McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

TABLE 14.5

DRUGS IN FOCUS Hormones and hormone modulators

Drug name

Dosage/route

Usual indications

abiraterone (Zytiga)

1 g PO once daily

Treatment of metastatic advanced prostate cancer Actions: Reduces androgen levels Special considerations: Administered with prednisone or prednisolone. Monitor cardiovascular and hepatic function Treatment of advanced breast cancer in postmenopausal women after tamoxifen therapy; first-line and adjunctive treatment of postmenopausal women with locally advanced breast cancer Actions: antioestrogen drug; blocks oestradiol production without effects on adrenal hormones Special considerations: GI effects, signs and symptoms of menopause—hot flushes, mood swings, oedema, vaginal dryness and itching—as well as bone pain and back pain, treatable with analgesics, may occur; monitor lipid concentrations in people at risk for high cholesterol level In combination with a luteinising hormone for the treatment of advanced prostate cancer Actions: antiandrogen drug that competitively binds androgen-receptor sites Special considerations: gynaecomastia and breast tenderness occur in 33% of people; GI complaints are common; pregnancy category X Treatment of hormone refractory metastatic prostate cancer Actions: Inhibits mitotic and interphase cellular functions Special considerations: Administered with prednisone or prednisolone. Weekly blood counts during cycle one and prior to each subsequent treatment. Closely monitor hydration status Treatment of people with advanced prostate cancer Actions: Gonadotropin-releasing hormone– receptor-site antagonist, leads to decreased follicle-stimulating hormone and luteinising hormone and decreased testosterone levels Special considerations: pregnancy category X; risk of prolonged QT interval; injection-site reactions, hot flushes, increased weight are common Treatment of advanced, metastatic breast cancer in postmenopausal women whose disease has progressed after tamoxifen therapy Actions: inactivates steroid aromatase, lowering circulating oestrogen levels and preventing the premenopausal women or in people with liver or renal dysfunction; hot flushes, headache, GI upset, anxiety and depression are common Continued on following page conversion of androgens to oestrogen Special considerations: avoid use in

anastrazole (Arianna, Arimidex)

1 mg/day PO

bicalutamide (Calutex, Cosamide, Cosudex)

50 mg/day PO

cabazitaxel (Jevtana)

25 mg/m 2 by IV infusion over 1 hour every 3 weeks

degarelix (Firmagon)

240 mg by subcutaneous given in two 120-mg injections, then 80 mg SC every 28 days for maintenance

exemestane (Aromasin)

25 mg/day PO with meals