joint and pain meds part 2

osteoporosis progressive disease

- where bone loss is greater than bone gained

- characterized by dec bone density and bone mass

osteoporosis inc risk of fractures

- hip

- wrist

- spinal

osteoporosis most people are

asymptomatic until their first fracture or vertebral collapse

osteoporosis goal

Identify and treat those at risk before the first fracture.

osteoporosis affects people of

- all ethnic backgrounds

- 2 million osteoporotic fractures annually in the US.

osteoporosis Risk Factors:

- Menopause (most common, due to estrogen loss)

- Over age 60.

- Family history.

- White or Asian race.

- Smoking,

- overuse of alcohol and caffeine.

- Physical inactivity.

- Testosterone deficiency

- Low vitamin D or calcium

- Drugs like corticosteroids, some anticonvulsants, and immunosuppressants

estrogen

helps prevent bone loss

Testosterone deficiency

testosterone helps build bone

Low vitamin D or calcium in the diet

dietary calcium is efficiently absorbed with vitamin D and parathyroid hormone (PTH)

Drugs like corticosteroids, some anticonvulsants, and immunosuppressants can

lower serum calcium levels and contribute to osteoporosis.

Medications to Treat/Prevent Osteoporosis:

- Calcium Supplements (e.g., Calcium citrate).

- Selective Estrogen Receptor Modulators (SERMs) (e.g., Raloxifene).

- Bisphosphonates (e.g., Alendronate).

- Calcitonin (only used to treat, does not prevent osteoporosis).

calcium citrate MOA

- Necessary for proper functioning of the heart, bones, nerves, muscles, and blood coagulation.

- Maintains musculoskeletal, neurological, and cardiovascular function.

calcium citrate routes of administration

- IV

- PO

calcium citrate uses

- Used as a calcium replacement for hypocalcemia

- Used for parathyroid hormone deficiencies.

- IV: critically low levels of calcium

Ca WNL

9-10.5 mg/dL

calcium citrate Complications/Adverse Reactions:

Hypercalcemia

Hypercalcemia signs and symptoms

- initially tachycardia and hypertension

- can lead to bradycardia and hypotension

- muscle weakness

- hypotonia

- constipation

- nausea

- vomiting

- abdominal pain

- lethargy

- confusion.

Signs of hypocalcemia

twitching, muscle spasms (tetany).

calcium citrate Drug Interactions

- give 1hr apart from glucocorticoids

- take 1hr apart from tetracycline

- thiazide diuretics

- spinach, rhubarb, beets, bran, whole grain

- digoxin

glucocorticoids

decrease calcium absorption

Calcium decreases the absorption of

tetracyclines and thyroid hormones

Thiazide diuretics can cause

potassium loss while retaining calcium, leading to hypercalcemia.

Digoxin can lead to

severe bradycardia, especially if calcium is administered parenterally/IV.

calcium citrate Precautions/Contraindications:

- Hypercalcemia, renal calculi, digoxin toxicity, ventricular fibrillation.

- Caution in clients with kidney disease or decreased GI function.

calcium citrate Nursing Responsibilities

- Administer IV slowly (0.5 to 2 mL/min) to avoid hypotension and dysrhythmias.

- Warm IV solution to body temperature before infusing.

- Monitor lab results for calcium due to narrow therapeutic range.

calcium citrate nursing education

- follow dosage directions

- take PO calcium w 8 oz of water & food

Raloxifene mechanism of action

Binds to estrogen receptors, producing estrogen-like effects on the bone, resulting in reduced reabsorption of bone and decreased bone turnover

Raloxifene uses

- Prevents and treats postmenopausal osteoporosis.

- Protects against estrogen-dependent breast cancers

- Decreases bone reabsorption

- increases bone density

- reduces the likelihood of vertebral fractures.

Raloxifene Complications/Adverse Reactions:

- Increased risk for stroke, Deep Vein Thrombosis (DVT), and pulmonary embolisms. This is related to estrogenic effects.

- Hot flashes (related to blocking of estrogen receptors).

Raloxifene Drug Interactions:

- Estrogen replacement therapy

- Black cohos

Raloxifene Precautions/Contraindications:

- Pregnancy.

- History of DVT.

- if premenopausal and using for breast cancer prevention

- use contraception and do not breastfeed during treatment.

Raloxifene Nursing Responsibilities

- Monitor serum calcium

- monitor liver enzymes

- monitor bone density every 12-18 months

Raloxifene Patient ed

- Contact provider if experiencing calf pain or difficulty breathing

- Stop medication 3 days prior to any surgery due to increased DVT risk.

- Perform weight-bearing exercises daily

- can be taken with or without food

- Therapeutic response may take 1 to 3 months

Alendronate MOA

- Lowers alkaline phosphatase (ALP), an enzyme associated with bone turnover.

- Decreases the number and actions of osteoclasts and inhibits bone turnover/reabsorption.

Alendronate use

- prophylaxis and treatment of postmenopausal osteoporosis.

- male clients with osteoporosis.

- Paget's disease of the bone

- glucocorticoid-related osteoporosis

Alendronate Complications/Adverse Reactions:

- Esophagitis and esophageal ulcerations.

- GI disturbances

- Musculoskeletal pain

- Visual disturbances

- Hypocalcemia

- Kidney toxicity with IV infusion.

- Long-term use can inc the risk for pathologic fractures.

Alendronate Visual disturbances

- blurred vision

- pain around the eye due to eye inflammation

Alendronate Drug Interactions:

- Calcium supplements and calcitonin take 2 hr apart

- Absorption decreased when taken with iron, magnesium, antacids, orange juice, and caffeine.

Alendronate Precautions/Contraindications:

- Clients with dysphagia, esophageal stricture, esophageal disorders, or

- kidney and liver impairment.

- Clients who cannot sit or stand for at least 30 minutes after taking the medication orally.

- Lactating women.

- Clients with upper GI disorders or infection

- Older adults are at risk for femur fractures.

Alendronate Patient Education:

- Patients must remain upright (sit or ambulate) for 30 minutes

- Take medication on an empty stomach with 8 ounces of plain water (nothing else)

- 30 minutes before the first meal or drink of the day.

- Therapeutic response may take 3 to 6 weeks,& effects can continue 12 weeks after discontinuation.

- do not double dose

- weight bearing exercises daily

alendronate nursing considerations

- Monitor for inflammation and swallowing difficulties due to risk of esophagitis.

- Do a good eye assessment for visual disturbances.

- Monitor kidney function, I&Os, and calcium levels.