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
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
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
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.
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
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
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
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
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