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Increased risk of adverse effects, in particular heart failure, GI ulceration and renal impairment.

It is 4 times risky for Elderly people

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

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Esomeprazole

Class: PPI Proton Pump Inhibitor
MOA: binds to proton pump to inhibit acid secretion
Signs and symptoms: headache, nausea, vomiting, abdominal pain and constipation.
Drug to drug interactions: citalopram, escitalopram,tacromilus,enzalutamide,apalutamide
How to prevent, assess or manage risks/nursing considerations: If given orally do not crush or chew.

Tamoxifen:
MOA:
Risks:

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Morphine

Class: is a potent analgesic (pain-relieving) medication that belongs to the class of drugs known as opioids. It is primarily used for the management of moderate to severe pain, especially when other pain relief methods have proven ineffective. Morphine is derived from the opium poppy plant and is one of the oldest and most well-known opioids.
MOA: Morphine works by binding to specific opioid receptors in the brain and spinal cord, which helps to block the transmission of pain signals and produces a sense of pain relief and euphoria.
Signs and symptoms: Like all opioids, morphine has a range of potential side effects, including constipation, nausea, vomiting, drowsiness, dizziness, confusion, respiratory depression (slowed breathing), and the potential for addiction or dependence with prolonged use.
Drug to drug interactions: Morphine can interact with other medications and substances, including alcohol and other central nervous system depressants, potentially leading to dangerous effects or interactions.
How to prevent, assess or manage risks/nursing considerations: Avoid driving or hazardous activity until you know how morphine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Also avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Tamoxifen: is a medication commonly used in the treatment of certain types of breast cancer and as a preventive measure for individuals at high risk of developing breast cancer. It belongs to a class of drugs known as selective estrogen receptor modulators (SERMs).
MOA: Tamoxifen works by binding to estrogen receptors in breast cancer cells. It acts as an antagonist, which means it blocks the effects of estrogen on these cells. Many breast cancers are estrogen receptor-positive, meaning they depend on estrogen to grow. By blocking estrogen's effects, tamoxifen helps slow down or inhibit the growth of these tumors.
Risks: Common side effects of tamoxifen can include hot flashes, vaginal dryness, irregular menstrual periods (or cessation of periods in postmenopausal women), and mood changes. It can also increase the risk of blood clots, stroke, and uterine cancer.

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Panadol Osteo

Class: non opiod analgesic
MOA: Inhibition of prostaglandin synthesis, primarily within the central nervous system. It does not possess anti-inflammatory activity. It provides relief from mild to moderate pain and fever. The combination of immediate release and sustained release paracetamol provides pain relief, which may last up to 8 hours.

Osteo targets: Osteoarthritis & Muscle aches and pains such as backache
also used for: headache, Period pain, Toothache and pain after dental procedures, Colds and flu, fever

Signs and symptoms:
Overdose: Diarrhea, increased sweating, loss of appetite, nausea or vomiting, stomach cramps or pain, swelling, pain, or tenderness in the upper abdomen or stomach area

Rare: tarry stools, bloody or cloudy urine, skin rashes
Drug to drug interactions:
-The anticoagulant effect of warfarin and other coumarins may be enhanced by prolonged regular daily use of paracetamol with increased risk of bleeding; occasional doses have no significant effect. Anticoagulant dosage may require reduction if paracetamol and anticoagulants are taken for a prolonged period of time.
-Paracetamol absorption is increased by substances hat increase gastric emptying, e.g. metoclopramide.
-Paracetamol may increase chloramphenicol concentrations.
-The risk of paracetamol toxicity may be increased in patients receiving other potentially hepatotoxic drugs or drugs that induce liver microsomal enzymes such as alcohol and anticonvulsant agents
-Paracetamol excretion may be affected and plasma concentrations altered when given with probenecid. -Colestyramine reduces the absorption of paracetamol if given within 1 hour of paracetamol.
How to prevent, assess or manage risks/nursing considerations:
- Monitor vital signs
- cease administration if adverse effects occur, and inform medical team/senior staff
- Ask patient if they have had hx of adverse effects with paracetamol or are hypersensitive to paracetamol.
- Take note of any known allergies
(Take with water or other fluid. Can be taken with or without food)
- Should not be used with other paracetamol-containing products.
- Minimum dosing interval: 6 hours. Maximum daily dose: 4000 mg
Tamoxifen:
MOA:
Risks t

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Ondansetron

Class:  5hT3 anatagonist
MOA: central and peripheral 5HT3 receptor blockade
Signs and symptoms:
-Common: constipation, headache, dizziness, transient rise in hepatic aminotransferase.
-Rare: hypersensitivity reactions: anaphylaxis, ECG changes.
Drug to drug interactions:
- rifampicin: increases metabolism which decreases its efficacy, and needs to monitor clinical effects. and increase ondansteron dose if required.
-Tramadol: It decreases the effect of tramadol.
How to prevent, assess or manage risks/nursing considerations:
Routes:
- Wafer, I/V, not exceeding 24ml daily (if there is hepatic impairment) as well as I/M.
Nursing Considerations:
-Monitor live function
-signs and symptoms of liver damage.
-more effective for acute than delayed symptoms.

Tamoxifen:
class: immunomodulators/ antineoplastics
MOA: competes with estrogen for breast tissue which inhibits the growth of tumors.
-also has estrogen agonist activity on the endometrium bone and lipids.
Risks:
- Avoid warfarin increases the risk of VTE.
-stop during prolonged immobilisation.
- Stop before 3 weeks elective surgery.
-Avoid using during pregnancy

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Naproxen

Class: NSAID( Nonsteroidal anti- inflammatory drug)
MOA: Inhibit both cyclooxygenese isoenzymes, COX-1 and cox-2
Signs and symptoms: Skin rash, allergic reaction, Nausea, headache, hypertension, salt and fluid retention
Drug to drug interactions: If given with ACE inhibitors it increases the risk of gastric ulceration.
Aldosterone:  increase the risk of hyperkalemia and reduced the renal function.

How to prevent, assess or manage risks/nursing considerations:
Take it  with  food or shortly after food.
do not take when you are dehydrated.

Tamoxifen:
MOA:
Risks:

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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?