Bioavailability of bisphosphonate drugs and appropriate patient education
Histamine2 blocking agents double alendronate bioavailability, but the impact is unknown. Aspirin may decrease the bioavailability of tiludronate by up to 50% when taken 2 hours after the tiludronate. Although indomethacin i...
NR566 Midterm
Bioavailability of bisphosphonate drugs and appropriate patient education - Answer
Histamine2 blocking agents double alendronate bioavailability, but the impact is
unknown. Aspirin may decrease the bioavailability of tiludronate by up to 50% when
taken 2 hours after the tiludronate. Although indomethacin increases the bioavailability
of tiludronate by 2- to 4-fold, the bioavailability is not significantly altered by diclofenac;
therefore, each NSAID must be considered individually.
Adverse effects associated with long-term use of bisphonates - Answer Etidronate has
also been associated with fractures in patients with Paget's disease when they are
given high doses or when therapy lasted longer than 6 months. These patients must be
carefully monitored with x-rays and laboratory work to assess for these lesions. The
development of a rare form of subtrochanteric femur fracture in non-Paget's patients
using bisphosphonates is under close scrutiny and has contributed to movement away
from osteopenia prevention care to only osteoporosis therapy (FDA, 2010a).
Specifics about administration and education regarding pancreatic enzymes - Answer
All doses are taken immediately before or with meals or snacks with a fatty component.
Fruit, hard candy, fruit juice like drinks, tea or coffee, or popsicles do not require
enzymes (CFF, 2009). Capsules may be opened and sprinkled on food. Capsules with
enteric-coated beads should not be chewed. They may be sprinkled on soft acidic food
that is not hot and that can be swallowed without chewing, such as applesauce or
gelatin. Swallow immediately because the proteolytic enzymes may irritate the mucosa.
Following with a glass of water or juice or eating immediately after taking the drug helps
to ensure that the medication is swallowed and does not remain in contact with the
mouth and esophagus for long periods. Pancrelipase is destroyed by acid. Proton pump
inhibitors, sodium bicarbonate, or aluminum-based antacids may be used with
preparations without enteric coating to neutralize gastric pH. Calcium- and magnesium-
based antacids should not be used for this purpose because they interfere with drug
action. Enteric-coated beads are designed to withstand the acid pH of the stomach.
Enteric-coated formulations should not be mixed with alkaline food or the coating will be
destroyed.
Common adverse effects with aromatase inhibitors - Answer Adverse effects for the
drug class include various pain syndromes, vertigo, insomnia resulting in daytime
sleepiness and confusion, increased risk of blood clots, and hair loss. A key concern is
the loss of bone mass. Bone loss can be significant when considering the concurrent
osteoporotic risks of postmenopause. Closer monitoring is required. All patients should
be on calcium and vitamin D supplementation. A relative leukopenia can occur, but the
incidence of viral and bacteria infections is not considered greater than matched groups
(about 10%). Hypertension occurs in 10% of patients. A life-threatening increase in
blood clotting can result in MI, stroke, or pulmonary embolus. Hot flashes can be
intense.
Drugs associated risk for bone loss which should be monitored - Answer Aromatase
inhibitors
Thyroid hormones
,NR566 Midterm
Glucocorticoids
PPIs
SSRIs
Clinical signs and symptoms DM - Answer Increased thirst
Frequent urination
Extreme hunger
Unexplained weight loss
Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle
and fat that happens when there's not enough available insulin)
Fatigue
Irritability
Blurred vision
Slow-healing sores
Frequent infections, such as gums or skin infections and vaginal infections
Risk factors & associated complications of DM - Answer Complications: stroke, heart
attack, peripheral artery disease, diabetic retinopathy, cataracts, glaucoma, diabetic
nephropathy, peripheral neuropathy, diabetic foot.
Risk factors: >45 years old, physical inactivity, 1st degree relative relative with DM, high
risk ethic group (african american, hispanic, native american, asian american, and
pacific islander), hx of gest DM, htn, HDL < 35, triglycerides >250, polycystic ovarian
syndrome, acanthosis nigricans, hx of cardiovascular disease.
Diagnostic criteria of DM - Answer Acute symptoms of diabetes plus casual plasma
glucose concentration ≥200 mg/dL.
*Casual is defined as any time of day without regard to time since last meal. The classic
symptoms of diabetes are polyuria, polydipsia, and unexplained weight loss.
Fasting plasma glucose ≥126 mg/dL. * Fasting is defined as no caloric intake for at least
8 h.
2-h postload plasma glucose in an oral glucose tolerance test ≥200 mg/dL. The test
uses a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in
water.
Hb A1c ≥6.5%.
PRE-DIABETES:
Fasting plasma glucose 100-125 mg/dL (IFG) or
plasma glucose 140-199 mg/dL (IGT) 2 hr post-ingestion of standard glucose load (75
g) or
Hb A1c 5.7%-6.4%
Criteria for screening asymptomatic adults - Answer Individuals ≥45 yr and who have a
BMI ≥25 kg/m2 should be tested. If normal, the test should be repeated at 3 yr intervals.
Individuals <45 yr and who have a BMI ≥25 kg/m2 and have additional risk factors
should have more frequent testing.
Additional risk factors are the following:
• Physically inactive
, NR566 Midterm
• First-degree relative with diabetes
• Members of high-risk ethnic group (African American, Hispanic, Native American,
Asian American, Pacific Islander)
• Delivered a baby weighing >9 lb or previously diagnosed with GDM
• Hypertensive (B/P ≥140/90 mm Hg)
• HDL cholesterol ≤35 mg/dL and/or triglyceride level ≥250 mg/dL
• Have polycystic ovary syndrome (PCOS)
• IGT or IFG on previous testing
• Have other clinical conditions associated with insulin resistance (PCOS or acanthosis
nigricans)
• History of CVD
Daily dose of insulin for initiation - Answer 0.1/kg or 10 units
Insulin Treatment Algorithm for Type 1 DM - Answer Total daily insulin requirement is
0.3 to 0.5 units/kg body weight/d with titration to glycemic targets. Higher doses for
acute illness. Adjustments made after reviewing patterns over 3 days. Hypoglycemia
addressed first, then hyperglycemia. Adjustments up or down done in increments of 1
unit.
A1C monitoring during oral or insulin diabetes management - Answer Because Hb A1c
reflects mean glycemia over the preceding 2 to 3 months, it should be measured at
least twice a year if patients are meeting treatment goals or have stable glycemic
control; it should be measured every 3 months if therapy has changed or if patients are
not meeting treatment goals
Correlate mean plasma glucose level according to A1C - Answer Hemoglobin A1c
Levels
Mean Plasma Glucose (mg/dL)
6=
126
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