Zoledronic Acid

INTRODUCTION

Indications

Hypercalcemia of malignancy (Zometa only). Multiple myeloma and metastatic bone lesions from solid tumors (Zometa only). Paget's disease (Reclast only). Treatment of osteoporosis in postmenopausal women (Reclast only). Prevention of new clinical fractures in patients with recent low-trauma hip fracture (Reclast only).

Action

Inhibits bone resorption. Inhibits increased osteoclast activity and skeletal calcium release induced by tumors. Therapeutic Effects: ↓ serum calcium. ↓ serum alkaline phosphatase. ↓ fractures; radiation/surgery to bone, or spinal cord compression in patients with multiple myeloma or metastatic bone lesions. ↓ hip, vertebral, or nonvertebral osteoporosisrelated fractures. ↓ new fractures in patients with recent low-trauma hip fractures.

Adverse Reactions/Side Effects

CNS: agitation, anxiety, confusion, insomnia. EENT: conjunctivitis. CV: hypotension, chest pain, leg edema. GI: abdominal pain, constipation, diarrhea, nausea, vomiting, dysphagia. GU: renal failure. Derm: pruritus, rash. F and E: hypophosphatemia, hypocalcemia, hypokalemia, hypomagnesemia. Hemat: anemia. MS: musculoskeletal pain, osteonecrosis (primarily of jaw). Misc: fever, flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any joint pain, muscle pain, or muscle spasms. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology, including fracture. Be especially aware of possible mouth and jaw pain due to osteonecrosis of the jaw.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor any chest pain and attempt to determine if pain is drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and bruising, and pale skin. Notify physician immediately if these signs occur.

• Monitor signs of electrolyte imbalances (hypocalcemia, hypokalemia, etc.), including headache, lethargy, confusion, weakness, irritability, and muscle hyperexcitability, tremors, cramping, and tetany. Notify physician immediately if these signs occur.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs immediately to the physician.

• Monitor and report anxiety, agitation, confusion, or other changes in mood and behavior.

Interventions

• Institute weight-bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low-impact or aquatic programs in patients with extensive demineralization, and ...