Adrianne Bazo

11-18-08

Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency
tamoxifen Nolvadex Antineoplastics/ 20mg PO Q day
antiestrogens
Peak Onset Duration Normal dosage range
Several months 4-10wk Several weeks 10-20 mg twice daily; doses of 20 mg/day may be taken as a single
dose
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or
Adjuvant therapy of breast cancer after surgery and radiation solutions
(delays recurrence) NA

Mechanism of action and indications Nursing Implications (what to focus on)

(Why med ordered) Contraindications/warnings/interactions
Competes with estrogen for binding sites in breast and other Hypersensitivity. Do not crush, break, chew, or administer an
tissues antacid within 1-2 hr of enteric-coated tablet.
Reduces DNA synthesis and estrogen response Common side effects
Nausea, hot flashes

Interactions with other patient drugs, OTC or
herbal medicines (ask patient specifically)
None for this pt
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
Lab value alterations caused by medicine
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
Assessment Evaluation
Why would you hold or not give this Check after giving
med? Decrease in the size or spread of
if pain or swelling of legs, shortness of breath, breast cancer. Observable effects
weakness, sleepiness, confusion, nausea, of therapy may not be seen for 4-
vomiting, weight gain, dizziness, headache, 10 wk after initiation
loss of appetite, or blurred vision occurs.
Patient should also report menstrual
irregularities, vaginal bleeding, pelvic pain or
pressure