Bronder Pharm Exam 2.0 MORE IN-DEPTH (but not the bariatric stuff yet obviously)

Three types of breast cancer (hormone positivity/negativity)

Estrogen positive

Progesterone positive

Estrogen/progesterone negative

What medications are given for endometriosis?

NSAIDs, oral contraception, IUDs, GnRH agonists

When is estrogen secreted?

During the menstrual cycle

What are SERMS?

selective estrogen receptor modulators

What is the main SERM?

tamoxifen citrate

What is the indication for tamoxifen citrate?

Pt with breast cancer, OR a family history of breast cancer that makes them very likely to get it.

What should you not do while taking tamoxifen citrate?

-try to get pregnant

-take St. John's Wort

-eat grapefruit

How is tamoxifen citrate administered?

P.O. - if prophylactic, taken for 5-10 years

List some of the side effects of tamoxifen citrate.

Menopause-like - hot flashes, mood swings, alopecia.

Clotting risk - P.E., stroke, thromboembolism.

Other - insomnia, fluid retention.

What are aromatase inhibitors?

Meds that decrease the secretion of aromatase, which is converted into estrogen.

What is the indication for taking an aromatase inhibitor?

hormone receptor-positive breast cancer

List the three main aromatase inhibitors.

Anastrozole

Letrizole

Exemestane

How are aromatase inhibitors given?

P.O, take at the same time each day.

What are some adverse effects of aromatase inhibitors?

Bone pain

Dyspnea

Vaginal bleeding

Alterations in behavior/memory

What are some considerations for aromatase inhibitors?

-Do not chew or crush tablets

-Take at the same time each day

-Take Aromasin 30 minutes after a meal

What is LHRH?

Luteinizing Hormone-Releasing Hormone. Regulates the release of luteinizing hormone, which blocks release of sex hormones.

What is the indication for giving LHRH?

breast cancer, endometriosis, uterine bleeding

What is the route for LHRH?

INJECTION

What is important patient teaching for a patient on LHRH?

Reminder to set up the next injection. Decreased sex hormones --> think about this for side effects.

What are targeted therapies?

Therapies that target the Her2 protein to slow growth.

Example of a targeted therapy med.

Trastuzumab (think Tra = Target)

What are the indications for trastuzumab?

Stomach cancer and breast cancer (but MUST be Her2 positive)

What is the route for trastuzumab?

IV infusion

What are some adverse effects for trastuzumab?

Hives

Syncope (passing out)

Bleeding and bruising

What are two things to teach your patient on trastuzumab?

1) DON'T GET PREGNANT

2) you might have more heart problems. oof.

Complementary therapy: Black Cohosh

taken for hot flashes, palpitations, irritability.

DO NOT take with estrogen.

Complementary therapy: Dong-Quai

treats cramps and irregular menses.

DO NOT take with estrogen or other hormones.

Echinacea can be toxic to what?

Liver

What does echinacea increase?

Tumor necrosis factor --> increased immunity.

What do ginko and garlic do?

Inhibit blood clotting.

What is the main drug interaction to know for saw palmetto?

INCREASES the effects of hormone therapies.

What increases with St. John's Wort?

Thrombocytopenia. So basically, platelet levels DECREASE. St John wants you to BLEED OUT, apparently.

Which is faster - external or internal clotting?

External.

What is Factor VIII replacement?

A.K.A. hemofil

What is hemofil given for?

Hemophilia A and prevention of bleeding

How is hemofil given?

IV ONLY!!! May be given prophylactically 3x a week. Weight-based.

What are some adverse effects of hemofil/Factor VIII?

Thrombosis

Stinging

Itching

Burning

What are some important patient teachings for hemofil?

-Make sure patient isn't allergic to MICE or BOVINE.

-May decrease hemoglobin levels and platelet count

-Not recommended during lactation

What is desmopressin acetate?

A hemostatic agent that is given for mild hemophilia A and also for Von Willebrand disease.

What does desmopressin acetate do for blood?

DECREASES amount of blood products needed.

What is the route for desmopressin acetate?

Oral, nasal, IV, subq (so basically any except for IM, which makes sense, because it's given for people who are thrombocytopenic.)

Patient teaching for desmopressin acetate.

-Apply ice (helps with bleeding)

-May have dizziness/dsypnea

-Strengthen muscles

-Avoid contact sports

What lab may drop if patient is taking desmopressin acetate?

sodium --> hyponatremia

What is aminocaproic acid?

A.k.a. amicar. Systemic hemostatic agent.

What is the indication for amicar?

Controlling severe bleeding, ex. overdose of thrombolytics or severe bleeding.

What are contraindications for amicar?

-History of clots

-Acute DIC

-Heart disease

-Renal OR hepatic dysfunction

-Pregnancy and lactation

What is thrombin?

Topical clotting agent.

Why shouldn't you leave a thrombin dressing on for too long?

Can lead to bacterial overgrowth.