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INTRODUCTION

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alendronate (a-len-drone-ate)

Fosamax

Classification

Therapeutic: bone resorption inhibitors

Pharmacologic: biphosphonates

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Indications
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Treatment and prevention of postmenopausal osteoporosis. Treatment of osteoporosis in men. Treatment of Paget's disease of the bone. Treatment of corticosteroid-induced osteoporosis in patients (men and women) who are receiving ≥7.5 mg of prednisone/day (or equivalent) with evidence of decreased bone mineral density.

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Action
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Inhibits resorption of bone by inhibiting osteoclast activity. Therapeutic Effects: Reversal of the progression of osteoporosis with decreased fractures. Decreased progression of Paget's disease.

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Adverse Reactions/Side Effects
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CNS: headache. EENT: blurred vision, conjunctivitis, eye pain/inflammation. CV: atrial fibrillation. GI: abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophageal ulcer, flatulence, gastritis, nausea, taste perversion, vomiting. Derm: erythema, photosensitivity, rash. MS: musculoskeletal pain, osteonecrosis (primarily of jaw).

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess heart rate, ECG, and heart sounds (See Appendices G, H). Report rhythm disturbances such as atrial fibrillation, or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess any muscle or joint pain. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology including fracture. Be especially aware of possible mouth and jaw pain due to osteonecrosis of the jaw.

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Interventions
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  • Institute weight-bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low impact or aquatic programs in patients with extensive demineralization, and increase exercise intensity slowly to prevent fractures.

  • Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.) and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

  • Because of the risk of cardiac arrhythmias (atrial fibrillation, others), use caution during aerobic exercise and endurance conditioning Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, unusual fatigue), or displays other criteria for exercise termination (See Appendix L).

  • Causes photosensitivity; use care if administering UV treatments.

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Patient/Client-Related Instruction
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  • Encourage patient to modify behaviors that increase the risk of osteoporosis (stop smoking, reduce alcohol consumption).

  • Advise patient about the benefits of proper diet in sustaining bone mineralization. If necessary, refer patient for nutritional counseling about supplemental calcium and vitamin D.

  • Instruct patient on the importance of taking this drug exactly as directed, and to remain upright for 30 min following dose to facilitate passage to stomach and minimize risk of esophageal irritation.

  • Instruct patient to notify physician about any vision disturbances or eye pain and inflammation.

  • Advise patient about photosensitivity, and to use sunscreens, protective clothing, and avoid prolonged sun exposure. Instruct patient to report any rashes or other skin reactions.

  • Instruct patient to report other ...

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