Misc. Hormone and Electrolyte Agents

Question 1

Anastrozole brand name

Answer 1

Arimidex

Question 2

Anastrozole indication/dosage

Answer 2

Adjuvant treatment of postmenopausal women with hormone receptor-positive early breast cancer: 1mg daily
First-line treatment of postmenopausal women with hormone-receptor-positive or -unknown locally advanced or metastatic breast cancer: 1mg daily
Treatment of advanced breast cancer in postmenopausal women with disease progression following tamoxifen therapy: 1mg daily

Question 3

Anastrozole mechanism

Answer 3

selective non-steroidal aromatase inhibitor.
aromatase is responsible for converting androstenedione to estrone in peripheral tissues, primary source of circulating estrogen in postmenopausal women.
growth of some breast cancers rely on stimulation of estrogen receptors on tumor by estrogen

Question 4

Anastrozole metabolism

Answer 4

metabolism: N-dealkylation, hydroxylation, and glucuronidation

Question 5

Anastrozole drug interactions

Answer 5

estrogen and estrogen-containing drugs may inhibit pharmacological action
Tamoxifen may inhibit the plasma levels of anastrozole

Question 6

Anastrozole CI/precautions

Answer 6

CI: hypersensitivity
may cause fetal harm in pregnant women, exclude pregnancy before initiation
not recommended in premenopausal women

Question 7

Anastrozole pregnancy category

Answer 7

D

Question 8

Anastrozole ADR’s

Answer 8

vasodilation, nausea, vomiting, asthenia, localized pain, constipation, diarrhea, headache, flu syndrome
may cause reduction in BMD because it lowers circulating estrogen levels

Question 9

Anastrozole patient education

Answer 9

if dose missed, take as soon as possible. if closer to time of next dose, skip missed dose and return to dosing schedule. do not double doses!
notify if marked weakness, drowsiness, pain or swelling of legs, blurred vision, or shortness of breath occur

Question 10

Calcitriol brand name

Answer 10

Rocaltrol

Question 11

Calcitriol indication/dosage

Answer 11

management of hypocalcemia in patients with postsurgical, idiopathic, and pseudo- hypoparathyroidism: begin at 0.25mcg daily, titrate at 2-4 week intervals. usual dosage is 0.5-2mcg daily

• secondary hyperparathyroidism in mod/severe renal failure
• management of hypocalcemia in dialysis

Question 12

Calcitriol mechanism

Answer 12

active form of D3
helps transport calcium through intestine
patients with renal failure do not synthesize calcitriol adequately, leading to hypocalcemia

Question 13

Calcitriol drug interactions

Answer 13

cholestyramine - reduced absorption
phenytoin and phenobarbital - increase metabolism
thiazides - precipitate hypercalcemia
digoxin - patients who develop hypercalcemia may develop arrhythmias
AVOID D3 and magnesium supplements
AVOID calcium supplements unless recommended by physician

Question 14

Calcitriol CI/precautions

Answer 14

CI: hypercalcemia and vitamin D toxicity
serum calcium x phosphate product should not exceed 70. calcitriol can increase serum phosphate levels, so use phosphate binder or low-phosphate diet

Question 15

Calcitriol monitoring

Answer 15

serum calcium x phosphate product

serum calcium: twice weekly early in therapy and daily if hypercalcemia experienced.

Question 16

Calcitriol ADRs

Answer 16

vitamin D toxicity: hypercalcemia syndrome and calcium intoxication.
Early symptoms: weakness, headache, somnolence, N/V, dry mouth, constipation, muscle/bone pain, metallic taste, anorexia
Late symptoms: polyuria, polydipsia, weight loss, nocturia, conjunctivitis, pancreatitis, photophobia, rhinorrhea, and hyperthermia

Question 17

Calcitriol patient education

Answer 17

do not take OTC Vitamin D!!
do not exceed prescribed amount of calcium from any source (800-1200mg/day)
no OTC mag or mag-containing antacids
without regard to meals
do not discontinue without consultation