McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

TABLE 37.4

DRUGS IN FOCUS Parathyroid agents

Drug name

Dosage/route

Usual indications

Antihypocalcaemic agents calcitriol (Kosteo, Rocaltrol)

0.5–2 mcg/day PO in the morning

Management of hypocalcaemia and reduction of parathormone levels Management of osteoporosis in postmenopausal women and men with primary hypogonadal osteoporosis who do not respond to standard therapy

teriparatide (Forteo)

20 mg SC daily

Antihypercalcaemic agents Bisphosphonates alendronate (generic)

10 mg/day PO; for males and for postmenopausal osteoporosis, 70 mg PO every week or 10 mg/day PO for treatment, 35 mg PO every week or 5 mg/day PO for prevention Initially, 2400–3600 mg PO daily in divided doses Maintenance: 1600 mg PO daily

Treatment of Paget’s disease, postmenopausal osteoporosis

treatment and prevention, treatment of glucocorticoid-induced osteoporosis, osteoporosis in men Treatment of hypercalcaemia in malignancy; treatment of osteolytic metastases Treatment of Paget’s disease, postmenopausal osteoporosis, hypercalcaemia of malignancy, osteolytic bone lesions in people with cancer Treatment of metatstic bone disease in breast cancer and tumour induced hypercalcaemia Treatment of Paget’s disease, postmenopausal osteoporosis in women, hypercalcaemia of malignancy, osteolytic bone lesions in people with cancer Treatment of osteoporosis and preservation of bone mineral density in patients receiving long-term corticosteroids Treatment of Paget’s disease, postmenopausal osteoporosis in women, hypercalcaemia of malignancy, osteolytic bone lesions in certain people with cancer Treatment of Paget’s disease

clodronate (Bonefos)

etidronate (Didronel)

5–10 mg/kg per day PO

ibandronate (Bondronat)

50 mg PO daily or 6 mg IV q 4 weeks

pamidronate (Aredia)

60–90 mg IV

risedronate (Acris, Actonel)

35 mg PO once weekly or 150 mg PO once monthly

tiludronate (Skelid)

400 mg PO daily for 3 months

zoledronic acid (Aclasta, Zometa)

4 mg IV as a single infusion over not less than 15 minutes (given once a year for postmenopausal osteoporosis)

Calcitonins (salcitonin) calcitonin salmon (salcitonin)* (Miacalcic)

Paget’s disease: 50–100 International Units/ day SC or IM Hypercalcemia: 4–8 International Units/kg SC or IM q 12 hours

Treatment of Paget’s disease, postmenopausal osteoporosis in

conjunction with vitamin D and calcium supplements; emergency treatment of hypercalcaemia

* This drug is not available in New Zealand

Clinically important drug–drug interactions The risk of hypermagnesaemia increases if these drugs are taken with magnesium-containing antacids. This combination should be avoided.

Reduced absorption of these compounds may occur if they are taken with cholestyramine or mineral oil because they are fat-soluble vitamins. If this combination is used, the drugs should be separated by at least 2 hours.