TERIPARATIDE

TERIPARATIDE
(ter-i-par'a-tide)
Forteo
Classifications: hormone; parathyroid hormone agonist;
Therapeutic: parathyroid hormone agonist

Pregnancy Category: C

Availability

750 mcg/3 mL injection

Action

Parathyroid hormone (PTH) is the primary regulator of calcium and phosphate metabolism in bone and kidney. Actions of PTH include regulation of bone metabolism, renal reabsorption of calcium and phosphate, and intestinal calcium absorption. Biological actions of PTH and teriparatide are similar in bone and the kidneys.

Therapeutic Effect

Stimulates new bone formation by preferential stimulation of osteoblastic activity over osteoclastic activity; improves bone microarchitecture, and increases bone mass and strength by stimulating new bone formation.

Uses

Treatment of osteoporosis in postmenopausal women at high risk for fracture; increase bone mass in men with primary or hypogonadal osteoporosis who are at high risk for fracture.

Contraindications

Hypersensitivity to teriparatide; osteosarcoma; Paget's disease; unexplained elevations of alkaline phosphatase; bone metastases or a history of skeletal malignancies; metabolic bone diseases other than osteoporosis; preexisting hypercalcemia; prior history of radiation therapy involving the skeleton; pediatric patients or young adults with open epiphyses; children 18 y and younger; lactation; pregnancy (category C).

Cautious Use

Active or recent urolithiasis, hypercalciuria; hypotension; concurrent use of digitalis; hepatic, renal, and cardiac disease.

Route & Dosage

Osteoporosis
Adult: SC 20 mcg q.d.

Administration

Subcutaneous
  • Do not administer to anyone with hypercalcemia. Consult physician.
  • Rotate SC injection sites.

Adverse Effects (≥1%)

Body as a Whole: Pain, asthenia, neck pain. CNS: Headache, dizziness, depression, insomnia, vertigo. CV: Hypertension, angina, syncope. GI: Nausea, constipation, dyspepsia, vomiting. Metabolic: Transient increase in calcium levels, increase in serum uric acid, antibodies to teriparatide after 12 mo therapy. Musculoskeletal: Arthralgia, leg cramps. Respiratory: Rhinitis, cough, pharyngitis, dyspnea, pneumonia. Skin: Rash, sweating.

Interactions

Drug: May increase risk of digoxin toxicity.

Pharmacokinetics

Absorption: Extensively absorbed from SC site. Onset: 2 h for calcium concentration increase. Peak: Max. calcium concentrations 4–6 h. Duration: 16–24 h. Metabolism: Parathyroid hormone is metabolized non-specific enzymes. Elimination: Primarily in urine. Half-Life: 1 h SC.

Nursing Implications

Assessment & Drug Effects

  • Monitor cardiovascular status including BP and subjective reports of angina.
  • Lab tests: Monitor periodically serum calcium, alkaline phosphatase, uric acid and bone density levels.
  • Concurrent drugs: Monitor closely for digoxin toxicity with concurrent use.

Patient & Family Education

  • Report unexplained leg cramps and bone pain.
  • Learn correct technique for SC injection.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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