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INTRODUCTION

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risedronate (ris-ed-roe-nate)

Actonel

Classification

Therapeutic: bone resorption inhibitors

Pharmacologic: bisphosphonates

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Indications
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Prevention and treatment of postmenopausal and corticosteroid-induced osteoporosis. Treatment of Paget's disease in men and women. Treatment of osteoporosis in men.

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Action
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Inhibits bone resorption by binding to bone hydroxyapatite, which inhibits osteoclast activity. Therapeutic Effects: Reversal of the progression of osteoporosis with decreased fractures and other sequelae. Reduced bone turnover and resorption; normalization of serum alkaline phosphatase with reduced complications of Paget's disease.

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Adverse Reactions/Side Effects
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CNS: weakness. EENT: amblyopia, conjunctivitis, dry eyes, eye pain/inflammation, tinnitus. CV: chest pain, edema. GI: abdominal pain, diarrhea, belching, colitis, constipation, dysphagia, esophagitis, esophageal ulcer, gastric ulcer, nausea. Derm: rash. MS: arthralgia, musculoskeletal pain, osteonecrosis (primarily of jaw). Misc: flu-like syndrome.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • 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.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

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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.

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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.

  • Instruct patient to report other troublesome side effects such as severe or prolonged weakness, chest pain, skin rash, buzzing/ringing in the ears (tinnitus), flu-like symptoms, new/worsening heartburn, or other GI problems (nausea, diarrhea, constipation, difficulty swallowing, belching, abdominal pain).

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Pharmacokinetics
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Absorption: Rapidly but poorly absorbed following oral administration (0.63% bioavailability).

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Distribution: 60% of absorbed dose distributes to bone.

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Metabolism and Excretion: 40% of absorbed dose is excreted unchanged ...

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