Metabolic Bone Medications Flashcards
Bisphosphonates are a class of medications that do what?
Decrease osteoclast resorption (breakdown)
BISPHOSPHONATE:
Alendronate (Fosamax and Binisto)
Can be given daily or weekly
• Binosto is an effervescent tablet
• Given in AM with 4-8 ounces of water 30-60” AC breakfast [no recumbancy for 30-60”]
• Thought to have worst GI side effect profile
• Approved for prevention and treatment of osteoporosis of hip and spine
• Rapidly cleared from plasma—binds to hydroxyapalite in the bone; once bound they are
cleared over months to years; renally eliminated [cannot be given in severe renal disease—
GFR <35 cc/min]
• ADE—GI distress, esophagitis, osteonecrosis of jaw [associated with high doses over long
periods3 consecutive years]; atypical fractures [seen with long term use]
BISPHOSPHONATE
Drug name: Risedronate (Actonel, Atelvia)
Route: PO Approved use for: hip and spine disease DOSAGE: 35 mg (weekly) PO 150mg (monthly) PO 35 mg pc (weekly)
BISPHOSPHONATE
Drug name: Ibandronate (Boniva)
Route: PO or IVP
Approved use for: spine disease
BISPHOSOPHONATE
Drug name: Zoledronic acid (Reclast, Zometa)
Route: IV infusion YEARLY
Approved use for: hip and spine disease
*contraindication: heart issues or high risk for a fib ; can have some flu like symptoms
Examples of SERMs
- Raloxifene (EVISTA)
2. Tamoxifen (Nolvadex, Solltamox)
Who do you give SERMs to?
- given for people intolerant to bisphosphonates, hx breast cancer, contraindicatated for women with hx of DVT, stroke, etc
Selective Estrogen Receptor Blockers
Drug name: Raloxifene (EVISTA)
- Oral daily agent – used for women intolerant to bisphosphonates
- It has estrogen like effects on bone and estrogen antagonistic effects on breast and endometrium
- This agent also lowers LDL cholesterol
- CONTRAINDICATED in women with prior history of thromboembolic disease [DVT, stroke, etc.]
- Main SE—HOT FLASHES!! MAJOR! 35% IN WOMEN
Bazedoxifne/conjugated estrogens (Duavee)
- 0.45/20 [1] tab daily
- Approved for vasomotor sx of menopause and osteoporosis prevention
• Estrogen + SERM—CANNOT be used in those with INTACT UTERUS; hx of breast, endometrial, ovarian cancers
- ADE—thromboembolism
- Same precautions as for estrogens & Evista
Calcitonin (Miacalcin)
Brand name: miacalcin
- ANTIRESPORPTIVE
- MAINLY USE TO HELP WITH PAIN AFTER A FX
- Can be used for acute pain after a fracture
- Approved to treat osteoporosis in women who are at least 5 year postmenopausal; also used in Paget’s disease
- Can be used in patients with vertebral osteoporosis – NOT effective for HIP disease
- Nasal spray used every day [alternate nostrils]
- ADE—nosebleeds and rhinitis
Drug name: Teriparatide (Forteo)
- Forteo is a synthetic form of parathyroid hormone (PTH)
- for men and women with severe disease and can not take anything else
-synthetic form of parathyroid hormone which stimulates bone formation
Only agent that will build bone by stimulating osteoblasts
- Approved for men and women with severe disease or those in need of treatment that cannot take the other agents
- SC injection daily for 2 years; then off – best option is to follow this therapy with bisphosphonate or Prolia [so patient will not lose new bone that they have built] *****
- Contraindicated in patients who have had skeletal XRT
ONLY DRUG THAT BUILDS BONE
Drug name: Denosumab (Prolia)
RANKL (receptor activator of nuclear factor kappa B) ligand inhibitor; prevents bone loss by blocking a certain receptor in the body to decrease bone breakdown
- Indicated for post-menopausal women with osteoporosis at high risk for fracture or patients who have failed/cannot tolerant other available therapies
- In post-menopausal women agent reduces the incidence of vertebral, non-vertebral, and hip fractures
- SQ injection twice per year
- Targeted for women and men with renal insufficiency **
- ADE—dermatological reactions, hypocalcemia (will need to monitor calcium!)
