after taking med
avoid all calcium containing foods and liquids or any meds within 30 min of takingalendronate
bone density scan every 12-18 months

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bisphosphate effectiveness

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increase in bone density
no fractures

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calcitonin

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proto: calcitonin-salmon (Fortical, Miacalcin)

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calcitonin MOA

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decreases bone resorption by inhibiting the activity of osteoclasts in osteoporosis
increases renal calcium excretion by inhibiting tubular resorption

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calcitonin use

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treats postmenopausal osteoporosis, and treats moderate to severe Paget's disease
hypercalcemia caused by hyperparathyroidism and cancer

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calcitonin adverse

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nausea
nasal dryness

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calcitonin contraindications

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hypersensitivity to med and fish protein
lactation, children, kidney disease

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calcitonin interactions

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lithium may decrease lithium levels

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calcitonin admin

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alternate nostrils daily
check for chvosek's or trousseau's signs to monitor for hypocalcemia
consume diet high in calcium and vit D

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calcitonin effectiveness

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increase in bone density
calcium level within expected reference range of 9-10.5 mg/dL