Top drugs qxd by mikesanye


									                                             ➣ Selected breast cancers (inoperable,
estrogens, esterified                        Adults: 10 mg P.O. t.i.d. for at least 3
                                             months in selected men and post-
Estratab, Estratest, Estratest H.S.,         menopausal women
Menest                                       ➣ Prevention of osteoporosis
Pharmacologic class: Estrogen                Adults: Initially, 0.3 mg P.O. daily, in-
                                             creased as needed to a maximum
Therapeutic class: Replacement hor-
                                             dosage of 1.25 mg/day
mone, antineoplastic, antiosteoporotic
Pregnancy risk category X                    Contraindications
                                             ● Hypersensitivity to drug
Action                                       ● Thromboembolic disease (current or
Bind to nuclear receptors in responsive      previous)
tissues (such as female genital organs,      ● Undiagnosed vaginal bleeding

breasts, and pituitary gland), enhanc-       ● Breast and reproductive cancers (ex-

ing DNA, RNA, and protein synthesis.         cept in metastatic disease)
In androgen-dependent prostate can-          ● Estrogen-dependent neoplasms

cer, estrogens compete for androgen          ● Pregnancy

receptor sites, inhibiting androgens.
Also decreases pituitary release of folli-   Administration
cle-stimulating hormone and luteiniz-        ●Administer with food or fluids.
ing hormone.                                 ●Give cyclically as prescribed, except
                                             when used palliatively for cancer treat-
Availability                                 ment.
Tablets: 0.3 mg, 0.625 mg, 1.25 mg,          Route      Onset      Peak        Duration
2.5 mg                                       P.O.       Slow       Days        Unknown
1Indications and dosages
➣ Moderate to severe vasomotor               Adverse reactions
symptoms or atrophic vaginitis               CNS: headache, dizziness, lethargy, de-
Adults: 0.3 to 1.25 mg P.O. daily, ad-       pression, asthenia, paresthesia, syn-
justed to lowest effective dosage; usual-    cope, increased risk of cerebrovascu-
ly given in cycles of 3 weeks on, 1 week     lar accident (CVA), seizures
off                                          CV: hypertension, chest pain, myocar-
➣ Female hypogonadism                        dial infarction (MI), thromboem-
                                             bolism, pulmonary embolism
Adults: 2.5 to 7.5 mg P.O. daily in di-
vided doses for 20 days, followed by         EENT: contact lens intolerance, wors-
rest period of 10 days. If no bleeding       ening of myopia or astigmatism, otitis
occurs, repeat same dosing schedule. If      media, sinusitis, rhinitis, pharyngitis
bleeding occurs before end of rest peri-     GI: nausea, vomiting, diarrhea, dys-
od, start 20-day estrogen-progestin cy-      pepsia, flatulence, gastritis, gastroen-
cle, with progestin P.O. given during        teritis, enlarged abdomen, hemor-
last 5 days of estrogen therapy.             rhoids, colitis, gallbladder disease,
➣ Inoperable prostate cancer                 anorexia, pancreatitis
                                             GU: urinary incontinence, dysuria,
Adults: 1.25 to 2.5 mg P.O. t.i.d. In
long-term therapy, gauge efficacy by         amenorrhea, dysmenorrhea, endome-
symptomatic response and serum               trial hyperplasia, urinary tract infec-
phosphatase level.                           tion, leukorrhea, vaginal discomfort or
                                             pain, vaginal hemorrhage, genital

   Canada                2Clinical alert             Reactions in bold are life-threatening
eruptions, gynecomastia, breast ten-           Red clover: interference with estrogen
derness, breast enlargement or secre-          therapy
tion, reduced libido, impotence, testic-       Saw palmetto: antiestrogenic effects
ular atrophy, increased risk of breast         St. John’s wort: decreased drug blood
cancer, endometrial cancer, hemolytic          level and effects
uremic syndrome                                Drug-behaviors. Smoking: increased
Hepatic: cholestatic jaundice, hepatic         risk of adverse cardiovascular reactions
Metabolic: hyperglycemia, hypercal-            Precautions
cemia, sodium and fluid retention, re-         Use cautiously in:
duced carbohydrate tolerance                   ● cardiovascular disease, severe hepatic
Musculoskeletal: leg cramps, back              or renal disease, asthma, bone disease,
pain, skeletal pain                            migraines, seizures, breast nodules, fi-
Respiratory: upper respiratory tract           brocystic breasts, abnormal mammo-
infection, bronchitis                          grams
Skin: acne, increased pigmentation, ur-        ● family history of breast or genital
ticaria, pruritus, erythema nodosum,           tract cancer
hemorrhagic eruption, alopecia, hir-           ● breastfeeding.
Other: increased appetite, weight              Patient monitoring
changes, edema, flulike symptoms,              ● Monitor fluid intake and output;
hypersensitivity reactions                     weigh patient daily.
                                               ● Evaluate patient for breast tenderness
Interactions                                   and swelling; as needed, administer
Drug-drug. Corticosteroids: enhanced           analgesics and apply cool compresses.
corticosteroid effects                         2Know that drug increases risk of
CYP450 inducers (such as barbiturates,         thromboembolism, CVA, and MI.
rifampin): decreased estrogen efficacy         ● Monitor liver function test results and
Hypoglycemics, warfarin: altered re-           assess abdomen for liver enlargement.
quirement for these drugs                      ● Check serum phosphatase levels in
Phenytoin: loss of seizure control             patients with prostate cancer.
Tamoxifen: interference with tamoxifen         ● Monitor calcium and glucose levels.
Tricyclic antidepressants: reduced anti-       Patient teaching
depressant effect                              ● Instruct patient to recognize and im-
Drug-diagnostic tests. Antithrombin            mediately report signs and symptoms
III, folate, low-density lipoproteins, pyri-   of thrombophlebitis and thrombo-
doxine, total cholesterol, urine pregnane-     embolism.
diol: decreased values                         ● Teach patient how to perform breast
Cortisol; factors VII, VIII, IX, and X;        self-examination; emphasize impor-
glucose; high-density lipoproteins; phos-      tance of monthly checks.
pholipids; prolactin; prothrombin; sodi-       ● Tell patient to report breakthrough
um; triglycerides: increased values            vaginal bleeding.
Metyrapone test: false decrease                ● Mention that drug may cause contact
Thyroid function tests: false interpreta-      lens intolerance; advise patient to re-
tion                                           port vision changes.
Drug-food. Caffeine: increased caffeine        ● Inform men that drug may cause
levels                                         gynecomastia.
Drug-herb. Black cohosh: increased             ● As appropriate, review all other sig-
risk of adverse reactions                      nificant and life-threatening adverse

   Canada                 2Clinical alert             Reactions in bold are life-threatening
reactions and interactions, especially
those related to the drugs, tests, foods,
herbs, and behaviors mentioned above.

   Canada               2Clinical alert     Reactions in bold are life-threatening

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