Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (161 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(es-tra-dye′ole)
Estrace
Depo-Estradiol
Divigel, Elestrin, Estrogel
Evamist
emulsion (Rx)
Estrasorb
Delestrogen
system (Rx)
Alora, Climara, Menostar, Vivelle-Dot
Vagifem
Estring, Femring
Func. class.:
Estrogen, progestins
Needed for adequate functioning of female reproductive system; affects release of pituitary gonadotropins; inhibits ovulation, adequate calcium use in bone
Vasomotor symptoms (menopause), inoperable breast cancer (selected cases), prostatic cancer, atrophic vaginitis, kraurosis vulvae, hypogonadism, primary ovarian failure, prevention of osteoporosis, castration
Pregnancy (X), breastfeeding, reproductive cancer, genital bleeding (abnormal, un
diagnosed), protein C, protein S, antithrombin deficiency
Black Box Warning:
Breast/endometrial cancer, thromboembolic disorders, MI, stroke
Precautions:
Hypertension, asthma, blood dyscrasias, gallbladder/bone/renal/hepatic disease, CHF, diabetes mellitus, depression, migraine headache, seizure disorders, family history of cancer of breast or reproductive tract, smoking, uterine fibroids, vaginal irritation/infection, accidental exposure of children, pets to topical product, history of angioedema
Black Box Warning:
Cardiac disease, dementia
Calculator
• Adult:
TRANSDERMAL
1 patch delivering 0.025, 0.0375, 0.05, 0.075, or 0.1 mg/day 2×/wk (Alora, Estraderm, Vivelle-Dot); 1 patch delivering 0.025, 0.0375, 0.05, 0.06, 0.075, or 0.1 mg/day replace q7days (Climara); 1 patch delivering 0.025 mg/day, replace q7days, may increase to 2 patches after 4-6 wk;
GEL
apply entire unit-dose packet to 5 × 7-inch area of upper thigh/day, alternate thighs;
SPRAY
(Evamist) 1 spray to inner surface of forearm/day in
AM
• Adult:
PO
1-2 mg/day, 3 wk on, 1 wk off or 5 days on, 2 days off;
IM
(cypionate) 1-5 mg q3-4wk; (valerate) 10-20 mg q4wk
• Adult:
TOP
(Estraderm) 0.05 mg/24 hr applied 2×/wk; (Climara) 0.05 mg/hr applied 1×/wk in cyclic regimen; women with hysterectomy may use continuously
• Adult:
IM
(valerate) 30 mg q1-2wk;
PO
(oral estradiol) 1-2 mg bid-tid
• Adult:
PO
10 mg tid × 3 mo or longer
• Adult:
VAG CREAM
2-4 g/day × 1-2 wk, then 1 g 1-3×/wk cycled; vag tab 1/day × 2 wk, maintenance 1 tab 2×/wk;
VAG RING
inserted, left in place continuously for 3 mo
• Adult:
TOP
after cleaning and drying skin on left thigh, calf, rub in contents of pouch using both hands until completely absorbed; wash hands
Available forms:
Estradiol:
tabs 0.5, 1, 2 mg;
valerate:
inj 10, 20, 40 mg/ml;
transdermal:
0.025, 0.0375, 0.05, 0.06, 0.075, 0.1 mg/24 hr release rate;
vag cream:
100 mcg/g;
vag tab:
10 mcg;
vag ring:
2 mg/90 days;
topical emulsion:
2.5 mg;
gel
(Divigel) 0.1%;
spray
(Evamist) 1.53 mg/acuation
•
Titrated dose; use lowest effective dose
•
IM inj deeply in large muscle mass
•
With food or milk to decrease GI symptoms
•
May contain aluminum or other metals in backing of patch, can overheat in MRI scan and burn patients
•
Apply to trunk of body 2×/wk; press firmly, hold in place for 10 sec to ensure good contact; do not apply to breasts
•
On intermittent cycle schedule: 3 wk on then 1 wk off; if patch falls off, reapply
•
Use Evamist daily; spray to inner upper arm; may increase to 2-3×/day based on response; allow to dry for 2 min,
avoid secondary exposure to children, pets, caregivers
•
Use a new applicator daily, provided
CNS:
Dizziness, headache, migraines, depression,
seizures
CV:
Hypertension, thrombophlebitis, edema,
thromboembolism, stroke, pulmonary embolism, MI,
chest pain
EENT:
Contact lens intolerance, increased myopia, astigmatism, throat swelling, eyelid edema
GI:
Nausea
, vomiting, diarrhea, anorexia, pancreatitis, cramps, constipation, increased appetite, increased weight,
cholestatic jaundice, hepatic adenoma
GU:
Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrhea, vaginal candidiasis, breast changes,
gynecomastia, testicular atrophy, impotence
,
increased risk of breast cancer, endometrial cancer,
changes in libido;
toxic shock, vaginal wall ulceration/erosion (vag ring)
INTEG:
Rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, erythema, pruritus, melasma; site irritation (transdermal)
META:
Folic acid deficiency, hypercalcemia, hyperglycemia
PO/INJ/TRANSDERMAL:
Degraded in liver, excreted in urine, crosses placenta, excreted in breast milk
Increase:
action of corticosteroids
Increase:
toxicity—cycloSPORINE, dantrolene
Decrease:
action of anticoagulants, oral hypoglycemics, tamoxifen
Decrease:
estradiol action—anticonvulsants, barbiturates, phenylbutazone, rifampin, calcium
•
Altered estrogen effect: black cohosh, DHEA
Decrease:
estrogen effect—saw palmetto, St. John’s wort
Increase:
estrogen level—grapefruit juice
Increase:
BSP retention test, PBI, T
4
, serum sodium, platelet aggregation, thyroxine-binding globulin (TBG), prothrombin; factors VII, VIII, IX, X; triglycerides
Decrease:
serum folate, serum triglyceride, T
3
resin uptake test, glucose tolerance test, antithrombin III, pregnanediol, metyrapone test
False positive:
LE prep, ANA
Black Box Warning:
For previous breast/endometrial cancer, thrombo-embolic disorders, MI, stroke, dementia
•
Blood glucose of diabetic patient; hyperglycemia may occur
•
Weight daily; notify prescriber of weekly weight gain >5 lb; if increase, diuretic may be ordered
•
B/P q4hr; watch for increase caused by water and sodium retention
•
I&O ratio; decreasing urinary output, increasing edema, report changes
•
Hepatic studies, including AST, ALT, bilirubin, alk phos at baseline, periodically; periodic folic acid level
•
Hypertension, cardiac symptoms, jaundice, hypercalcemia
•
Mental status: affect, mood, behavioral changes, aggression
•
Female patient for intact uterus; if so, progesterone should be added to estrogen therapy to decrease risk of endometrial cancer
•
Therapeutic response: reversal of menopause symptoms; decrease in tumor size in prostatic, breast cancer
•
To weigh weekly; to report gain >5 lb
To report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, chest pain; tenderness, redness, and swelling in extremities; males to report impotence, gynecomastia; to report dermal rash with transdermal patch
•
To avoid grapefruit or grapefruit juice (PO)
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert