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TAMOXIFEN
Risks associated:
- Leg cramps
- alopecia

Why are the risks signficant?
- leg cramps may mean not enough blood flow
- alopecia means that your immune system mistakenly attacks a part of your body

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TAMOXIFEN
Risks associated:
- stevens johnson syndrome
- leg cramps
- alopecia
- menopause like symptoms
- leg swelling
- nausea
- skin rash
- vaginal discharge
- weight gain
- fluid retention
- headache

Why are the risks significant?
- Tamoxifen works by blocking the actions of oestrogen which is a natural female sex hormone.

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TAMOXIFEN
Risks associated:
Menopausal syndrome
Signs and symptoms of hot flush, night sweat, and regular menstration
It can increased blood clot formation which could potentially led to thrombo-embolic episod such as pulmonary embolism and stroke. It can also increased risk of uterine cancer because it acts like estogen.

Why are they significant?
Decreased the risk of having breast cancer

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- Increased body fat
- Decreased body water
- Decreased muscle mass
- Changes in renal and liver function
- Brings on menopause

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Mrs Marple now has constipation. What medication/s will you give her to relieve this?
Deakin Hospital Protocol needs to be considered for this decision

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Note: this maybe what you need to consider???

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What factors may result in impaired medication effects in these patients?

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Naproxen Nsaid

MOA: it works by blocking natural substance that causes inflamation

Indications for use: pain due to inflamation and swelling such as headache, pain and arthritis

Nursing considerations: check for kidney problems and allegys to NSAIDS
Drink plenty of fluids to prevent dehaydration
Stop smoking and alcohol because it cause stomach bleeding avoid driving cause it has sedation effect

Drug - drug interactions:
Anti-platelet increased bleeding
Other pain reliever- it may increased kidney damage.

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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Ondansetron (5HT3 antagonist)
Anti emetic

MOA: Seretonin -HT3 receptor agonist. Works by blocking the action of seretonin, a natural substance that may cause nausea and vomiting

Indications for use: Nausea and vomiting
Cancer chemotherapy
post operative
pregnancy
radiotherapy induced

Nursing considerations:
More effective for acute than delayed symptoms
Can be given orally or intravenously

Drug - drug interactions:
Ondansetron + Rifamipicin
- may increase metabolism of ondansetron, decreasing its efficacy. Monitor clinical effect

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Esomeprazole

MOA: Bind to the hydrogen/potassium ATPase enzyme system (proton pump), inhibit and both stimulated and basal acid secretion

Indications for use: GORD, Zollinger/Ellison syndrome, H.pylori eradication, treatment prevention for NASID peptic ulcers, prevention of peptic ulcer re-bleeding

Nursing considerations: asses ongoing PPI use regularly. consider stop treatment, intermittent use when symptoms develop, step down to lowest effective dose. watch for enteric infection. watch for possible association of decrease vitamin B12, pneumonia, fracture, iron deficiency and chronic kidney disease with PPI therapy

Drug - drug interactions: anticoagulants

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Morphine

MOA: act on the receptors in the CNS and GIT producing analgesia. Acting mainly at mu-opioid receptors in the CNS to reduce the pain impulse.

Indications for use:
- Used for severe pain management.
- Opioids that are used for general anaesthesia

Nursing considerations:
- Reassess the patient's pain frequently using the numerical pain assessment and adjust morphine dose accordingly
- peak analgesic effects occur within 60mins after oral dose, 50-90mins after SC injection and 20mins after IV injection
- Advise laxatives as opioids can cause constipation
- Education for dental hygiene

Drug - drug interactions
- Pregabalin = may lead to additive CNS or respiratory depression
- Tramadol = additive serotonergic effects therefore increasing the risk of serotonin syndrome
- Naloxone =

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What would they be for this medication chart?

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Significant risks / drug-drug interactions???                           

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Significant risks / drug-drug interactions???                           

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?

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Compare and contrast the significant risks for Tamoxifen

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Compare and contrast the significant risks for Tamoxifen

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What were your significant risks Tamoxifen? Are you able to group these risks? Why are they significant?
Do you understand the MoA of how the patient might develop the risks?
Did you need to go and look them up again?