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Tamoxifen p 1319
- blocks estrogen receptors sites of malignant cells and thus inhibits the growth-stimulating effects of estrogen. It is commonly used in early-stage or advanced breast cancer and to treat recurent disease.
- indicated for prevention, adjuvant and metastatic disease
- side effects include hot flashes, mood swings, vaginal discharge, an dryness. It also increases the risk of blood clots, cataracts, stroke and endometrial cancer in postmenopausal women.
- Treatment last 5 years
- Instruct the patient to immediately report decrease visual acuity. Monitor for DVT, pulmonary embolism, and stroke, including SOB, leg cramps and weakness
Normodyne (labetalol) p 749
- beta blocker-for hypertension
- produces peripheral vasodilation and decreased heart rate
- reduces CO, SVR, and BP
- side effects include hypotension, bradycardia, orthostatic hypotension, dizziness, fatigue, nausea, vomiting, dyspepsia, paresthesia, nasal stuffiness, erectile dysfunctipn, edema and hepatic toxicity.
- nursing considerations: IV form used to treat hypertensive crisis in hospitalized patients, pt must be kept supine during IV administration. Assess patients tolerance of upright position (severe orthostatic hypotension) before allowing activities.
Corgard (nadolol) p 749
- beta blocker-hypertension
- It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
- may induce or excaberate heart failure in susceptible patients
- use in caution in patients with diabetes mellitus because drug may depress the tachycardia associated with hypoglycemia.
- Nursing considerations: monitor BP and pulse regularly
Aldactone (spironolactone) p 748
- aldosterone receptor blocker (diuretic)-for hypertension
- inhibit the Na+ retaining and K+ excreting effects of aldosterone in the distal and collecting tubules
- may cause gynecomastia, erectile dysfunction, decrease libido, menstrual irregularities.
- Nursing considerations: monitor for orthostatic hypotension and hyperkalemia. DO NOT combine with potassium sparing diuretic or potassium supplements. Use in caution in patients on ACE inhibitors or angiotensin II blockers. These drugs are also classified as potassium sparing diuretics.
hydrochlorothiazide p 748
- thiazide diuretic-for hypertension
- inhibit NaCl reabsorption in the distal convoluted tubule; increase excretion of NA+ and Cl-. Initial decrease in ECF; sustained decrease in SVR
- Adverse effects include fluid electrolyte imbalances, volume depletion, metabolic alkalosis, CNS effects, vertigo, headache, weakness, GI effects, anorexia, nausea, vomiting, diarrhea, constipation, pancreatitis, erectile dysfunction.
- Nursing considerations: monitor for orthostatic hypotension, and electrolye imbalances. Thiazide may potentiate cardiotoxicity of digoxin by producing hypokalemia. Dietary sodium restriction reduces risk of hypokalemia. NSAIDs can decrease diuretic and antihypertensive effect. Advise patient to supplement with potassium rich foods.
Vasotec (enalapril) p 750
- angiotensin-converting enzyme inhibitors-hypertension
- inhibits ACE when oral agents are not appropriate
- Adverse effects include hypotension, dizziness, loss of taste, cough, hyperkalemia, acute renal falure, skin rash, angioedema.
- Nursing considerations: give IV over 5 minutes, monitor BP
sodium nitroprusside p 750
- direct arterial vasodilation reduce SVR and BP
- Adverse effects include acute hypotension, nausea, vomiting, muscle twitching. Signs of thiocyanate toxicity include anorexia, fatigue, and disorientation.
- Nursing considerations: IV use for hypertensive crisis in hospitalize patients. Administered by continuous IV infusion with pump or control device. NO BOLUS. Intraarterial monitoring of BP recommended. Wrap IV solutions with an opaque material to protect from light; stable for 24 hours. Metabolized to cyanide, then thiocyanate. Monitor thiocyanate levels with prolonged use (>3 days).
lisinopril p 750
- angiotensin inhibitors
- Inhibits A-II mediated vasoconstriction
- Adverse effects include hypotension, dizziness, loss of taste, cough, hyperkalemia, acute renal failure, skin rash, angioedema.
- Nursing considerations: asprin and NSAIDs may reduce drug effectiveness. Addition of diuretic enhances drug effect. Should not be used with potassium sparing diuretics. Inhibits breakdown of bradykinin, which may cause a dry hacking cough.
Lasix (furosemide) p 748
- loop diuretic-hypertension
- inhibit NaCl reabsorption in the thick ascending limb of the loop of Henle, increase excretion of Na+ and Cl-. More potent diuretic effect than thiazides, but shorter duration of action. Less effective for hypertension.
- Adverse effects include fluid and electrolyte imbalances, except no hypercalcemia. Ototoxicity, vertigo. Metabolic effects including hyperuricemia, hyperglycemia, increased LDL cholesterol and triglycerides, decreased HDl cholesterol.
- Nursing considerations: monitor for orthostatic hypotension and hyperkalemia. Loop diuretics rmain effective despite renal insufficiency. Diuretic effect increases at higher doses.
Catapres (clonidine) p 748
- Central acting alpha-adrenergic antagonist
- reduce sympathetic outflow from CNS, reduce peripheral sympathetic tone, produce vasodilation, decrease SVR and BP.
- Adverse effects include dry mouth, sedation, erectile dysfunction, nausea, dizziness, sleep disturbance, nightmares, restlessness, depression. Symptomatic bradycardia in patients with conduction disorder.
- Nursing considerations: sudden discontinuation may cause withdrawal syndrome including rebound hypertension, tachycardia headache, tremors, apprehension and sweating. Chewing gum or hard candy may relieve dry mouth. Alcohol and sedatives increase sedation.
Tenormin (atenolol) p 749
- Reduces BP by antagonizing B-adrenergic effects. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.
- Adverse effects include hypotension, bronchospasm, atrioventricular conduction block, impaired peripheral circulation, erectile dysfunction. May induce or exacerbate heart failure in susceptible patients. Sudden withdrawal can cause rebound hypertension and exacerbate symptoms of ischemic heart disease.
- Nursing considerations: monitor BP and pulse regularly. Use with caution in patients with diabetes mellitus bc drugs may depress tachycardia associated with hypoglycemia. IV administration-rapid onset and short duration of actions.
Lopressor (metoprolol) p 749
- nonselective agents block b1 and b2 adenergic receptors.
- Same as Tenormin.
- Monitor pulse and BP regularly
- Systolic 120-139
- Diastolic 80-89
Isolated Systolic Hypertension
- Systolic > 140 coupled with diastolic < 90
- more common in older adults
- control of ISH decreased incidence of stoke, heart failure and death.
occurs with advanced atherosclerosis. arterioles are rigid and do not relax when cuff is inflated, which is called Osler's sign. Intrarterial catheter is the only accurate way to get a reading.
Stage 1 hypertension
- Systolic 140-159
- Diastolic 90-99
Stage 2 hypertension
- Systolic > 160
- Diastolic > 100
measuring orthostatic hypotension
- pt supine, wait 2-3 minutes to take BP and pulse
- Sit pt upright, wait 1-2 minutes to take BP and pulse
- Stand pt upright, wait 1-2 minutes to take BP and pulse
- Severely elevated BP, often above 220/140 with evidence of target organ damage, especially to the central nervous system.
- Can cause encepalopathy, intracranial or subarachnid hemorrhage, acute left ventricular falure, MI, renal failure, dissecting aortic aneurysm, and retinopathy.
IV drugs for hypertensive crisis
- Sodium nitroprusside-most effective (vasodilator)
- Enalapril (Normodyne)-ACE inhibitor
should assess BP every 2-3 minutes during initial administration
estrogen progesterone receptor status:
RECEPTOR POSITIVE TUMORS
- commonly show histologic evidence of being well differentiated
- frequently have a low proliferative indices
- have a lower chance of recurrence
- are frequently hormone dependent and are responsive to hormone therapy
estrogen progesterone receptor status
RECEPTOR NEGATIVE TUMORS
- often poorly differentiated
- have higher incidence of proliferation
- frequently recur
- usually unresponsive to hormonal therapy