McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

TABLE 14.5

DRUGS IN FOCUS Hormones and hormone modulators (continued)

Drug name

Dosage/route

Usual indications

flutamide (Eulexin, Flutamin)

250 mg PO t.d.s. given 8 hours apart

With a luteinising hormone for treatment of locally confined and metastatic prostate cancer Actions: antioestrogenic drug, inhibits androgen uptake and binding on target cells Special considerations: may cause liver toxicity, so liver function should be monitored regularly; associated with impaired fertility and cancer development; urine may become greenish; protect person from exposure to the sun— photosensitivity is common Treatment of hormone receptor–positive metastatic breast cancer in postmenopausal women with disease progression after antioestrogen therapy Actions: competitively binds to oestrogen receptors, downregulating the oestrogen receptor protein in breast cancer cells Special considerations: pregnancy category X; hot flushes, depression, headache and GI upset are common; mark calendar with monthly injection dates; injection-site reactions may occur Treatment of advanced prostatic and breast cancers; management of endometriosis Actions: synthetic luteinising hormone that inhibits pituitary release of gonadotropic hormones symptoms of endometriosis; associated with hypercalcaemia and bone density loss—monitor serum calcium levels regularly; impairs fertility and is carcinogenic; monitor males for possible ureteral obstruction, especially during the first month Treatment of advanced breast cancer in postmenopausal women with disease after antioestrogen therapy; postsurgery adjunct for postmenopausal women with early hormone receptor–positive breast cancer Actions: prevents the conversion of precursors to oestrogens in all tissues Special considerations: GI toxicity, bone marrow depression, alopecia, hot flushes and CNS depression are common effects; discontinue drug at any sign that the cancer is progressing Palliative treatment of advanced breast or endometrial cancer; appetite stimulant for HIV people Actions: blocks luteinising hormone release; efficacy not understood Special considerations: monitor for thromboembolic events and weight gain; not for use during pregnancy Special considerations: a 3.6-mg dose is effective in decreasing the signs and

fulvestrant (Faslodex)

250 mg IM at 1-month intervals

goserelin (Zoladex)

3.6–10.8 mg implant, SC, every 28 days to 12 weeks, varies with diagnosis

letrozole (Femara)

2.5 mg/day PO

megestrol (Megace)

160 mg/day PO