A 70-year-old patient who has a high fracture risk has been ...

[Caiter2013]

A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx level, which is 42 . The NP should discontinue the alendronate and prescribe:
 
  a. raloxifene (Evista).
  b. teriparatide (Forteo).
  c. calcitonin (Miacalcin nasal spray).
  d. ibandronate sodium (Boniva).

Question 2

A patient takes hydrochlorothiazide to treat hypertension and asks the primary care NP why it is necessary to reduce sodium intake while taking this medication. The NP should explain that decreasing sodium is necessary to:
 
  a. prevent renal insufficiency.
  b. minimize the risk of hypokalemia.
  c. prevent postdiuretic sodium retention.
  d. increase the likelihood that the drug may be discontinued.

[heyhey123]

Answer to Question 1

B
Teriparatide is used in patients with a high fracture risk or in whom bisphosphonate therapy has failed. Raloxifene and ibandronate are second-line treatments for patients with usual fracture risks. Calcitonin is a last-line treatment.

Answer to Question 2

C
If dietary salt intake is high, the amount of sodium lost in response to the diuretic may be partially or completely offset by postdiuretic sodium retention. Sodium restriction does not prevent renal insufficiency or minimize the incidence of hypokalemia. Sodium restriction is necessary to maintain the drug's effectiveness but does not increase the chance of discontinuing the medication.

[Caiter2013]

Gracias!

[bulacsom]

Excellent