Raloxifene (Evista) is contraindicated in a patients with a history of
Bisphosphonates administered at high doses (especially those given intravenously, such as zoledronic acid (Reclast) and pamidronate (Andreia)), have been linked to the complication of
Patients taking a bisphosphonate, such as alendronate (Fosamax) must take the medication on an empty stomach (enhances absorption) with 8 ounces of WATER only (prevents pill from getting stuck). To prevent the complication of esophagitis, what else should the patient be instructed to do?
Remain in an upright position for 30-60 minutes, before eating.
Name the two nursing interventions for Raloxifene (estrogen receptor modulator)
- 1. Teach pt s/s of VTE
- Rationale- Raloxifene can cause increased risk for VTE, especially in the first 4 months of therapy
- 2. Monitor LFT’s in collaboration with health care provider
- Rationale- Raloxifene can cause increased LFT values or worsen hepatic disease (contraindicated in pt with liver disease.)
What is the rationale for “pushing fluids” in a patient taking calcium supplementation?
Prevention of calcium-based kidney stones
A patient has been order to take 1500mg of calcium citrate daily. How much calcium should the patient receive at bedtime?
A third of the dose given a bedtime (500mg)
Which four classes of medications taken over a long period of time may affect calcium metabolism and bone metabolism, and thus cause secondary osteoporosis:
- loop diuretics
- thyroid meds
List three nursing considerations related to calcium supplements:
- give with food in divided doses with 6-8 oz water
- GI upset
- monitor for constipation and hypercalcemia
What are the therapeutic uses for Vitamin D supplements?
Increases absorption of Ca+ from intestinal tract and availability of Ca+ in the serum needed for remineralization of bone
Needed by individuals who are not exposed to adequate amounts of sunlight or who do not meet its daily requirements
A patient receiving acetaminophen is at risk for liver damage if he:
- take more than 3,000mg daily
- liver disease
- **older age at risk too
Patient education regarding acetaminophen should include the following:
- read OTC labels or RX drugs that may contain acetaminophen
- LFT’s will be monitored while taking
Celecoxib (Celebrex) is an NSAID COX-2 Inhibitor. Patients with a history of what should not receive celecoxib?
- GI issues (ulcers, GERD)
- renal impairment
- cardiovascular disease
Muscle relaxants, such as cyclobenzaprine hydrochloride (Flexeril) may be given for painful muscle spasms associated with osteoarthritis. Why must this medication be used with caution in older patients?
Can cause acute confusion
NSAID usage may result in gastrointestinal complications. Learn the first six nursing considerations listed under gastrointestinal discomfort:
- damage to GI mucosa can lead to GI bleed and perforation, especially in long term use
- Risk increased in older adults, smokers, alcohol use, hx peptic ulcers
- advise to take with food or 8 oz of water or milk
- advise to avoid alcohol
- observe for indications of GI bleeding
- administer a PPI, such as omeprazole or H2 receptor antagonist, such as ranitidine to decrease risk for ulcer
NSAIDS are nephrotoxic. Four signs and symptoms of NSAID-related impaired kidney function are as follows:
- decreased urine output
- weight gain from fluid retention
- increased BUN (7-20)
- increased creatinine (0.6-1.2 (M) / 0.5-1.1 (F))
Capsaicin (cream or patch) is a topical analgesic. What education should a patient receive regarding capsaicin?
- Expect burning sensation after applying
- Use plastic gloves for application
- Wash hands immediately after application
A client with CHRONIC GOUT has an order for Allopurionol (Zyloprim). What should the patient be instructed to do to prevent the medication-related complication of kidney injury?
Drink at least 8 – 8 oz glasses of water per day
What are the complications related to allopurinol use?
- Hypersensitivity reaction
- Gastrointestinal distress
A patient with ACUTE GOUT has an order for colchine (Colcrys). Two complications related to the use of colchine are bone marrow suppression and rhabdomyolysis. What education must you provide a patient in relation to these complications?
- Bruising or bleeding or sore throat
- Muscle pain or tenderness
In Paget's Disease, what is the first line treatment of choice for Paget ’s disease when alkaline phosphatase (ALP) levels are twice the normal serum level (>88).
The administration of intravenous bisphosphonates may result in hypocalcemia (low calcium level in the serum). To prevent hypocalcemia during treatment, which two supplements will prophylactically be ordered for the patient?
- For two weeks post zoledronic acid infusion (unless prone to kidney stones):
- Calcium 1500mg/daily in divided doses
- Vitamin D3 800 iu/daily
Adverse drug reactions (ADE’s) may occur in olders adults, especially when a new medication is started. Which of the following are common ADE’s among older adults? (Select all that apply)
b) Acute confusion (delirium)
c) Urinary incontinence
- acute confusion
**there are many more**
Medications included in the Beers Criteria for Potentially Inappropriate Medication Use of Older Adults include which of the following medications? (Select all that apply)
a) Amitriptyline (Elavil)
b) Meperidine (Demerol)
c) Ketorolac (Toradol)
d) Diphenhydramine (Benadryl)
f) Cyclobenzaprine (Flexeril)
- a) Amitriptyline (Elavil)
- b) Meperidine (Demerol)
- c) Ketorolac (Toradol)
- d) Diphenhydramine (Benadryl)
- e) Doxepin (>6mg/day)
- f) Cyclobenzaprine (Flexeril)
Name two adverse effects of colchicine (Colcrys)
- bone marrow suppression