Neoplasia - tamoxifen

tamoxifen 1. used for 2. primary MOA 3. also used for 4. may increase levels of (3) 5. assess for s/sx of

1. breast cancer 2. compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors 3. delaying the recurrence of cancer following mastectomy 4. Calcium, cholesterol, and triglycerides 5. hypercalcemia: increased urine volume, excessive thirst, N/V, constipation, hypotonicity of muscles, and deep bone and flank pain

Tamoxifen is prescribed for the client with metastatic breast carcinoma. The nurse understands that the primary action of this medication is to: 1. Increase DNA and RNA synthesis. 2. Promote the biosynthesis of nucleic acids. 3. Increase estrogen concentration and estrogen response. 4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors.

4. Compete with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy. Tamoxifen reduces DNA synthesis and estrogen response.

Tamoxifen The client must report changes in

visual acuity immediately because this adverse effect may be irreversible, drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don't warrant a change in therapy.

The client receives tamoxifen (Nolvadex) for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse?

"Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue."

The client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium levels should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

The nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should include information about which medication?

3. Tamoxifen (Nolvadex)

When the nurse is administering a vesicant chemotherapeutic agent intravenously, an important consideration is to a. stop the infusion if swelling is observed at the site. b. infuse the medication over a short period. c. administer the chemotherapy through small-bore catheter. d. hold the medication unless a central venous line is available.

A Rationale: Swelling at the site may indicate extravasation, and the IV should be stopped immediately. The medication should generally be given slowly to avoid irritation of the vein. The size of the catheter is not as important as administration of vesicants into a running IV line to allow dilution of the chemotherapy drug. These medications can be given through peripheral lines, although central vascular access devices (CVADs) are preferred.

The 70-year-old woman who is considering coming off of hormone replacement therapy (HRT) for the reduction of postmenopausal discomfort asks the nurse what advantage is offered by tamoxifen, also called a "designer estrogen." The nurse's best response is that tamoxifen: a. provides estrogen to some tissues while acting as an antiestrogen to others. b. has no side effects. c. needs to be taken only once a week. d. improves the skin turgor and complexion.

ANS: A "Designer estrogens" selectively act as an estrogen on some tissues and an antiestrogen on others. There are side effects, and the drug is usually taken twice a day.

The pathology report for a 42-year-old who has had a modified radical mastectomy identifies the tumor as an estrogen-receptor positive adenocarcinoma. The nurse will plan on teaching the patient about a. estradiol (Estrace). b. raloxifene (Evista). c. tamoxifen (Nolvadex). d. trastuzumab (Herceptin).

ANS: C Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used postmastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2 receptor.

After the nurse has completed teaching a patient who has breast cancer about the newly prescribed tamoxifen (Nolvadex), which patient statement indicates that the teaching has been effective? a. "I will expect to have leg cramps with this drug." b. "I will call the clinic if I develop any hot flashes." c. "I will be taking the medication for at least a year." d. "I will call immediately if I have any eye problems."

ANS: D Retinopathy, cataracts, and decreased visual acuity should be immediately reported because it is likely that the tamoxifen will be discontinued or decreased. Tamoxifen treatment generally lasts 5 years. Hot flashes are an expected side effect of tamoxifen. Leg cramps may be a sign of deep vein thrombosis, and the patient should immediately notify the health care provider if pain occurs.

After a patient is diagnosed with lobular carcinoma in situ (LCIS), the nurse will anticipate that patient teaching may be needed about a. lumpectomy. b. lymphatic mapping. c. MammaPrint testing. d. tamoxifen (Nolvadex).

ANS: D Tamoxifen is used as a chemopreventive therapy in some patients with LCIS. The other diagnostic tests and therapies are not needed because LCIS does not usually require treatment.

"A client is prescribed tamoxifen (Nolvadex), 20 mg by mouth twice per day for treatment of breast cancer. The client complains to the nurse that she has worsening bone pain. How should the nurse respond?

Acute worsening of bone pain commonly indicates that the drug will produce a good response.

Jeovina, with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately? a. Vision changes b. Hearing loss c. Headache d. Anorexia

Answer A. The client must report changes in visual acuity immediately because this adverse effect may be irreversible. Tamoxifen isn't associated with hearing loss. Although the drug may cause anorexia, headache, and hot flashes, the client need not report these adverse effects immediately because they don't warrant a change in therapy.

Hormonal agents are used to treat some cancers. An example would be: a. Thyroxine to treat thyroid cancer. b. ACTH to treat adrenal carcinoma. c. Estrogen antagonists to treat breast cancer. d. Glucagon to treat pancreatic carcinoma.

Answer C. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. A well-known estrogen antagonist used in breast cancer therapy is tamoxifen (Nolvadex). This drug, in combination with surgery and other chemotherapeutic drugs reduces breast cancer recurrence by 30 percent. Estrogen antagonists can also be administered to prevent breast cancer in women who have a strong family history of the disease. Thyroxine is a natural thyroid hormone. It does not treat thyroid cancer. ACTH is an anterior pituitary hormone, which stimulates the adrenal glands to release glucocorticoids. It does not treat adrenal cancer. Glucagon is a pancreatic alpha cell hormone, which stimulates glycogenolysis and gluconeogenesis. It does not treat pancreatic cancer.

The client receives tamoxifen (Nolvadex) for treatment of breast cancer. She asks the nurse why the medicine works. What is the best response by the nurse? 1. "Tamoxifen (Nolvadex) works by inhibiting the metabolism of breast cancer cells." 2. "Tamoxifen (Nolvadex) works by blocking estrogen receptors on breast tissue." 3. "Tamoxifen (Nolvadex) works by inhibiting the cellular mitosis of breast cancer." 4. "Tamoxifen (Nolvadex) works by binding to the DNA of breast cancer cells."

Answer: 2 Rationale: Breast cancer is dependent on estrogen for growth. Tamoxifen (Nolvadex) acts by blocking estrogen receptors; the tumor is deprived of estrogen.Tamoxifen (Nolvadex) does not inhibit the metabolism of breast cancer cells.Tamoxifen (Nolvadex) does not inhibit the cellular mitosis of breast cancer.Tamoxifen (Nolvadex) does not bind to the DNA of breast cancer cells.

A 34-year-old woman has undergone a modified radical mastectomy for a breast tumor. The pathology report identified the tumor as a stage I, estrogen-receptor-positive adenocarcinoma. The nurse will plan on teaching the patient about a. raloxifene (Evista). b. estradiol (Estrace). c. trastuzumab (Herceptin). d. tamoxifen (Nolvadex).

Answer: D Rationale: Tamoxifen is used for estrogen-dependent breast tumors in premenopausal women. Raloxifene is used to prevent breast cancer, but it is not used post-mastectomy to treat breast cancer. Estradiol will increase the growth of estrogen-dependent tumors. Trastuzumab is used to treat tumors that have the HER-2/neu antigen.

A nurse is caring for a client who is receiving tamoxifen for treatment of breast cancer. The nurse will teach the client that postchemotherapy monitoring will be necessary to detect or treat which drug-associated adverse effect? a. Paralytic ileus b. Alopecia c. Pulmonary fibrosis d. Endometrial cancer

Endometrial cancer Rationale: Tamoxifen is associated with an increased risk of endometrial cancer and monitoring will be necessary to detect early changes that may indicate this adverse effect has occurred. Options 1, 2, and 3 are incorrect. Paralytic ileus and pulmonary fibrosis are not associated with tamoxifen. Alopecia is a common adverse effect of many chemotherapy drugs but will not require long-term monitoring.

Chemotherapy Agents: Interactions with Tamoxifen (Nolvadex)

Fluoxetine=Don't use warfarin, halperidol, benadryl, bupropion, sertaline, carbamazepine

A 43-year-old woman with a strong family history of breast cancer considers tamoxifen (Nolvadex) for cancer prevention. Which assessment finding is a possible contraindication?

History of deep vein thrombosis (DVT)

A client with cancer is started on a chemotherapeutic agent that is a known vesicant. The nurse performs which priority activity related to this drug? Monitor the client's: a. Response to antinausea drugs. b. Intake of calcium-rich foods. c. Respiratory status for cough. d. IV port site for redness, swelling, and pain.

IV port site for redness, swelling, and pain. Rationale: Many antineoplastics are classified as vesicant agents that can cause serious tissue injury if they escape from an artery or vein during an infusion or injection. The nurse should closely monitor the infusion site for swelling and pain. Options 1, 2, and 3 are incorrect. Vesicants do not necessarily cause nausea. It would be inappropriate for the nurse to monitor the client's intake of calcium-rich foods, because this is not related to receiving a chemotherapy classified as a vesicant. Respiratory status is not related to the administration of a vesicant-type chemotherapy agent

This antineoplastic drug is given to prevent breast cancer in high-risk patients.

Tamoxifen

A nurse is caring for a client who has had an estrogen receptor-positive breast tumor surgically removed. The client is told that follow-up with hormonal therapy will be prescribed. The nurse outlines a teaching plan, knowing that client will most likely receive: Letrozole (Femara) Raloxifene (Evista) Anastrozole (Arimidex) Tamoxifen citrate (Nolvadex)

Tamoxifen citrate (Nolvadex) is the usual choice of treatment in postmenopausal women who with estrogen receptor-positive tumors. It is an anti-estrogen medication that blocks the estrogen receptor sites of malignant cells and thus inhibits the growth-stimulating effects of estrogen

A client with advanced breast cancer is prescribed tamoxifen (Nolvadex). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?

Vision changes