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Zoledronic Acid Audit

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Zoledronic Acid Audit

  1. 1. Zoledronic acid Audit Dr R Musa
  2. 2. Introduction <ul><li>Zoledronic Acid Highly potent bisphosphonate </li></ul><ul><li>Developed for therapy of malignant hypercalcaemia </li></ul><ul><li>Major advantage once yearly IV infusion over 15 mins </li></ul><ul><li>IV route lowers risk of esophagitis seen with oral bisphosphonate </li></ul><ul><li>Licensed for postmenopausal osteoporosis </li></ul>
  3. 3. Reduce New Clinical Fracture <ul><li>38% RRR </li></ul><ul><li>5% ARR </li></ul><ul><li>NNT 20 </li></ul>13.9% 8.6%
  4. 4. Adverse Events <ul><li>Atrial fibrillation (1.3% with ZA vs 0.5% with placebo) </li></ul><ul><li>Adverse events more common in treatment group than placebo group: </li></ul><ul><ul><li>Myalgias around infusion time (3.1 vs 0.9%) </li></ul></ul><ul><ul><li>Pyrexia around infusion time (6.9 vs 0.9%) </li></ul></ul><ul><li>No reported cases of osteonecrosis of the jaw </li></ul>
  5. 5. Conduct of the Audit <ul><li>The aims of the Audit To evaluate the current practice of Zoledronic acid therapy at NNUH. </li></ul><ul><li>Methods: </li></ul><ul><li>The Audit form prepared by Dr R Musa </li></ul><ul><li>Data collected by the nurses in rheumatology day units </li></ul><ul><li>The period from (March 2009 to June 2009) 4 months </li></ul><ul><li>Total of (12 patients) attended for Zolendronic acid infusion </li></ul><ul><li>11 patients had the infusion </li></ul>
  6. 7. Indication for Aclasta 73 % osteoporosis 3% osteoporosis + Malignancies 3% Paget disease 3% Pathologic fracture
  7. 8. which osteoporosis therapy tried IV Pamidronate (3) Alendronic acid (5) Ibandronate Risedronate (1) Actonel (1)
  8. 9. 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 not Know (2) patients
  9. 10. Has the patient been given oral calcium & Vitamin D Yes (55%) No (36%) Do not know (3%)
  10. 11. Creatinine clearance > 40ml/min 0 2 4 6 8 10 12 11 patients One patient C.C < 35 Not given ZA All patients have their calcium level Checked (100%)
  11. 12. 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
  12. 13. Observation for 20 min after the end of infusion 73% (Yes) 27 % (No)
  13. 14. YES (91%) NO (9%) Has the patient been informed that one third may develop flu like illness
  14. 15. Conclusion <ul><li>1-make sure the indication for ZA in NNUH is for osteoporosis </li></ul><ul><li>2-patient already tried all usual Osteoporotic therapy before referral for ZA </li></ul><ul><li>3-information should be explained to patients and given leaflet during clinic time. </li></ul><ul><li>4-patients should be given adequate Vit D & Ca supplement before referral for ZA infusion </li></ul><ul><li>5-Creatinine clearance and Calcium level should be checked </li></ul><ul><li>6-patient should be told to drink adequate water before ZA infusion </li></ul>

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