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Tamoxifen
Risks:
- stroke: increased risk of blood clot formation
- blood clots: produces oestrogen like effects at some receptors, resulting in increased risk of VTE
- cancer of the uterus: offers endometrial cells that contain pre-existing mutations a growth advantage via estrogenetic alterations

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Tamoxifen
- Deep Vein Thrombosis
- Pulmonary Embolism
- Leg Cramps
- Alopecia
- Loss of Libido
- Endometrial Cancer
- Angioedema
- Hot Flushes
- Sweating
- Vaginal Discharge
- Nausea
- Uterine Polyps
- Ovarian Cysts
- Stroke

these risks are all related to the blocking of estrogen from performing its duties around the body which are numerous.

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Tamoxifen

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Tamoxifen

significant risks:

Blood clots, deep vein thrombosis (DVT) and strokes.

Cataracts or other eye problems.

Endometrial (uterine) cancer.

Menopause-like symptoms,including hot flashes, night sweats and vaginal dryness. Weight gain (more common) or fluid retention (edema). Irregular or loss of menstrual periods.

- can be grouped as tamoxifen binds to estrogen receptors which produces estrogenic and anti-estrogen effects

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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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Ondansetron
MOA: Central and peripheral 5HT₃ receptor blockade.
apomorphine + ondansetron - Severe hypotension, loss of consciousness, bradycardia and seizure activity may result- avoid combination.
rifampicin + ondansetron - Rifampicin may increase metabolism of ondansetron, decreasing its efficacy; monitor clinical effect and increase ondansetron dose if necessary
tramadol + ondansetron - Ondansetron may decrease tramadol’s analgesic effect (vomiting may also worsen if the tramadol dose is increased to compensate); other 5HT₃ antagonists are likely to behave similarly. Avoid combination or change the antiemetic or opioid if these problems occur.

Side effects: constipation, headache, dizziness, transient rise in hepatic aminotransferases

Nursing considerations include assessing pt dizziness to determine if might affect functional ability

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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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Naproxen drug class NSAID

Mode of action
Have analgesic, antipyretic and anti-inflammatory actions. they inhibit synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX).

Indications
rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, pain especially due to inflammation.

Side Effects
- nausea
- GI ulceration and bleeding
- heart failure
- hyperkalaemia
- renal impariment
- confusion
- bronchospasm
- rash

nursing consierations
- take with or after food
- dont adminster to dehydrated patients as it might it increase the risk of side effects.
- dont mix it with aspirin for pain as it will increase the risk of side effects

interactions
- Naproxen (NSAIDs)+ ACE inhibitors- NSAIDS may reduce antihypertensive effect of ACE inhibitor and may increase risk of renal impairment and hyperkalaemia.
- Naproxen (NSAIDs) + Aspirin- aspirin increases the risk of gastric ulceration. NSAIDs can reduce the antiplatelet activity of low dose aspirin and potentially reduce its cardioprotective effect.
- Naproxen (NSAIDs) + Warfarin- NSAIDs increase the risk of serious GI bleeding.

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Esomeprazole
esomeprazole is a protein pump inhibitor. Binds to the hydrogen/potassium ATPase enzyme system, inhibiting both stimulated and basal acid secretion. Used to treat PUD, GORD, dyspepsia.
interactions:
- citalopram: increase concentration, increase risk of adverse effects
- apalutamide: increases metabolism of drug and may reduce clinical effect
- enzalutamide: increases metabolism of drug and may reduce clinical effect
- escitalopram: increase concentration and increase risk of adverse effects
- tacrolimus: increase concentration which may lead to toxicity
nursing management: assess ongoing use of protein pump inhibitors

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Morphine
Morphine promotes the inactivation of tamoxifen through increased glucuronidation
Which means the slowed metabolism of morphine in the body
MOA
Opiod analgesics act on receptors in the CNS and GIT producing analgesia, respiratory depression, sedation and constipation. They act mainly at mu-opioid receptors in the CNS, reducing transmission of the pain impulse and by modulating the descending inhibitory pathways from the brain
signs and symptoms: nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure.

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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?