Bifosfonatos

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction would
the nurse provide?

• 1. Take the medication at bedtime.

• 2. Take the medication in the morning with breakfast.

• 3. Lie down for 30 minutes after taking the medication.

• 4. Take the medication with a full glass of water after
  rising in the morning.

Answer explanation

Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal adverse effects
(especially esophageal irritation) and to increase absorption
of the medication. The medication needs to be taken with a
full glass of water after rising in the morning. The client is not
to eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.
Test-Taking Strategy: Focus on the subject, the administration of alendronate. Recalling that this medication can cause
esophageal irritation will direct you to the correct option.

The nurse has received a prescription for an oral bisphosphonate for a client with osteoporosis. Which finding in the client's medical history would contraindicate the administration of this medication?

• A.diabetes mellitus.

• B.hypercalcemia.

• C.lactose intolerance.

• D.Roux-en-Y gastric bypass

Answer explanation

Choice D is correct. Roux-en-Y gastric bypass is a surgery that contraindicates the client taking oral bisphosphonates. Bisphosphonates may adversely cause esophageal ulceration. The risk for significant esophageal ulceration is higher in those who have had this surgery because of the higher risk of reflux.

Choice A is incorrect. Diabetes mellitus is not a contraindication for a client taking bisphosphonates. Diabetes mellitus is a risk factor for osteoporosis.

Choice B is incorrect. Hypercalcemia is not a contraindication for bisphosphonates. Bisphosphonates may be a treatment for hypercalcemia. Hypocalcemia is a contraindication because bisphosphonates low serum calcium levels to put it into the bones via osteoblastic activity.

Choice C is incorrect. Lactose intolerance is not a contraindication for bisphosphonates. This problem with metabolism may lead to hypocalcemia if the client does not get non-dairy sources of calcium.

The nurse is conducting a client teaching session at the clinic for a client who has been prescribed a bisphosphonate for osteoporosis treatment.

Which instructions should the nurse provide to this client?

• A."Take this medication sitting upright first thing in the morning with a full glass of water."

• B."Take this medication at night, just before bed."

• C."This medication should be taken with a full meal."

• D."This medication is the best alternative if an esophageal disorder is present."

Answer explanation

Choice A is correct. Bisphosphonates should be taken first thing in the morning with a full glass of water. Clients should also wait 30 minutes to eat any food and should remain sitting or standing during that time. This prevents esophageal damage that may occur when this medication is taken improperly.

Choice B is incorrect. This medication should not be taken at night because the client needs to remain sitting or standing for 30 minutes following medication administration.

Choice C is incorrect. This medication should not be taken with a full meal.

Choice D is incorrect. Bisphosphonates are contraindicated in clients with esophageal disorders.

The nurse is preparing to give alendronate to the client with osteoporosis.

 The nurse should explain to the client that the expected outcome of this medication is primarily to

• A.decrease bone inflammation.

• B.increase synovial fluid in the joint space.

• C.inhibit bone resorption.

• D.increase serum calcium levels.

Answer explanation

Choice C is correct. Bisphosphonates such as risedronate, alendronate, ibandronate, zoledronic acid, and pamidronate are administered to inhibit bone resorption. Alendronate prevents bone loss by inhibiting and/or reversing osteoclast-mediated bone resorption. This medication is prescribed for the prevention and treatment of osteoporosis in men and in postmenopausal women. Bone resorption occurs when osteoblasts break down tissue in bones, which can cause shrinkage or loss of bone. Bisphosphonates decrease osteoclastic activity. The decrease in osteoclastic activity increases bone density, making the bone less prone to fracture.

Choice A is incorrect. Bisphosphonates are not anti inflammatory medications. Osteoporosis is not an inflammatory condition; it results from increased osteoclastic activity and decreasing bone density.

Choice B is incorrect. Bisphosphonates do not increase synovial fluid in the joint space. Osteoporosis is not a condition altering the synovial fluid in the joint space. Rheumatoid arthritis (RA) causes thickening of synovial joint fluid. Medications such as glucosamine chondroitin are used in conditions such as RA and osteoarthritis.

Choice D is incorrect. Bisphosphonates do not increase serum calcium levels. Instead, they inhibit osteoclastic activity, preventing the bone's calcium from going into the blood. For this reason, bisphosphonates can also be used in hypercalcemia.

The nurse provides medication teaching on the use of alendronate to a client with osteoporosis.


Which client statements indicate correct understanding of medication teaching? Select all that apply.

• 1. "I need to take this medication with a full glass of water."

• 2. "I should tell my healthcare provider if I start to have painful swallowing."

• 3. "I can sit and watch television for 30 minutes after taking this medication."

• 4. "I should take this medication in the evening with dinner so I never forget."

• 5. "Taking this medication regularly can make my bones stronger and prevent fractures."

Answer explanation

Bisphosphonates (e.g., alendronate, ibandronate) increase bone density and reduce fracture risk in clients with osteoporosis by inhibiting bone resorption [Choice 5]. Bisphosphonates can cause pill esophagitis (i.e., irritation of the esophagus). Client teaching to prevent and recognize esophagitis includes:

Taking the medication with a full, 8 ounce (240 mL) glass of water to minimize esophageal irritation [Choice 1].


Reporting any signs of pill esophagitis (e.g., pain with swallowing) to the healthcare provider [Choice 2].


Remaining seated upright for at least 30 minutes after taking alendronate to prevent reflux of medication into the esophagus [Choice 3]. Clients should stay upright for 60 minutes after taking the once-monthly bisphosphonate ibandronate.

Incorrect understanding:

Alendronate has an oral bioavailability of 1% when taken on an empty stomach; taking alendronate with food reduces oral availability to almost 0%. Bisphosphonates should be taken in the morning and on an empty stomach to ensure adequate absorption [Choice 4]. 

Fosamax (alendronate sodium) 60 mg by mouth is ordered. Fosamax 70 mg/75 ml. is available. How many milliliters should the nurse administer to the patient?
Round to the nearest whole number.

• A 56 mL

• B. 64 mL

• C. 65 mL

• D. 88 mL

Answer explanation

Reason: To determine if 56 mL is correct, we need to calculate the dosage.
The ordered dose is 60 mg, and the available concentration is 70 mg in 75 mL.
Using the ratio: 60 mg ÷ 70 mg = 0.8571 0.8571 × 75 mL = 64.2857 mL
Rounding 64.2857 mL to the nearest whole number gives us 64 mL, not 56 mL. Therefore, 56 mL is incorrect.
Reason: This choice is correct. The calculation is as follows: 60 mg ÷ 70 mg = 0.8571 0.8571 × 75 mL = 64.2857 mL Rounding 64.2857 mL to the nearest whole number gives us 64 mL. Thus, the nurse should administer 64 mL.
Reason: To determine if 65 mL is correct, we follow the same calculation: 60
mg = 70 mg = 0.8571 0.8571.x 75 mL = 64.2857 mL. Rounding 64.2857 mL to
Lithe nearest whole number gives us 64 mL, not 65 mL. Therefore, 65 mL is
incorrect.
Reason: To determine If 88 mL is correct, we follow the same calculation: 60 mg - 70 mg = 0.8571 0.8571 ≤ 75 mL = 64.2857 mL Rounding 64.2857 mL to the nearest whole number gives us 64 mL, not 88 mL. Therefore, 88 mL is incorrect.

A nurse is reviewing a new prescription for alendronate 70 mg PO once per week upon waking to be taken 30 min before food, fluids, or medication with a client who has osteoporosis. The client is to remain upright for 30 min after administration. How should the nurse interpret this prescription for the client?

• A. Take the medication at 1800, 30 min afler the evening meal

• B. Over-the-counter oral preparations can be taken with this medication.

• C. Choose the same day of each week to take this medication:

• D. The client can retur to bed'after taking the medication, but before eating

Answer explanation

Take the medication at 1800, 30 min after the evening meal. is incorrect.
• Statement:The prescription specifies that the medication should be taken upon waking, 30 minutes before any food, fluids, or other medications. Taking it at 1800,30 minutes after the evening meal, would not meet these requirements.
Over-the-counter oral preparations can be taken with this medication. is incorrect
• Statement:The prescription states that alendronate should be taken 30 minutes before any other medications. This includes over-the-counter oral preparations, as they could potentially interfere with the absorption of alendronate.
Choose the same day of each week to take this medication. is the correct interpretation of the prescription.
• Statement:Alendronate is typically taken once a week to maintain consistent levels in the body and effectively treat osteoporosis. Choosing the same day each week helps ensure that the medication is taken regularly and consistently.
The client can return to bed after taking the medication, but before eating. is incorrect. Statement: The prescription instructs the client to remain upright for 30 minutes after taking alendronate. This is because lying down can increase the risk of the medication irritating the esophagus.

Which instruction should a nurse give to a client taking alendronate (Fosamax) for osteoporosis?

• A. Chew the tablef well and report any dillicully swallowing

• B. Take the medication with six to eight ounces of milk.

• C. Lie down for 15 to 30 minutes afler taking the medicallion.

• D. Take this medication al least 30 minutes before ingesting any food or medication.
  Explanation

Answer explanation

Chew the tablet well and report any difficulty swallowing. This is wrong because alendonate fablets should nof be chewed or crushed, but swallowed whole with a full glass of plain water.
Chewing or crushing the tablets can increase the risk of imtation or damage to the esophagus (the tube that connects the mouth to the stomach). Difticulty swallowing is a possible side effect of alendronate and should be reported to the doctor, but a is not an instruction for taking the medication.
Take the medication with sor to eight cunces of mik. This is wrong because milk contains calcium, which can bind to alendanale and prevent its absorption. Alendronate should not be taken with any beverages other than plain water
Lie down for 15 to 30 minutes after taking the medication. This is wrong because lying down aller faking alendronale can increase the risk of esophageal infaton or ulceration. Alendronate should be taken in the moming, at least 30 minutes before eating or drinking anything, and the person shoukd remain upright (sitting or standing) for al least 30 minules after faking it.
This is because alendonate (Fosamax) is a bisphosphonale that works by inhibiting tha breakdown and reabsorption of bone. However, it has a very low bioavadability, which means that oniy a small amount of the drug is absorbed into the bloodstream when faken orally. Therefore, faking it with food or other medications can interfere with its absorption and reduce is alfectiveness

The nurse provides medication teaching on the use of alendronate to a client with osteoporosis.


Which client statements indicate correct understanding of medication teaching? Select all that apply.

• 1. I need to take this medication with a full glass of water."

• 2I should tell my healthcare provider if I start to have painful swallowing."

• 3. i can sit and watch television for 30 minutes after taking this medication."

• 4, i should take this medication in the evening with dinner so I never forget."

• 5. Taking this medication regularly can make my bones stronger and prevent fractures."

Answer explanation

Bisphosphonates (e.g., alendronate, ibandronate) increase bone density and reduce fracture risk in clients with osteoporosis by inhibiting bone resorption [Choice 5]. Bisphosphonates can cause pill esophagitis (i.e., irritation of the esophagus). Client teaching to prevent and recognize esophagitis includes:

Taking the medication with a full, 8 ounce (240 mL) glass of water to minimize esophageal irritation [Choice 1].


Reporting any signs of pill esophagitis (e.g., pain with swallowing) to the healthcare provider [Choice 2].


Remaining seated upright for at least 30 minutes after taking alendronate to prevent reflux of medication into the esophagus [Choice 3]. Clients should stay upright for 60 minutes after taking the once-monthly bisphosphonate ibandronate.

Incorrect understanding:

Alendronate has an oral bioavailability of 1% when taken on an empty stomach; taking alendronate with food reduces oral availability to almost 0%. Bisphosphonates should be taken in the morning and on an empty stomach to ensure adequate absorption [Choice 4].

Key Takeaway:

Bisphosphonates increase bone density and reduce fracture risk in clients with osteoporosis.

To prevent pill esophagitis, take alendronate with a glass of water and remain seated for 30 minutes.

Alendronate should be taken in the morning on an empty stomach.