NR 566 Week 1 Study Guide {2020} – Chamberlain College of Nursing
NR566 Week 1 Study Outline
Chapter 21: Drugs Affecting the Endocrine
... [Show More] 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 [Show Less]