Osteoporosis Care Sheet

Transcription

1 Osteoporosis Care Sheet Serial no Keynote for Osteoporosis Care Not to emphasize side effect too much. No need to explain too many things at the first counseling. Support patient's self care! 1) Diagnosis and evaluation BMD t-score (SD) Definition Bone Profile -1 Normal Albumin: g/l < -1 to > -2.5 Osteopenia (low bone mass) Ca: mmol/l -2.5 Osteoporosis PO 4 : mmol/l fragility fracture Severe / established osteoporosis Alk Phosphatase: IU/L BMD t-score (SD) Definition The World Health Organisation (WHO) definitions based on BMD T score: comparison with young adult mean 2) Risk factors associated with osteoporosis Potentially modifiable Non modifiable Inadequate intake of calcium or vitamin D Advanced age Use of medications (glucocorticoids, anticonvulsants or Early menopause antineoplastics) Small body build or low body weight First degree relative with fracture Estrogen deficiency Race (Caucasian or Asian) Current cigarette smoking Dementia Excessive alcohol intake Hormonal, neoplastic or connective tissue disorders Sedentary lifestyle Poor health Environmental risks (loose rugs, dark stairs, etc) Female Poor eyesight History of organ transplants 3) Nutrition recommendations 4)Exercise Adequate intake of Calcium through food and (see table 1) "Anytime, Anywhere, By yourself" Low fat, high Calcium diet (see table 2) Walking 1-2 times/day 30mins/time etc Vitamin or mineral (vitamin D) Exercising stimulates bone growth Advise on smoking cessation Precaution against over-exercising Table 1: Calcium daily requirements Amount (mg/day) Children Ages Adolescents and young Ages adults Adult women Pregnant or lactating Ages (Premenopausal women) 1000 Ages (Postmenopausal women on HRT) 1000 Ages (Postmenopausal women not on HRT) 1500 Ages Adult men Ages Ages Source: National Institutes of Health Consensus Development Panel ( Table 2 Food sources for calcium Food Serving Calcium content Skim or 1% fat milk 8 oz 300mg Sardines with bones 3 oz 371mg Fresh brocolli (cooked and drained) 1 cup 172mg Tofu 4 oz 154mg

2 5) Drug treatment Bisphosphonates Mode of action Administ ration Missed doses Adverse reaction (Alendronate) Rebuild bone and makes bone less likely to fracture HRT SERM Calcitriol Calcium Active form of vitamin D. Improves the absorption of calcium from the intestine and by stimulating growth of healthy bones. Maintains bone. Cannot prevent or cure osteoporosis, but important part of the overall treatment for osteoporosis. Before food with or without food. Separate doses of calcium to bd. Calcium carbonate- taken with food. Calcium lactate - taken any time. Separate intake of alendronate & calcium by at least 30 minutes. * stomach pain * gas in the stomach * feeling sick (nausea), vomiting * constipation, diarrhoea * headache * aching muscles, joints or bones * skin rash or redness of the skin, * mouth ulcers * difficulty or pain upon swallowing * chest pain * new or worsening heartburn Counseling notes for Alendronate Administration 70mg weekly. Choose a day of the week to take tablet. Take tablet after getting up for the day. Do not take it at bedtime. Swallow whole with a full glass of plain water only. Stay upright (sitting, standing or walking around) for at least 30 minutes after swallowing Do not lie down immediately after swallowing it. Do not take at bedtime or before getting up for the day. Wait at least 30 minutes before taking any food, other drinks or medicines Do not chew or suck 10mg daily - As above except dosage is taken once daily Do not take an extra dose. Wait until the next dose and take your normal dose then. Do not double dose. * loss of appetite * feeling sick * headache * fever * vomiting or stomach ache * constipation * weakness or muscle weakness * dry mouth or thirst * irregular and/or rapid heart beat * urinary tract infection Missed doses 70 mg tablet Take one tablet on the morning after you remember. Do not take two tablets on the same day. Return to taking one tablet once a week, as originally scheduled on your chosen day. 10 mg tablet Skip the dose you missed and take your next dose the following morning. If you take the forgotten tablet after you have eaten or had a drink, it will not work as well as it should. Do not take a double dose to make up for the dose that you missed.

3 Pharmacist checklist Visit no Date Does Pt know their BMD level? Does pt know how to take alendronate/risedronate? Can pt describe how they take their 1 As soon as get up from bed 1 As soon as get up from bed 1 As soon as get up from bed medication? Does pt understand Purpose of medication? Side effect? Missed doses? 1 Yes 2 No Does pt know risk factors for osteoporosis? Lifestyle modifications 1Adequate Calcium intake 1Adequate Calcium intake 1Adequate Calcium intake 2Low fat high Calcium foods 2Low fat high Calcium foods 3Vitamin or mineral 3Vitamin or mineral 2Low fat high Calcium foods 3Vitamin or mineral 4 Smoking cessation 4 Smoking cessation 4 Smoking cessation 5Drug-drug interaction 5Drug-drug interaction 5Drug-drug interaction 6Exercise regularly 6Exercise regularly 6Exercise regularly 7 Preventing falls 7 Preventing falls 7 Preventing falls Any hospitalizations since we last met? Any ADR or complications? (Brief description of incident)

4 Types of 1Inappropriate dose / regimen 2Wrong strength / not available 3Inappropriate dosage form 4Inappropriate quantity/duration 5Drug-drug interaction 6Contraindication 7Allergy / Sensitivity 8Side effects/toxicity 9Duplicate therapy 10Cost saving 11Others 1Inappropriate dose / regimen 2Wrong strength / not available 3Inappropriate dosage form 4Inappropriate quantity/duration 5Drug-drug interaction 6Contraindication 7Allergy / Sensitivity 8Side effects/toxicity 9Duplicate therapy 10Cost saving 11Others 1Inappropriate dose / regimen 2Wrong strength / not available 3Inappropriate dosage form 4Inappropriate quantity/duration 5Drug-drug interaction 6Contraindication 7Allergy / Sensitivity 8Side effects/toxicity 9Duplicate therapy 10Cost saving 11Others Recommendation Action taken by pharmacist 1Contact prescriber 2Check patient s profile 3Check drug information sources 4 Others Time taken to resolve problem (min) Type of 1life saving 2prevents organ damage 3moderately important 4minor importance 1Contact prescriber 2Check patient s profile 3Check drug information sources 4 Others 1life saving 2prevents organ damage 3moderately important 4minor importance 1Contact prescriber 2Check patient s profile 3Check drug information sources 4 Others 1life saving 2prevents organ damage 3moderately important 4minor importance

5 Follow up via telephone calls Tel calls Date How are you? Why not good? Any problems with taking medicines? If yes, what is the problem? Have you missed any doses? If yes, why? Is there anything else I can help you with? Additional comments