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P A R T 2
Chemotherapeutic agents
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Hormones and hormonal agents are used to treat
specific cancers that respond to hormone stimulation
such as breast cancer or prostate cancer.
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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.
KEY POINTS
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.
Care considerations for people receiving
hormones and hormone modulators
Assessment: History and examination
■
■
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
.
■
■
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).
■
■
Monitor for adverse effects (bone marrow
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).
