Tamoxifen Nolvadex

Adrianne Bazo 11-18-08 Clinical Medications Worksheets Classification Dose Route Time/frequency Antineoplastics/ 20mg PO Q day antiestrogens Duration Normal dosage range 10-20 mg twice daily; doses of 20 mg/day may be taken as a single Several weeks

Generic Name tamoxifen

Trade Name Nolvadex

Peak Several months

Onset 4-10wk

dose

Why is your patient getting this medication Adjuvant therapy of breast cancer after surgery and radiation (delays recurrence)

For IV meds, compatibility with IV drips and/or solutions NA

Mechanism of action and indications (Why med ordered)

Nursing Implications (what to focus on) Contraindications/warnings/interactions

Competes with estrogen for binding sites in breast and other tissues Reduces DNA synthesis and estrogen response

Hypersensitivity. Do not crush, break, chew, or administer an antacid within 1-2 hr of enteric-coated tablet.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) None for this pt

Lab value alterations caused by medicine

Common side effects Nausea, hot flashes Monitor CBC, platelets, and calcium levels before and during therapy. May cause transient hypercalcemia in patients with metastases to the bone. An estrogen receptor assay should be assessed before initiation of therapy. Monitor serum cholesterol and triglyceride concentrations in patients with pre-existing hyperlipidemia. May cause ↑ concentrations. Monitor hepatic function tests and thyroxine (T4) periodically during therapy. May cause ↑ serum hepatic enzyme and thyroxine concentrations. Gynecologic examinations should be performed regularly; may cause variations in Papanicolaou and vaginal smears

Be sure to teach the patient the following about this medication Instruct patient to take medication as directed. If a dose is missed, it should be omitted. Advise patient to report bone pain to health care professional promptly. This pain may be severe. Inform patient that this may be an indication of the drug's effectiveness and will resolve over time. Analgesics should be ordered to control pain. monitor weight weekly. Weight gain or peripheral edema should be reported to health care professional

Nursing Process- Assessment (Pre-administration assessment) Assess for an increase in bone or tumor pain. Confer with physician or other health care professional regarding analgesics. This transient pain usually resolves despite continued therapy

Assessment Why would you hold or not give this med? if pain or swelling of legs, shortness of breath, weakness, sleepiness, confusion, nausea, vomiting, weight gain, dizziness, headache, loss of appetite, or blurred vision occurs. Patient should also report menstrual irregularities, vaginal bleeding, pelvic pain or pressure

Evaluation Check after giving Decrease in the size or spread of breast cancer. Observable effects of therapy may not be seen for 410 wk after initiation