bisphosphonates

Question 1

what is licensed for men for osteoporosis

Answer 1

alendronic acid 10mg tablets, OD
risedronate sodium 35mg tablets, once weekly

Question 2

MHRA safety info - what is there

Answer 2

• atypical femoral fractures
• osteonecrosis of jaw
• osteonecrosis of external auditory canal

Question 3

signs of atypical femoral features that pt should report

Answer 3

any thigh, hip, or groin pain during treatment with a bisphosphonate.

Question 4

pt should carry out the following measures to prevent osteonecrosis of jaw during treatment

Answer 4

patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms e.g. dental mobility, pain, swelling, non-healing sores or discharge

Question 5

signs to report which may indicate osteonecrosis of external auditory canal

Answer 5

report any ear pain, discharge from ear or an ear infection during treatment with a bisphosphonate.

Question 6

signs of oesophageal reactions pt should report and what action to take

Answer 6

stop taking drug and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

Question 7

who is more likely to have atypical femoral feature

Answer 7

mainly in patients receiving long-term treatment for osteoporosis

Question 8

bisphosphonate treatment should be reviewed after 5 years, except for this drug which should be reviewed after 3 years

Answer 8

zolendronic acid

Question 9

who is more likely to have osteonecrosis of the jaw

Answer 9

risk of osteonecrosis of the jaw is substantially greater for patients receiving intravenous bisphosphonates in the treatment of cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget’s disease

Question 10

risk factors for developing osteonecrosis of the jaw

Answer 10

potency of bisphosphonate (highest for zoledronate), route of administration, cumulative dose, duration and type of malignant disease, concomitant treatment, smoking, comorbid conditions, and history of dental disease.

Question 11

which bisphosphonate holds the highest risk of osteonecrosis of the jaw

Answer 11

zolendronate

Question 12

what to do before prescribing an IV bisphosphonate

Answer 12

• patients should be given a patient reminder card and informed of the risk of osteonecrosis of the jaw.
• Advise patients to tell their doctor if they have any problems with their mouth or teeth before starting treatment, and if the patient wears dentures, they should make sure their dentures fit properly.
• Patients should tell their doctor and dentist that they are receiving an intravenous bisphosphonate if they need dental treatment or dental surgery

Question 13

what to do for all pt with cancer and pt its poor dental status before bisphosphonate treatment (in regards to risk of osteonecrosis of jaw)

Answer 13

dental check up and any necessary remedial work should be performed before treatment, or ASAP after starting

Question 14

who is at risk of osteonecrosis of the external auditory canal

Answer 14

has been reported very rarely with bisphosphonate treatment, mainly in patients receiving long-term therapy (2 years or longer)

Question 15

consider the possibility of osteonecrosis of the external auditory canal in pt receiving bisphosphonates who present with…

Answer 15

ear symptoms, including chronic ear infections, or suspected cholesteatoma.

Question 16

risk factors for developing osteonecrosis of the external auditory canal

Answer 16

steroid use, chemotherapy, infection, an ear operation, or cotton-bud use.

Question 17

alendronic acid contraindication

Answer 17

Abnormalities of oesophagus; hypocalcaemia; other factors which delay emptying (e.g. stricture or achalasia)

Question 18

cautions for all bisphosphonates

Answer 18

oral: elderly in pt with a current or recent history of upper gastrointestinal disease or bleeding (risk of relapse/exacerbation of oesophagitis, oesophageal ulcer or oesophageal stricture).

Question 19

common SE for all bisphosphonates includes

Answer 19

• alopecia
• anaemia
• decreased appetite
• arthralgia
• constipation, diarrhoea
• dizziness
• dysphagia
• eye inflammation
• fever
• GI discomfort
• headache

Question 20

which side effects warrant discontinuation of treatment

Answer 20

oesophageal ulcer (discontinue); oesophagitis (discontinue)oesophageal stenosis (discontinue)

Question 21

avoid alendronic acid if creatine clearance

Answer 21

less than 35

Question 22

monitoring requirements of alendronic acid

Answer 22

• Correct disturbances of calcium and mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia) before starting treatment.
• Monitor serum-calcium concentration during treatment.

Question 23

directions for admin - alendronic

Answer 23

tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.

Question 24

how do bisphosphonates work

Answer 24

adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover

Question 25

what is ibandronic acid licensed for and what is the dose

Answer 25

treatment of postmenopausal osteoporosis
dose is 150mg once a month by mouth
alternatively can be used IV (diff dose)

Question 26

when used for postmenopausal osteoporosis, avoid ibandronic acid if creatinine clearance is less than

Answer 26

30

Question 27

monitoring requirements for ibandronic acid

Answer 27

Monitor renal function and serum calcium, phosphate and magnesium.

Question 28

directions for admin for ibandronic acid

Answer 28

tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva ® tablets, 150 mg) before first food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet.

Question 29

A patient reminder card should be provided to patients receiving intravenous bisphosphonates due to…

Answer 29

risk of osteonecrosis of the jaw

Question 30

dose of risedronate in men vs women

Answer 30

men = 35mg once weekly
females = 5mg daily, alternatively 35mg once weekly (weekly dose not for prevention osteoporosis in postmenopausal women)

Question 31

all bisphosphonates are contraindicated in the following electrolyte disturbance

Answer 31

hypocalcaemia

Question 32

monitoring for risedronate

Answer 32

Correct hypocalcaemia before starting.

Correct other disturbances of bone and mineral metabolism (e.g. vitamin-D deficiency) at onset of treatment.

Question 33

directions for admin for risedronate

Answer 33

swallow tablets whole with full glass of water; on rising, take on an empty stomach at least 30 minutes before first food or drink of the day or, if taking at any other time of the day, avoid food and drink for at least 2 hours before or after risedronate (particularly avoid calcium-containing products e.g. milk; also avoid iron and mineral supplements and antacids); stand or sit upright for at least 30 minutes; do not take tablets at bedtime or before rising.

Question 34

what are the IV bisphosphonates

Answer 34

zolendronate, ibrandronic acid (also oral), pamidronate