A nurse is reviewing the medical record of a female client who asks about a prescription for alendronate for the treatment of osteoporosis. Which of the following findings should the nurse identify as a safety risk for the client when taking this medication?
A.
The client has a history of anaphylaxis following a bee sting.
B.
The client has a first-degree relative who has Paget’s disease.
C.
The client is postmenopausal.
D.
The client has immobility that restricts her to a supine position.
The Correct answer and Explanation is:
The correct answer is:
D. The client has immobility that restricts her to a supine position.
Explanation:
Alendronate is a bisphosphonate used to treat osteoporosis by inhibiting bone resorption, thereby increasing bone density and reducing the risk of fractures. However, this medication has specific administration guidelines and contraindications that are critical to ensuring patient safety.
Alendronate must be taken with a full glass of water, at least 30 minutes before the first meal or drink of the day, and the patient must remain upright (either sitting or standing) for at least 30 minutes after taking the medication. This is crucial because alendronate can cause severe esophageal irritation, including esophagitis, esophageal ulcers, or even esophageal perforation. If the client is immobile and cannot remain upright, there is a significant risk of the medication lingering in the esophagus, leading to these severe complications. Therefore, immobility that restricts the client to a supine position is a safety risk and may contraindicate the use of alendronate.
Option A (Anaphylaxis following a bee sting): Anaphylaxis is a severe allergic reaction, but it is unrelated to alendronate use. There is no known cross-reactivity between bee venom and alendronate, so this does not present a specific safety risk for taking the medication.
Option B (First-degree relative with Paget’s disease): Paget’s disease is a disorder of abnormal bone remodeling. While alendronate is sometimes used to treat Paget’s disease, having a relative with this condition does not increase the risk of taking the medication. This factor is not a safety concern.
Option C (Postmenopausal status): Postmenopausal women are commonly prescribed alendronate for osteoporosis because the loss of estrogen increases bone resorption, leading to decreased bone density. Being postmenopausal is not a safety risk; rather, it is an indication for the treatment.
In summary, immobility that restricts a client to a supine position poses a significant safety risk due to the potential for esophageal irritation and damage. Thus, the nurse should identify this as a contraindication for alendronate therapy and discuss alternative treatments with the healthcare provider.