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NR 566 Final Exam Study Guide ALL WEEKS

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NR566 Week 1 Study Outline Chapter 21: Drugs Affecting the Endocrine System Bisphosphonates • Drugs: etidronate (Didronel), pamidronate (Aredia), risedronate (Actonel) alendronate (Fosamax), til... udronate (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 [Show More]

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