zoledronic acid audit
TRANSCRIPT
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Zoledronic acid Audit
Dr R Musa
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Introduction
Zoledronic Acid Highly potent bisphosphonate
Developed for therapy of malignant hypercalcaemia
Major advantage once yearly IV infusion over 15 mins
IV route lowers risk of esophagitis seen with oral bisphosphonate
Licensed for postmenopausal osteoporosis
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Reduce New Clinical Fracture
38% RRR 5% ARR NNT 20
13.9%
8.6%
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Adverse Events
Atrial fibrillation (1.3% with ZA vs 0.5% with placebo)
Adverse events more common in treatment group than placebo group:
– Myalgias around infusion time (3.1 vs 0.9%)– Pyrexia around infusion time (6.9 vs 0.9%)
No reported cases of osteonecrosis of the jaw
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Conduct of the Audit
The aims of the AuditTo evaluate the current practice of Zoledronic acid therapy at NNUH.
Methods: The Audit form prepared by Dr R Musa Data collected by the nurses in rheumatology day units The period from (March 2009 to June 2009) 4 months Total of (12 patients) attended for Zolendronic acid infusion 11 patients had the infusion
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Indication for Aclasta
73 % osteoporosis
3% osteoporosis + Malignancies
3% Paget disease
3% Pathologic fracture
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which osteoporosis therapy tried
IV Pamidronate (3)
Alendronic acid (5)
Ibandronate
Risedronate (1)
Actonel (1)
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Have the information been explained to the patients
Have the information been explained to the patient
0
2
4
6
8
Yes(7) patients
No(2) patients
Do notKnow(2) patients
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Has the patient been given oral calcium & Vitamin D
Yes (55%)
No(36%)
Do not know (3%)
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Creatinine clearance > 40ml/min
02468
1012
11 patients One patientC.C < 35Not given ZA
All patients
have their
calcium level
Checked(100%)
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5 patients Not told to drink more water
5 patients Told to drink more water
One patient Given tea
Has the patient been told to drink glass of water before the infusion
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Observation for 20 min after the end of infusion
73% (Yes)
27 % (No)
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YES (91%)
NO(9%)
Has the patient been informed that one third may develop flu like illness
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Conclusion
1-make sure the indication for ZA in NNUH is for osteoporosis
2-patient already tried all usual Osteoporotic therapy before referral for ZA
3-information should be explained to patients and given leaflet during clinic time.
4-patients should be given adequate Vit D & Ca supplement before referral for ZA infusion
5-Creatinine clearance and Calcium level should be checked
6-patient should be told to drink adequate water before ZA infusion