McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

■ ■ See the Critical thinking scenario for a full discussion of assessing and evaluating antineo­ plastic therapy for a woman with breast cancer . Implementation with rationale ■ ■ Arrange for blood tests to monitor bone marrow function before and periodically during therapy to discontinue the drug or reduce the dose as needed . ■ ■ Provide small, frequent meals, frequent mouth care and dietary consultation as appropriate to maintain nutrition when GI effects are severe . ■ ■ Provide comfort measures to help the person cope with menopausal signs and symptoms such as hygiene measures, temperature control and stress reduction. Expect to reduce the dose if these effects become severe or intolerable. ■ ■ Advise the individual of the need to use barrier contraceptive measures while taking these drugs to avert serious fetal harm . ■ ■ Provide the following teaching: –– Follow the appropriate dosage regimen, including dates to return for further doses. –– Maintain nutrition even if GI effects are severe. –– Use barrier contraceptives to prevent pregnancy during therapy. –– Try using comfort measures such as staying in a cool environment. –– Perform hygiene and skin care and use measures to reduce stress to help cope with menopausal effects. –– You may need to have periodic blood tests to monitor the effects of this drug on your body. Evaluation ■ ■ Monitor response to the drug (alleviation of cancer being treated and palliation of signs and symptoms of cancer being treated). suppression, GI toxicity, menopausal signs and symptoms, hypercalcaemia and cardiovascular effects). ■ ■ Evaluate the effectiveness of the teaching plan (person can name the drug, dosage, possible adverse effects to watch for and specific measures to help avoid adverse effects). ■ ■ Monitor for adverse effects (bone marrow

receiving adjuvant tamoxifen therapy, reduction in incidence of breast cancer in women at high risk for breast cancer, treatment of McCune–Albright syndrome, and treatment of precocious puberty in females 2 to 10 years of age. Actions: Competes with oestrogen for binding sites in target tissues, such as the breast; a potent antioestrogenic agent. Pharmacokinetics: Route Onset Peak Oral Varies 4–7 hours T 1/2 : 7 to 14 days; metabolised in the liver and excreted in the faeces. Adverse effects: Hot flushes, rash, nausea, vomiting, vaginal bleeding, menstrual irregularities, oedema, pain, cerebrovascular accident, pulmonary emboli. ■ ■ Assess for contraindications or cautions: history of allergy to the drug in use or any related drugs to avoid hypersensitivity reactions ; bone marrow suppression to prevent further suppression ; renal or hepatic dysfunction that might interfere with drug metabolism and excretion ; current status of pregnancy or breastfeeding to prevent potentially serious adverse effects on the fetus or breastfeeding baby ; history of hypercalcaemia and hypercholesterolaemia to avoid further increases in levels . ■ ■ Perform a physical assessment to establish baseline data for determining the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy . ■ ■ Assess orientation and reflexes to evaluate any CNS effects ; skin to evaluate for lesions ; hair and hair distribution to monitor for adverse drug effects ; blood pressure, pulse and perfusion to evaluate the status of the cardiovascular system and monitor for adverse drug effects ; and bowel sounds and mucous membrane status to monitor for GI effects . ■ ■ Monitor the results of laboratory tests such as FBC with differential to identify bone marrow suppression and toxic drug effects, serum calcium levels to evaluate for hypercalcaemia, and renal and liver function tests to determine the need for possible dose adjustment to evaluate toxic drug effects . Care considerations for people receiving hormones and hormone modulators Assessment: History and examination

KEY POINTS

■■ Hormones and hormonal agents are used to treat specific cancers that respond to hormone stimulation such as breast cancer or prostate cancer. ■■ The adverse effects of hormones and hormonal agents used to treat cancers are increased or decreased effects of the hormones on the body: virilisation, increased risk of cardiovascular disease, increased calcium levels.