Mosby's 2014 Nursing Drug Reference (162 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
estramustine (Rx)
(ess-tra-muss′teen)
Emcyt
Func. class.:
Antineoplastic alkylating agent
Metastatic prostate cancer
Pregnancy (D), hypersensitivity to estradiol, thromboembolic disorders, stroke, thrombophlebitis
Calculator
• Adult:
PO
14-16 mg/kg/day or 600 mg/m
2
/day in 3-4 divided doses; treatment may continue for ≥3 mo
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
Cenestin, Premarin
synthetic B (Rx)
Enjuvia
Func. class.:
Estrogen, hormone
Do not confuse:
Premarin
/Provera
Needed for adequate functioning of female reproductive system; affects release of pituitary gonadotropins, inhibits ovulation, adequate calcium use in bone
Vasomotor symptoms (menopause), inoperable breast cancer, prostatic cancer, abnormal uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosis, castration, atrophic vaginitis
Unlabeled uses:
hyperparathyroidism, infertility
Pregnancy (X), breastfeeding, thromboembolic disorders, reproductive cancer, genital bleeding (abnormal, undiagnosed), hypersensitivity, MI, stroke, thrombophlebitis
Black Box Warning:
Endometrial, breast cancer, thromboembolic diseases
Precautions:
Hypertension, asthma, blood dyscrasias, CHF, diabetes mellitus, depression, migraine headache, seizure disorders, gallbladder/bone/hepatic/renal disease, family history of cancer of breast or reproductive tract, smoking, dementia, hypothyroidism, obesity, SLE
Calculator
• Adult:
PO
0.3-1.25 mg/day 3 wk on, 1 wk off
• Adult:
PO
0.3 mg/day or in cycle
• Adult:
VAG CREAM
0.5 g/day × 21 days, off 7 days, repeat
• Adult:
PO
1.25-2.5 mg tid
• Adult:
PO
10 mg tid × ≥3 mo
• Adult:
IV/IM
25 mg q6-12hr
• Adult:
PO
1.25 mg/day 3 wk on, 1 wk off
• Adult:
PO
2.5-7.5 mg/day × 20 days/mo
• Adult:
PO
0.625 mg/day initially; may increase based on response
Available forms:
Tabs 0.3, 0.45, 0.625, 0.9, 1.25, 2.5 mg; inj 25 mg/vial; vag cream 0.625 mg/g;
synthetic B:
tabs 0.625, 1.25 mg
•
Titrated dose; use lowest effective dose
•
Give with or immediately after food to reduce nausea
•
IM reconstitute after withdrawing 5 ml of air from container, inject sterile diluent on vial side, rotate to dissolve; give inj deep in large muscle mass, aspirate before inj
•
Use applicator provided, wash after use
•
IV, after reconstituting as for IM, inject into distal port of running IV line of D
5
W, 0.9% NaCl at ≤5 mg/min
Y-site compatibilities:
Heparin, hydrocortisone, potassium chloride, vit B/C
CNS:
Dizziness, headache, migraine, depression,
seizures,
mood disturbances
CV:
Hypertension, thrombophlebitis, edema,
thromboembolism, stroke, pulmonary embolism, MI,
chest pain
EENT:
Contact lens intolerance, increased myopia, astigmatism
GI:
Nausea
, vomiting, diarrhea, anorexia, pancreatitis, cramps, constipation, increased appetite,
cholestatic jaundice, hepatic adenoma,
weight gain/loss
GU:
Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, breast changes,
gynecomastia, testicular atrophy, impotence
,
increased risk of breast cancer, endometrial cancer,
libido changes
INTEG:
Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma
META:
Folic acid deficiency, hypercalcemia, hyperglycemia
PO/IM/IV:
Degraded in liver, excreted in urine, crosses placenta, excreted in breast milk
Increase:
toxicity—cycloSPORINE, dantrolene
Increase:
action of corticosteroids
Decrease:
action of estrogens—anticonvulsants, barbiturates, phenylbutazone, rifampin
Decrease:
action of anticoagulants, oral hypoglycemics, tamoxifen, thyroid
Increase:
estrogen level—grapefruit juice
Increase:
BSP retention test, PBI, T
4
, serum sodium, platelet aggregation, thyroxine-binding globulin (TBG), prothrombin; factors VII, VIII, IX, X; triglycerides
Decrease:
serum folate, serum triglyceride, T
3
resin uptake test, glucose tolerance test, antithrombin III, pregnanediol, metyrapone test
False positive:
LE prep, antinuclear antibodies
Black Box Warning:
Breast, endometrial cancer:
estrogens should not be used in known, suspected, or history of these disorders
Black Box Warning:
Stroke, thromboembolic disease of MI:
Should not be used in these conditions or known protein C deficiency, protein S deficiency, or antithrombin deficiency
•
Blood glucose if diabetic patient; hyperglycemia may occur
•
Weight daily; notify prescriber of weekly weight gain >5 lb; if increase, diuretic may be ordered; check for edema; B/P baseline and periodically
•
Hepatic studies: AST, ALT, bilirubin, alk phos
•
Hypertension, cardiac symptoms, jaundice, hypercalcemia
•
Mental status: affect, mood, behavioral changes, aggression
•
Female patient for intact uterus; if so, progesterone should be added to estrogen therapy to decrease risk of endometrial cancer; abnormal uterine bleeding, breast exam; Pap smear
•
Therapeutic response: absence of breast engorgement, reversal of menopause symptoms, decrease in tumor size with prostatic cancer
•
To avoid breastfeeding, since product excreted in breast milk
•
To weigh weekly; to report gain >5 lb
Black Box Warning:
To report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain; leg pain and redness, numbness or stiffness; chest pain; males to report impotence or gynecomastia
•
To avoid sunlight or wear sunscreen; burns may occur
•
To notify prescriber if pregnancy is suspected
•
That vasomotor symptoms improve in 2 wk, max relief in 8 wk
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
estropipate
(ess-troe-pip′ate)
Func. class.:
Estrogen
Primary ovarian failure, menopausal symptoms, prevention of osteoporosis, vaginal atrophy
Hypersensitivity, coagulation disorders, breast and reproductive cancers, undiagnosed genital bleeding
Black Box Warning:
Pregnancy (X)
Calculator
• Adult (women):
PO
0.75-6 mg/day × 3 wk on 1 wk off, may be used continuously in menopausal symptoms
• Adult (women):
PO
1.5-9 mg/day × 3 wk, then off for 8-10 days; if bleeding does not occur, repeat cycle
• Adult (women):
PO
0.75 mg/day × 25 days, 6 days off, repeat as needed