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      <title>Chapter 34: Bone Disorders by Amy Stein</title>
      <link>https://padlet.com/amy_stein/m495vuhpwp88</link>
      <description>Amy Stein and Kendra Newton</description>
      <language>en-us</language>
      <pubDate>2017-09-05 16:21:43 UTC</pubDate>
      <lastBuildDate>2025-08-13 19:01:08 UTC</lastBuildDate>
      <webMaster>hello@padlet.com</webMaster>
      <image>
         <url></url>
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      <item>
         <title>Calcium Supplements</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186587497</link>
         <description><![CDATA[<div><br><strong><em>Prototype:&nbsp; Calcium Citrate<br><br></em></strong>Pregnancy Risk Category C</div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-11 22:53:12 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186587497</guid>
      </item>
      <item>
         <title>Selective Estrogen Receptor Modulator</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186595436</link>
         <description><![CDATA[<div><strong><em>Prototype:&nbsp; Raloxifene<br><br></em></strong>Pregnancy Risk Category X</div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-11 23:54:53 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186595436</guid>
      </item>
      <item>
         <title>Bisphosphonates</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186596036</link>
         <description><![CDATA[<div><br><strong><em>Prototype:&nbsp; Alendronate<br><br></em></strong>Pregnancy Risk Category C</div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 00:00:03 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186596036</guid>
      </item>
      <item>
         <title>Calcitonin</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186596216</link>
         <description><![CDATA[<div><br><strong><em>Prototype: Calcitonin-salmon<br><br></em></strong>Pregnancy Risk Category&nbsp;C</div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 00:01:22 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186596216</guid>
      </item>
      <item>
         <title>Expected pharmacological action:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612343</link>
         <description><![CDATA[<div>Maintain musculoskeletal, neurological and cardiovascular functions<br><br><br><br><br><br><br><br><br><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:45:51 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612343</guid>
      </item>
      <item>
         <title>Expected pharmacological action:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612497</link>
         <description><![CDATA[<ul><li>Work as endogenous estrogen in bone, lipid metabolism, and blood coagulation.</li><li>Decrease bone resorption, slowing bone loss and preserving bone mineral density.</li><li>Work as an antagonist to estrogen on breast and endometrial tissue</li><li>Can decrease plasma levels of cholesterol</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:46:52 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612497</guid>
      </item>
      <item>
         <title>Expected pharmacological action:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612523</link>
         <description><![CDATA[<div>Decrease the number and action of osteoclasts, and inhibit bone resorption<br><br><br><br><br><br><br><br><br><br><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:47:04 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612523</guid>
      </item>
      <item>
         <title>Expected pharmacological action:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612541</link>
         <description><![CDATA[<ul><li>Decrease bone resorption by inhibiting the activity of osteoclasts in osteoporosis</li><li>Increase renal calcium excretion by inhibiting tubular resorption</li></ul><div><br><br><br><br><br><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:47:12 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612541</guid>
      </item>
      <item>
         <title>Therapeutic uses</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612556</link>
         <description><![CDATA[<ul><li>Prevention/treatment of hypocalcemia or deficiencies of parathyroid hormone, Vitamin D or dietary calcium</li><li>Dietary supplement for adolescents, older adults, and women who are postmenopausal, pregnant or breastfeeding</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:47:20 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612556</guid>
      </item>
      <item>
         <title>Therapeutic uses:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612647</link>
         <description><![CDATA[<ul><li>Prevent and treat postmenopausal osteoporosis to prevent spinal fractures in female clients</li><li>Protection against breast cancer</li></ul><div><br></div>]]></description>
         <enclosure url="https://padletuploads.blob.core.windows.net/prod/218455069/3db86f53e6640f0dbd77cdd2051ec8e4/webmd_rm_photo_of_porous_bones.jpg" />
         <pubDate>2017-09-12 01:47:58 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612647</guid>
      </item>
      <item>
         <title>Therapeutic uses:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612663</link>
         <description><![CDATA[<ul><li>Prophylaxis and treatment of postmenopausal osteoporosis</li><li>For male clients who have osteoporosis</li><li>Prophylaxis treatment of osteoporosis produced by long-term glucocorticoid use</li><li>Treatment of Paget's disease of the bone</li></ul><div><br></div>]]></description>
         <enclosure url="https://padletuploads.blob.core.windows.net/prod/218455069/6e3ce58f1eaea884d2a6afd4c1d174c2/paget_s_image.jpg" />
         <pubDate>2017-09-12 01:48:08 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612663</guid>
      </item>
      <item>
         <title>Therapeutic uses:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612687</link>
         <description><![CDATA[<ul><li>Treatment of postmenopausal osteoporosis</li><li>Treatment of moderate to severe Paget's disease</li><li>Treatment of hypercalcemia caused by hyperparathyroidism</li><li>Treatment of cancer</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:18 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612687</guid>
      </item>
      <item>
         <title>Contraindications:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612711</link>
         <description><![CDATA[<ul><li>Hypercalcemia</li><li>Renal calculi</li><li>Hypophosphatemia</li><li>Digoxin toxicity</li><li>Ventricular fibrillation</li></ul><div><strong><em>Use cautiously in clients with:</em></strong></div><ul><li>Kidney disease</li><li>Decrease in GI function</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:32 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612711</guid>
      </item>
      <item>
         <title>Contraindications:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612725</link>
         <description><![CDATA[<ul><li>Pregnancy </li><li>History of venous thrombosis</li><li>Concurrent use with estrogen hormone therapy is discouraged</li></ul><div><br></div><div><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:39 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612725</guid>
      </item>
      <item>
         <title>Contraindications:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612743</link>
         <description><![CDATA[<ul><li>Dysphagia</li><li>Esophageal stricture</li><li>Esophageal disorders</li><li>Serious kidney impairment</li><li>Hypocalcemia</li><li>Should not be given to patients who cannot sit or stand for at least 30 minutes post administration</li><li>Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice and caffeine.&nbsp; </li></ul><div><strong><em>Use cautiously for clients who:</em></strong></div><ul><li>Are lactating women</li><li>Have histories of upper GI disorders, infection or liver impairment</li><li>Are older adults</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:45 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612743</guid>
      </item>
      <item>
         <title>Contraindications:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612753</link>
         <description><![CDATA[<ul><li>Hypersensitivity to fish protein</li><li>Concurrent use with lithium can decrease serum lithium levels</li></ul><div><strong><em>Use cautiously with:</em></strong></div><ul><li>Children</li><li>Women who are lactating&nbsp;</li><li>Patients with kidney disease</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:51 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612753</guid>
      </item>
      <item>
         <title>Side/Adverse Effects:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612772</link>
         <description><![CDATA[<ul><li>Hypercalcemia</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:48:58 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612772</guid>
      </item>
      <item>
         <title>Side/Adverse Effects</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612814</link>
         <description><![CDATA[<ul><li>Deep-vein thrombosis</li><li>Hot flashes</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:49:17 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612814</guid>
      </item>
      <item>
         <title>Side/Adverse Effects</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612829</link>
         <description><![CDATA[<ul><li>Esophagitis or esophageal ulceration&nbsp;</li><li>GI disturbances</li><li>Musculoskeletal pain</li><li>Visual disturbances</li><li>Kidney toxicity (IV infusion)</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:49:25 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612829</guid>
      </item>
      <item>
         <title>Side/Adverse Effects:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612861</link>
         <description><![CDATA[<ul><li>Nausea/vomiting</li><li>Nasal dryness and/or irritation</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 01:49:34 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186612861</guid>
      </item>
      <item>
         <title>Nursing Interventions:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616228</link>
         <description><![CDATA[<ul><li>Warm IV infusions of calcium to body temp before infusion</li><li>Administer IV injections at 0.5 to 2 mL/minute</li><li>Monitor serum calcium levels</li><li>Assess for signs of hypercalcemia</li></ul>]]></description>
         <enclosure url="https://padletuploads.blob.core.windows.net/prod/218455069/485f2521e3e306be10a8f18dd1a392cc/hypercalcemia.jpg" />
         <pubDate>2017-09-12 02:10:58 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616228</guid>
      </item>
      <item>
         <title>Nursing Interventions:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616336</link>
         <description><![CDATA[<ul><li>Medication should be stopped prior to scheduled immobilization (e.g., surgery) to decrease risk of DVT.&nbsp; Resume medication when patient is fully mobile.</li><li>Monitor for signs of DVT</li><li>Discourage long periods of sitting and inactivity.&nbsp;</li><li>Monitor bone density</li><li>Monitor serum calcium&nbsp;</li><li>Monitor liver function tests and for signs of liver toxicity</li></ul><div><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:11:32 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616336</guid>
      </item>
      <item>
         <title>Nursing Interventions:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616416</link>
         <description><![CDATA[<ul><li>Inform patients that Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice and caffeine</li><li>Instruct patient to sit upright or ambulate for 30 minutes after taking this medication orally</li><li>Withhold food or other medications for 1 hour after taking this medication orally</li><li>Provide (minimum) 8 oz. water to take with oral tablet and 2 oz. water with liquid formulation</li><li>Notify MD if patient shows signs of inadequate nutritional intake due to GI disturbances</li><li>Discontinue medication if client experiences blurred vision and eye pain and immediately contact the MD</li></ul><div><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:11:56 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616416</guid>
      </item>
      <item>
         <title>Nursing Interventions:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616448</link>
         <description><![CDATA[<ul><li>Should be administered by nasal spray (most common), IM or subcutaneously.&nbsp; Rotate injection sites to reduce inflammation</li><li>Keep the container in an upright position</li><li>Inspect nasal mucosa periodically for ulceration</li><li>Monitor serum calcium levels and bone density scans periodically</li><li>Check for Chvostek's or Trousseau's signs to monitor for hypocalcemia</li></ul>]]></description>
         <enclosure url="https://padletuploads.blob.core.windows.net/prod/218455069/4b7691cbfe9e92619cc3c5feda75afed/CATS_of_hypocalcemia.png" />
         <pubDate>2017-09-12 02:12:03 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616448</guid>
      </item>
      <item>
         <title>Patient Education:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616484</link>
         <description><![CDATA[<ul><li>Take 1 hour apart from glucocorticoids, tetracyclines, or thyroid hormones</li><li>Chewable tablets provide more consistent bioavailability</li><li>Do not change doses without consulting with MD, because recommended doses can vary widely depending on the specific calcium preparation</li><li>Take oral calcium with 8 oz. of water</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:12:11 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616484</guid>
      </item>
      <item>
         <title>Patient Education:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616538</link>
         <description><![CDATA[<ul><li>Medication can cause hot flashes</li><li>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.</li><li>Medication should be taken once every day</li><li>Medication can be taken with or without food</li><li>Follow up with MD for bone density scans every 12-18 months</li><li>Perform weight-bearing exercises daily for 30-60 minutes (e.g. walking)</li></ul><div><br><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:12:31 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616538</guid>
      </item>
      <item>
         <title>Patient Education:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616567</link>
         <description><![CDATA[<ul><li>Take medication first thing in the morning after getting out of bed.</li><li>Take oral medication on an empty stomach, drinking at least 8 oz. water with tablets and at least 2 oz. water with liquid formation</li><li>Sit or ambulate for 30 minutes after taking the medication</li><li>Avoid all calcium-containing foods and liquids or any medications within 30 minutes of taking alendronate</li><li>Do not chew or suck on the tablet</li><li>Perform weight-bearing exercises daily for 30-60 minutes</li><li>Notify MD of difficulty swallowing, painful swallowing, or new or worsening heartburn</li><li>If a dose is skipped, wait until next day 30 minutes before eating breakfast to take the dose.&nbsp; Do not take two tablets on the same day. &nbsp;</li><li>For maximum benefits, consume diet high in calcium and vitamin D</li></ul><div><br></div>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:12:44 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616567</guid>
      </item>
      <item>
         <title>Patient Education:</title>
         <author>amy_stein</author>
         <link>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616598</link>
         <description><![CDATA[<ul><li>If using nasal spray, alternate nostrils daily</li><li>Consume a diet high in calcium and vitamin D</li></ul>]]></description>
         <enclosure url="" />
         <pubDate>2017-09-12 02:12:52 UTC</pubDate>
         <guid>https://padlet.com/amy_stein/m495vuhpwp88/wish/186616598</guid>
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