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Prototype:  Calcium Citrate

Pregnancy Risk Category C

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Prototype:  Raloxifene

Pregnancy Risk Category X

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Prototype:  Alendronate

Pregnancy Risk Category C

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Prototype: Calcitonin-salmon

Pregnancy Risk Category C

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Maintain musculoskeletal, neurological and cardiovascular functions

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Work as endogenous estrogen in bone, lipid metabolism, and blood coagulation.

Decrease bone resorption, slowing bone loss and preserving bone mineral density.

Work as an antagonist to estrogen on breast and endometrial tissue

Can decrease plasma levels of cholesterol

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Decrease the number and action of osteoclasts, and inhibit bone resorption

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Decrease bone resorption by inhibiting the activity of osteoclasts in osteoporosis

Increase renal calcium excretion by inhibiting tubular resorption

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Prevention/treatment of hypocalcemia or deficiencies of parathyroid hormone, Vitamin D or dietary calcium

Dietary supplement for adolescents, older adults, and women who are postmenopausal, pregnant or breastfeeding

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Prevent and treat postmenopausal osteoporosis to prevent spinal fractures in female clients

Protection against breast cancer

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Prophylaxis and treatment of postmenopausal osteoporosis

For male clients who have osteoporosis

Prophylaxis treatment of osteoporosis produced by long-term glucocorticoid use

Treatment of Paget's disease of the bone

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Treatment of postmenopausal osteoporosis

Treatment of moderate to severe Paget's disease

Treatment of hypercalcemia caused by hyperparathyroidism

Treatment of cancer

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Hypercalcemia

Renal calculi

Hypophosphatemia

Digoxin toxicity

Ventricular fibrillation

Use cautiously in clients with:

Kidney disease

Decrease in GI function

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Pregnancy

History of venous thrombosis

Concurrent use with estrogen hormone therapy is discouraged

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Dysphagia

Esophageal stricture

Esophageal disorders

Serious kidney impairment

Hypocalcemia

Should not be given to patients who cannot sit or stand for at least 30 minutes post administration

Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice and caffeine.

Use cautiously for clients who:

Are lactating women

Have histories of upper GI disorders, infection or liver impairment

Are older adults

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Hypersensitivity to fish protein

Concurrent use with lithium can decrease serum lithium levels

Use cautiously with:

Children

Women who are lactating

Patients with kidney disease

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Hypercalcemia

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Deep-vein thrombosis

Hot flashes

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Esophagitis or esophageal ulceration

GI disturbances

Musculoskeletal pain

Visual disturbances

Kidney toxicity (IV infusion)

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Nausea/vomiting

Nasal dryness and/or irritation

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Warm IV infusions of calcium to body temp before infusion

Administer IV injections at 0.5 to 2 mL/minute

Monitor serum calcium levels

Assess for signs of hypercalcemia

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Medication should be stopped prior to scheduled immobilization (e.g., surgery) to decrease risk of DVT.  Resume medication when patient is fully mobile.

Monitor for signs of DVT

Discourage long periods of sitting and inactivity.

Monitor bone density

Monitor serum calcium

Monitor liver function tests and for signs of liver toxicity

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Inform patients that Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice and caffeine

Instruct patient to sit upright or ambulate for 30 minutes after taking this medication orally

Withhold food or other medications for 1 hour after taking this medication orally

Provide (minimum) 8 oz. water to take with oral tablet and 2 oz. water with liquid formulation

Notify MD if patient shows signs of inadequate nutritional intake due to GI disturbances

Discontinue medication if client experiences blurred vision and eye pain and immediately contact the MD

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Should be administered by nasal spray (most common), IM or subcutaneously.  Rotate injection sites to reduce inflammation

Keep the container in an upright position

Inspect nasal mucosa periodically for ulceration

Monitor serum calcium levels and bone density scans periodically

Check for Chvostek's or Trousseau's signs to monitor for hypocalcemia

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Take 1 hour apart from glucocorticoids, tetracyclines, or thyroid hormones

Chewable tablets provide more consistent bioavailability

Do not change doses without consulting with MD, because recommended doses can vary widely depending on the specific calcium preparation

Take oral calcium with 8 oz. of water

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Medication can cause hot flashes

Consume adequate amounts of calcium and vitamin D in diet to maximize the effects of the drug.  Inadequate amounts of dietary calcium and vitamin D cause release of PTH, which stimulates calcium release from bone.

Medication should be taken once every day

Medication can be taken with or without food

Follow up with MD for bone density scans every 12-18 months

Perform weight-bearing exercises daily for 30-60 minutes (e.g. walking)

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Take medication first thing in the morning after getting out of bed.

Take oral medication on an empty stomach, drinking at least 8 oz. water with tablets and at least 2 oz. water with liquid formation

Sit or ambulate for 30 minutes after taking the medication

Avoid all calcium-containing foods and liquids or any medications within 30 minutes of taking alendronate

Do not chew or suck on the tablet

Perform weight-bearing exercises daily for 30-60 minutes

Notify MD of difficulty swallowing, painful swallowing, or new or worsening heartburn

If a dose is skipped, wait until next day 30 minutes before eating breakfast to take the dose.  Do not take two tablets on the same day.

For maximum benefits, consume diet high in calcium and vitamin D

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If using nasal spray, alternate nostrils daily

Consume a diet high in calcium and vitamin D