Question

Bone and Joint Drugs Case Study Assignment

MS is a relatively healthy 73 year old retired clerk who has recently been diagnosed with post-menopausal osteoporosis. She has been prescribed treatment with ibandronate 150 mg each month. She has many questions, and you are reviewing the drug and its use with her.

Questions

MS tells you she likes to heave breakfast, take her morning medications, and then lie down on the couch to read the morning newspaper. She asks whether the ibandronate will fit into her routine. What will you tell her?

A week later, MS calls the clinic to ask what to use for headaches. She mentions she has several different types of pills and asks you if they are all same. How will you respond?

A few months later MS comes in for a follow up visit. She tells you that she is due for her next osteoporosis next week, but she has been having some jaw pain ever since she went to the dentist 2 weeks earlier to have a tooth pulled. She is worried that her osteoporosis has affected her jaw. What could be the reason for this pain? What do you think will be done about it?

Answer 1

· MS tells you she likes to heave breakfast, take her morning medications, and then lie down on the couch to read the morning newspaper. She asks whether the ibandronate will fit into her routine. What will you tell her?

MS will need to change the schedule once a month to prevent risks of the ibandronate drug therapy. When these drugs are trapped in the esophagus before entering the stomach, there is a chance of esophageal burns.To prevent adverse effects, such as stomach discomfort or bleeding and drug reactions, the drug must be administered first thing in the morning and without any other drugs. Certain steps to help in reducing complications or adverse effects include:

• Take ibandronate with 8 ounces of water or more.

• Wait 30 minutes until any other fluid, food, or medicine is taken.

• Try to remain upright for 30 minutes after taking the drug. The patient must be instructed that she should not lie down for up to 30 minutes after taking the drug under any circumstances.

· A week later, MS calls the clinic to ask what to use for headaches. She mentions she has several different types of pills and asks you if they are all same. How will you respond?

Bisphosphonate drug interactions include medications that are irritating when absorbed in the stomach, such as non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin. Other drug interactions with any medication taken along with ibandronate may occur, so this drug needs to be taken by itself, and other medications that are ordered and not contraindicated need to be taken at least 30 minutes later. Calcium supplements and antacids can interfere with the Bisphosphonate absorption, and these drugs therefore need to be spaced 1 to 2 hours apart. Acetaminophen (Tylenol), would be a good over-the-counter choice for pain.

· A few months later MS comes in for a follow up visit. She tells you that she is due for her next osteoporosis next week, but she has been having some jaw pain ever since she went to the dentist 2 weeks earlier to have a tooth pulled. She is worried that her osteoporosis has affected her jaw. What could be the reason for this pain? What do you think will be done about it?

A risk of bisphosphonate therapy is jaw osteonecrosis including severe and possibly disabling pain in the bone , muscle, or jaw. Nonetheless, the jaw problems may be due to delayed healing and infection that may occur after dental procedures, such as Extraction of the dents. Assess the symptoms of MS, and then promptly inform her health care provider that the medication will need to be discontinued. Osteoporosis generally does not affect the jaw.