Mosby's 2014 Nursing Drug Reference (380 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Inhibits cell division by binding to cytoplasmic estrogen receptors; resembles normal cell complex but inhibits DNA synthesis and estrogen response of target tissue
Advanced breast carcinoma not responsive to other therapy in estrogen-receptor–positive patients (usually postmenopausal), prevention of breast cancer, after breast surgery/radiation for ductal carcinoma in situ
Unlabeled uses:
Mastalgia, to reduce pain/size of gynecomastia, ovulation stimulation, malignant carcinoid tumor, carcinoid syndrome, metastatic melanoma, desmoid tumors, McCune-Albright syndrome (female pediatric patients), osteoporosis, bipolar I disorder, infertility, precocious puberty, gynecomastia, mastalgia
Pregnancy (D), breastfeeding, hypersensitivity
Black Box Warning:
Thromboembolic disease
Precautions:
Women of childbearing age, leukopenia, thrombocytopenia, cataracts
Black Box Warning:
Endometrial cancer, stroke
Calculator
• Adult:
PO
20-40 mg/day for 5 yr; doses >20 mg/day, divide
AM
/
PM
• Adult:
PO
20 mg/day × 5 yr
• Adult:
PO
20 mg/day × 5 yr
• Child 2-10 yr (girls):
PO
20 mg/day for ≤1 yr
• Adult:
PO
40 mg bid
• Adult:
PO
20-80 mg/day × 5 days
• Adult (female):
PO
10-20 mg/day × 3-6 mo
• Adult (male):
PO
20 mg/day for ≤1 yr
Available forms:
Tabs 10, 20 mg
•
Do not break, crush, or chew tabs
•
Antacid before oral agent; give product after evening meal, before bedtime; give with food or fluids for GI symptoms
•
Antiemetic 30-60 min before product to prevent vomiting
CNS:
Hot flashes, headache, lightheadedness
, depression, mood changes
CV:
Chest pain,
stroke,
fluid retention, flushing
EENT:
Ocular lesions, retinopathy, cataracts, corneal opacity, blurred vision (high doses)
GI:
Nausea, vomiting
, altered taste (anorexia)
GU:
Vaginal bleeding, pruritus vulvae,
uterine malignancies,
altered menses, amenorrhea
HEMA:
Thrombocytopenia, leukopenia,
DVT
INTEG:
Rash
, alopecia
META:
Hypercalcemia
RESP:
Pulmonary embolism
PO:
Peak 4-7 hr, half-life 7 days (1 wk terminal), metabolized in liver, excreted primarily in feces
Increase:
risk for death from breast cancer—PARoxetine
Increase:
bleeding—anticoagulants
Increase:
tamoxifen levels—bromocriptine
Increase:
thromboembolic events—cytotoxics
Increase:
toxicity—CYP3A4 inhibitors (aprepitant, antiretroviral protease inhibitors, clarithromycin, danazol, delavirdine, diltiazem, erythromycin, fluconazole, FLUoxetine, fluvoxaMINE, imatinib, ketoconazole, mibefradil, nefazodone, telithromycin, voriconazole)
Decrease:
tamoxifen levels—aminoglutethimide, rifamycin
Decrease:
letrozole levels—letrozole
Decrease:
tamoxifen effect—CYP3A4 inducers (barbiturates, bosentan, carBAMazepine, efavirenz, phenytoins, nevirapine, rifabutin, rifampin)
Decrease:
tamoxifen effects—CYP2D6 inhibitors (antidepressants)
•
Avoid use with St. John’s wort, dong qui, black cohosh
Increase:
serum calcium, T
4
, AST, ALT, cholesterol, triglycerides
•
CBC, differential, platelet count weekly; withhold product if WBC count is <3500 or platelet count is <100,000; notify prescriber; breast exam, mammogram, pregnancy test, bone mineral density, LFTs, serum calcium, serum lipid profile, periodic eye exams (cataracts, retinopathy)
Black Box Warning:
Bleeding
q8hr: hematuria, guaiac, bruising, petechiae, mucosa or orifices
•
Effects of alopecia on body image; discuss feelings about body changes
Uterine malignancies, symptoms of stroke, pulmonary embolism
that may occur in women with ductal carcinoma in situ (DCIS) and women at high risk for breast cancer
Severe allergic reactions:
rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
•
Bone pain; may give analgesics; pain usually transient
•
Storage in light-resistant container at room temp
•
Therapeutic response: decreased tumor size, spread of malignancy
•
To use nonhormonal contraception during and for 2 months after discontinuing treatment, pregnancy (D)
•
To notify prescriber of stroke: blurred vision, headache, weakness on one side of the body; PE: chest pain, fainting, sweating, difficulty breathing
•
To report any complaints, side effects to prescriber; that use may be 5 yr
•
To increase fluids to 2 L/day unless contraindicated
•
To wear sunscreen, protective clothing, sunglasses
•
That vaginal bleeding, pruritus, hot flashes are reversible after discontinuing treatment
•
To immediately report decreased visual acuity, which may be irreversible; about need for routine eye exams; that care providers should be told about tamoxifen therapy
•
To report vaginal bleeding immediately
•
Tumor flare
—increase in size of tumor, increased bone pain—may occur and will subside rapidly; may take analgesics for pain
•
That premenopausal women must use mechanical birth control because ovulation may be induced
•
That hair may be lost during treatment; that a wig or hairpiece may make patient feel better; that new hair may be different in color, texture
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(tam-sue-lo′sen)
Flomax
Func. class.:
Selective α
1
-peripheral adrenergic blocker, BPH agent
Chem. class.:
Sulfamoylphenethylamine derivative
Do not confuse:
Flomax
/Fosamax/Volmax
Binds preferentially to α
1A
- adrenoceptor subtype, which is located mainly in the prostate
Symptoms of benign prostatic hyperplasia (BPH)
Hypersensitivity
Precautions:
Pregnancy (B), breastfeeding, children, hepatic disease, CAD, severe renal disease, prostate cancer; cataract surgery (floppy iris syndrome)
Calculator
• Adult:
PO
0.4 mg/day increasing to 0.8 mg/day if required after 2-4 wk
Available forms:
Caps 0.4 mg
•
Without regard to food
•
Swallow caps whole; do not break, crush, or chew
•
Give 1/2 hr after same meal each day
•
If treatment is interrupted for several days, restart at lowest dose (0.4 mg/day)
CNS:
Dizziness, headache
, asthenia, insomnia
CV:
Chest pain, orthostatic hypotension
EENT:
Amblyopia, floppy iris syndrome
GI:
Nausea, diarrhea, dysgeusia
GU:
Decreased libido, abnormal ejaculation,
priapism
INTEG:
Rash, pruritus, urticaria
MS:
Back pain
RESP:
Rhinitis, pharyngitis, cough
SYST:
Angioedema
Peak 4-5 hr, duration 9-15 hr, half-life 9-13 hr, metabolized in liver, excreted via urine, extensively protein bound (98%)
Increase:
B/P—prazosin, terazosin, doxazosin, α-blockers, vardenafil
Increase:
toxicity—cimetidine
•
Prostatic hyperplasia:
change in urinary patterns at baseline and throughout treatment; I&O ratios, weight daily; edema; report weight gain or edema
•
Orthostatic hypotension:
monitor B/P, standing, sitting
•
Storage in tight container in cool environment
•
Therapeutic response: decreased symptoms of benign prostatic hyperplasia
•
Not to drive or operate machinery for 4 hr after 1st dose or after dosage increase
•
To continue to take even if feeling better
•
To advise providers of all products, herbs taken
•
To make position changes slowly because orthostatic hypotension may occur
•
To take 1/2 hr before same meal each day
•
To teach about priapism (rare)
•
Not to crush, break, chew