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Hormones & hormone modulators for cancer treatment: Nursing Pharmacology

Notes

Notes

HORMONES & HORMONE MODULATORS for CANCER TREATMENT,
PART 1/2
DRUG NAME
hydroxyprogesterone (Duralutin), medroxyprogesterone (Depo-Provera), megestrol (Megace)
tamoxifen (Nolvadex), raloxifene (Evista), toremifene (Fareston)
anastrozole (Arimidex), letrozole (Femara), exemestane (Aromasin)
CLASS
Sex hormones
Selective estrogen receptor modulators (SERMs)
Aromatase inhibitors
MECHANISM of ACTION
Suppress gonadotropin release by the pituitary → block sex hormone production by the gonads
Block estrogen receptors on cancer cells
Reduce estrogen production
INDICATIONS
  • Breast cancer
  • Prostate cancer
  • Endometrial cancer
  • Brain tumors
  • Renal cancer
ROUTE(S) of ADMINISTRATION
  • IM and SubQ (hydroxy-progesterone)
  • PO (medroxy-progesterone, megestrol)
  • PO
SIDE EFFECTS
  • Weight gain
  • Myalgia, arthralgia, decreased bone mineral density, fractures
  • Decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness, or irritation
  • Anorexia, nausea, vomiting, diarrhea
  • Increased risk for cardiovascular disease
  • Tamoxifen (boxed warnings): thromboembolic events, stroke, uterine cancers
  • Raloxifene (boxed warnings): thromboembolic events, stroke
  • Toremifene (boxed warning): QT prolongation
CONTRA-INDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Hepatic or renal disease
HORMONES & HORMONE MODULATORS for CANCER TREATMENT,
PART 2/2
DRUG NAME
flutamide (Eulexin), apalutamide (Erleada), bicalutamide (Casodex, Calutex)
leuprolide (Eligard, Lupron, Viadur), goserelin (Zoladex)
CLASS
Antiandrogens
Gonadotropin-releasing hormone analogs
MECHANISM of ACTION
Block androgen receptors on cancer cells
Reduce gonadotropin release by the pituitary → block sex hormone production by the gonads
INDICATIONS
  • Breast cancer
  • Prostate cancer
  • Endometrial cancer
  • Brain tumors
  • Renal cancer
ROUTE(S) of ADMINISTRATION
  • PO
  • SubQ
  • IM (leuprolide)
SIDE EFFECTS
  • Weight gain
  • Myalgia, arthralgia, decreased bone mineral density, fractures
  • Decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness, or irritation
  • Anorexia, nausea, vomiting, diarrhea
  • Increased risk for cardiovascular disease
  • Flutamide (boxed warning): severe hepatotoxicity
CONTRAINDICATIONS & CAUTIONS
  • Pregnancy and breastfeeding
  • Hepatic or renal disease
NURSING CONSIDERATIONS for
HORMONES & HORMONE MODULATORS for CANCER TREATMENT
ASSESSMENT & MONITORING
Assessment and monitoring: Tamoxifen for ductal carcinoma in situ

Assessment
  • Vital signs
  • Laboratory test results: liver and renal function, CBC, calcium, and lipid panel
  • Diagnostic test results: mammogram, breast ultrasound, MRI, and biopsy results; baseline bone mineral density test

Monitoring
  • Side effects
  • Evaluate for the desired therapeutic effect: decreased tumor size, slowed cancer progression 
CLIENT EDUCATION
  • Purpose of medication: help delay tumor growth; decrease the risk of developing invasive breast cancer
  • Take once daily, with or without food
    • Avoid grapefruit juice
  • Regular follow up for breast, eye, and bone density exams, mammograms, gynecological exams; laboratory tests to monitor lipids and calcium levels 
  • Side effects
    • Weight gain
    • Hot flashes
    • Myalgia
    • Vaginal dryness, or irritation
    • Temporary increase in tumor size
    • Seek immediate medical attention
      • Symptoms of clotting; weakness on one side of the body, problems speaking or breathing, chest pain, coughing up blood, and pain or swelling in the lower extremities
      • Decreased visual acuity, color vision changes
      • Hypercalcemia: muscle weakness, fatigue, nausea, constipation, or bone pain
      • Malignancies: pelvic pain or pressure; abnormal vaginal bleeding; breast soreness or pain 
Transcript

Hormones and hormone modulators are a group of medications that suppress the function of specific hormones, which slows or stops the growth of hormone-dependent cancers, such as breast, endometrial, and prostate cancers. They can also be used to ease the symptoms caused by certain types of cancer, such as brain or renal cancers.

Now, hormones and hormone modulators can be broadly classified as sex hormones; antiestrogens; aromatase inhibitors; antiandrogens; and gonadotropin-releasing hormone analogs.

Now, some commonly used sex hormones include hydroxyprogesterone, which is administered intramuscularly or subcutaneously for advanced uterine adenocarcinoma; as well as medroxyprogesterone, and megestrol, which are taken orally for endometrial or breast cancer. Once administered, these medications work by suppressing the pituitary gland from releasing gonadotropins, so follicle-stimulating hormone or FSH for short, and luteinizing hormone or LH. As a result, gonadotropins aren’t available to stimulate sex hormone production by the gonads, which ultimately delays the growth of sex hormone-dependent tumors.

There are also antiestrogens, which include selective estrogen receptor modulators, or SERMs for short, such as tamoxifen, raloxifene, and fulvestrant. These medications are administered orally, and work by blocking estrogen receptors on cancer cells, which delays the growth of estrogen-dependent tumors.

Similarly, there’s aromatase inhibitors, which include anastrozole, letrozole, and exemestane. These medications are administered orally, and act by blocking the production of estrogen, which ultimately also helps limit the growth of estrogen-dependent tumors.

Next are antiandrogens, which include flutamide, apalutamide, and bicalutamide. These medications are also administered orally, and they block androgen receptors on cancer cells, ultimately stopping the growth of androgen-dependent tumors like prostate cancer.

Finally, gonadotropin-releasing hormone or GnRH analogs include leuprolide and goserelin. These medications are administered subcutaneously, and leuprolide may also be administered intramuscularly. Once administered, these medications inhibit the release of gonadotropins from the pituitary gland. This blocks the secretion of sex hormones by the gonads, ultimately stopping the growth of sex hormone-dependent tumors like breast or prostate cancers. Alright, now common side effects of hormones and hormone modulators can include weight gain, myalgia, arthralgia, and even fractures due to decreased bone mineral density, as well as decreased libido, gynecomastia, hot flashes, and vaginal discharge, dryness, or irritation. Additionally, clients may experience gastrointestinal side effects, such as anorexia, nausea, vomiting, or diarrhea. More serious side effects include an increased risk for cardiovascular disease. Finally, tamoxifen and raloxifene have boxed warnings for causing thromboembolic events and stroke; and tamoxifen also has a boxed warning for causing uterine cancers; and flutamide has a boxed warning for severe hepatotoxicity.