DRUGS

Leuprolide BRANDNAME: Lupron, eligard

MECHANISM OF ACTION
Stimulates and then inhibits release of follicle Stimulating Hormone and Leutenizing hormone, which suppresses testosterone and estrogen level

SIDE EFFECT/ADVERSE NURSING EFFECT/CONTRAINDICATION INTERVENTIONS

CNS: dizziness, depression, headache, pain GI: nausea, vomiting GU: impotence MET: weight gain or weight loss OTHER: gynecomastia, androgen like effect ADVERSE EFFECT: CNS: Paresthesia CV: Angina, hypertension GI: constipation SKIN: reaction at injection site Never give by IntraVenous administration Inject into vial; then shake well. Suspension will appear milky. Use immmediately. after starting treatment For central precocious puberty, monitor patient response every 1-2 mos. With gonadotropin Releasing hormone stimulation test and sex corticosteroid level determination measure bone age of advancement every 6-12 months. During first few weeks of treatment for prostate Cancer , sign and symptoms may occur (tumor flare).

DOSAGE: Injection -5mg/ml multiple dose vial

CLASSIFICATION: antineoplastic that alter hormone balance

CONTRAINDICATION: contraindicated in patient hypersensetive to drug or other gonadotropin-releasing hormone analogue use cautiously in patient hypersensitive to benzyl alcihol

IMPLANT: 72 mg

ROUTE: IM, implant

CATEGORY: Pregnancy risk category X

DRUGS
GOSERELIN ACETATE BRAND NAME: Zoladex

MECHANISM OF SIDE EFFECT/ADVERSE NURSING ACTION EFFECT/CONTRAINDICATION INTERVENTIONS

A Leutinizing hormone releasing hormone (LH-RH) analogue that acts on the pituitary gland to the release of follicle Stimulating Hormone and LH dramatically lowering sex hormone levels(estrogen in women and testosterone in men) CNS: insomia, depression, headache CV: heart failure, arrythmias GU: impotence ADVERSE EFFECT: CNS: lethargy ,pain, chills CV: hypertension GI: nausea, vomiting, diarrhea, constipation, ulcer HEM: Anemia MUSCULO: back pain SKIN: rash, diaphoresis Never give by IV give drug into upper abdominal wall using aseptic technique when this drugs use for prostate cancer patient LH-RH analogues such as goserelin may initially worsen symp. Cecause drud increase testosterone level. Some patient may temporarily have increase bone pain, rarely disease may get worse (spinal cord compression )although the relationship to therapy is uncertain.

DOSAGE: IMPLANTS: 3-6 mg, 10.8 mg Subcutaneous into upper abdominal wall every 12 weeks

CLASSIFICATION: antineoplastic that alter hormone balance

CONTRAINDICATION: Contraindicated in patient hypersensetive to LH-R agonist analogues Contraindicated to pregnant women it may cause bone mineral density loss that can cause osteoporisis

ROUTE: Subcutaneously

CATEGORY: pregnancy risk category X (endometriosis and endometrial thinning); breast cancer

DRUGS
FLUTAMIDE

MECHANISM OF ACTION
Inhibits androgen uptake or prevents binding of androgen in nucleus of cells in target tissues.

SIDE EFFECT/ADVERSE NURSING EFFECT/CONTRAINDICATION INTERVENTION

CNS: encephalopathy HEM: leukopenia HEP: hepatitis Monitor liver function test ,and CBC periodically. flutamide must be taken continously with drugs use for medical castration (such as leuprolide) To alloe full therapeutic benefit Leuprolide suppresses testoserone production, where as flutamide inhibit testosterone action at cellularlevel, together they can impair growth of androgenresponsive tumors .

BRAND NAME: Eufleat, Eulexin

DOSAGE: 125mg, 250 mg

CLASSIFICATION: antineoplastic that alter hormone balance

ADVERSE EFFECT: CNS: drowsiness , confusion,depression, anxiety , nervousness and paresthesia CV: hypertension GI: diarrhea, nausea, vomting, anorexia GU: impotence HEM: anemia SKIN: rash, photosensitivity CONTRAINDICATION: Contraindicated in patient hypersensitive to drugs and in those with severe liver function

ROUTE: P.O

CATEGORY: Pregnancy risk category D

DRUGS
Mitoxantrone BRAND NAME: Novantrone

MECHANISM OF ACTION
Reacts with DNA, producing cytotoxic Effect. Probably not specific to cell cycle

SIDE EFFECT/ADVERSE NURSING EFFECT/CONTRAINDICATION INTERVENTION

CNS: headache, fever CV: Tachycardia GU: renal failure HEP: jaundice SKIN: alopecia Patients with significant myelosuppression shoudnt receive drug unless benefits outweight risks. Closely monitor hematologic and laboratory chemistry parameters. To prevent bleeding, avoid all I.M. injec. If the platelet count falls below 50,000/mm. If severe nonhematologic toxicity occurs during first course, delay second course until patient recovers.

DOSAGE: INJECTION: 2mg,/ml in 10-ml/,12.5ml,15-ml vials

DRUD CLASSIFICATION: Antineoplastic that alter the hormone balance

ADVERSE EFFECT: METABOLIC: hyyperurecemia RESP.: dyspnea MUSC: back pain OTHER: sepsis.

ROUTE: IM

CATEGORY: Pregnancy risk category D

CONTRAINDICATED: Contraindicated in patients hypersensetive to drug. Use catiously in patients with prevoius exposure to anthracyclines or other cardiotoxic drugs, previous radiation therapy to mediastinal area, or heart disease.

DRUGS
VINBLASTINE SULFATE BRAND NAME: Velban

MECHANISM OF ACTION
Arrest mitosis in metaphase, blocking cell division.

SIDE EFFECT/ ADVERSE NURSING EFFECT/CONTRAINDICATION INTERVENTIONS

CNS:MI GI: nausea and vomiting, constipatio abdominal pain. HEM: anemia MUSC: muscle pain weakness, loss of deeptendon reflex SKIN: irritation, phlebitis ADVERSE EFFECT: CNS:headache CV: hypertension RESP: acute bronchospasm SKIN: reversible alopecia,necrosis with extravasation. Dont give drug into a limb with compromised circulation Assess patients for numbness and tingling sensation in hands and feet . Assess gait early evidence of footdrop Warn patient that hair loss may occur but explain that its usually reversible. Tell the paitient that pain may occur in organ with the tumor.

DOSAGE: Injec. 10-mg vials(lyophilized powder), 1 mg/ml in 10ml and 25-ml vials

CLASSIFICATION: Miscellaneous antineoplastic that alter the hormone balance

ROUTE: I.V.

CATEGORY: Pregnacy risk category D

CONTRAINDICATION: Contraindicated in patients with severe leukopenia or bacterial infection or in patients hrpersensetive to drugs Use cautiously in patients with hepatic dysfunction.

PROSTATE CANCER CONTENTS: Anatomy and physiology Pathophysiology Complications Laboratory Examinations Drug study Medical- Surgical Management Nursing Care Plan Storyline.. Patient CG , a 71-year-old African American, was admitted to the ward for a radical retropubic prostatectomy. His medical history identified that three years ago he was diagnosed with lower urinary tract symptoms, which included dysuria, a weak, hesitant and intermittent stream on voiding followed by some dribbling. Following a Digital Rectal Examination(DRE) and a prostatic specific antigen (PSA) test that showed a level 12.5ng/ml, a formal diagnosis of benign prostatic hyperplasia(BPH) was made. Symptom control was initially by a treatment of choice of watchful waiting and the use of minipress. Mr. CG found it increasingly difficult to cope with his symptoms and subsequently had a transurethral resection of his prostate (TURP). At this present time, his PSA was increased(27.5ng/ml) and his prostatic biopsies revealed adenocarcinoma, necessitating his admission. During his admission procedure, the nurse provided information about the purpose of the surgery, its effect on urinary elimination and sexual functioning. The nurse caring for Mr CG in the early postoperative period was surprised when he explained to her that he was not sure about what to expect. Watchful Waiting A.K.A. observation, expectant therapy or deferred therapy. Diagnosis of an early-stage (T1-T2), low-grade tumor. No medical treatment is provided. Patient receives regular follow-up to monitor tumor. TRENDS: Cancer of the prostate is the second leading cause of cancer death after lung cancer among American men and is the most common carcinoma in men over 65 years of age. How many men get prostate cancer? According to the American Cancer Society, about 241,740 new cases of prostate cancer will be diagnosed in the United States in 2012 and as many as 28,170 men will DIE of it.

Anatomy and Physiology The prostate is a walnut-sized gland that is only present in men. It is located just below the bladder and top of the penis. This gland surrounds the upper part of the urethra ( the tube through which urine flows from the bladder and out through the penis ). The seminal vesicles are just behind the bladder and above the prostate. They are about 4 inches long and 2 inches wide. They produce a sticky, yellowish fluid that contains fructose. This fluid provides sperm cells energy and aids in their motility. The vas deferens is a long tube that carries sperm from the testicle (found in the scrotum) to the urethra. It merges with the seminal vesicle duct to form a canal (ejaculatory duct) which enters the prostate and opens into the urethra that is encircled by the prostate (2). What does prostate gland do? The prostate gland is one amongst a class of glands within the body called exocrine glands. Exocrine glands are named because they secrete through ducts to the outside of the body (or into a cavity that communicates with the outside). The primary function of the prostate gland, which is regulated by testosterone, is to secrete a fluid that is added together with the spermatozoa from the seminal vesicles to constitute majority of semen. This secretion is known to facilitate sperm motility and survival by providing a protective and fluid medium for their passage through the vagina for fertilization. Without this helpful fluid, sperm cells may inefficiently reach the egg, because this fluid prolongs the lifespan of the sperm by being weakly alkaline to neutralize the mildly acidic environment in the vaginal tract. The prostate also contains a system of complex valves which during ejaculation direct semen into the urethra while a round muscle of the prostate called a sphincter contracts and seals off the bladder during the ejaculatory process to prevents urine from entering the urethra. The prostate also secretes an enzyme, Prostate Specific Antigen (PSA) that is secreted by the cells lining the prostate into the seminal fluid and is thought to function as an aid to the liquefaction of semen after ejaculation. What is PSA? PSA, or prostate specic antigen, is a protein produced by the prostate and released in very small amounts into the bloodstream. When theres a problem with the prostate, such as when prostate cancer develops and grows, more and more PSA is released, until it reaches a level where it can be easily detected in the blood. Highest levels found in the seminal fluid PSA can escape prostate and can be found in the serum. Used to track the response to therapy in men with prostate cancer or as screening mechanism ZONES The prostate has distinct zones. The basic zones are the peripheral, central, transition, anterior (consists mainly of smooth muscle), and preprostatic tissue (plays a key role during ejaculation). The areas of concern when something goes wrong with the prostate are the peripheral and the transition zones.

The peripheral zone accounts for the bulk of the normal prostate (about 70% of the glandular tissue). It includes all of the tissue at the apex (bottom of the prostate) and the tissue near the back of the prostate next to the rectum. This is the area most susceptible to prostate cancer and where prostate cancer is most often found (5,6,7). The transition zone surrounds the prostatic urethra that passes through the prostate. This zone is the common site where the prostate enlarges and presses on the urethra as a man grows older (5). Development of Prostate Cancer Prostate carcinoma begins when prostate gland cells multiply and grow out of normal control. It usually begins in the peripheral zone where some clusters of cells are confined within the prostate gland. If this condition progresses, the uncontrolled cells will form a tumor and may invade the stroma as well as extend to the seminal vesicle. If the tumor breaches the capsule, it can now spread more widely and invade the lymphatic system, travelling to regional lymph nodes and then to other organs. This phenomenon is known as metastasis. As with other forms of cancer, the malignant transformation of prostate epithelial cells is a result of complex series of initiator and promoter events with genetic and environmental influences. The exact cause is often unknown. PATHOPHYSIOLOGY

SIGNS AND SYMPTOMS The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms. The symptoms listed below can occur with prostate cancer, usually at a late stage. These symptoms can also be caused by other prostate problems: Delayed or slowed start of urinary stream Dribbling or leakage of urine, most often after urinating Slow urinary stream Straining when urinating, or not being able to empty out all of the urine Blood in the urine or semen Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread) Labs and Diagnostic Tests

Laboratory Results HEMATOLOGY Hemoglobin (N: 135-180): 99 gms/L RBC (N: 4.6-6.2): 3.54x10 to the 9th power/L

WBC (N: 5-10): 5.1x10 to the 9th power/L Segmenters (N: .58-.66): .64 Lymphocytes (N: .21-.30): .27 Monophils (N: .04-.10): .05 Eosinophils (N: .02-.06): .04 Total Neutrophils (N: .68-.70): .64 Hematocrit (N: .40-.50): .30 BLOOD CHEMISTRY Creatinine (N: .5-1.7): 1.8mg/dl Potassium (N: 3.4-5.3): 4.83mEq/L Sodium (N: 135-152): 143.2 mEq/L Hemoglobin is the protein found in the red blood cell that oxygen attach to. The hematocrit count calculates the percentage of red blood cells per micro liter of blood. It represents the cells present in the whole blood. The lab result of the patient shows that both the hemoglobin and hematocrit are low. The low hemoglobin may be due to the low number of red blood cells in the blood. The patient is not receiving the adequate supply of oxygen because of this PSA Test This blood test measures a protein made by the prostate that normally is present in the blood. The amount of this protein in the blood will increase in men who have prostate cancer. A PSA count of 0 to 4 ng/ml is considered below normal (and in some men, 1.0 or 2.0) is normal. A PSA count of 4 to 10 ng/ml is considered slightly elevated. A PSA count of 10 to 20 ng/ml is considered moderately elevated. Anything above 20 ng/ml is considered highly elevated. Nursing Management: Assess if the patient is taking over-the-counter medications Instruct patient not to do vigorous exercises in the 48 hours before the procedure Any sexual activity that results in ejaculation in the 48 hours before a PSA test may raise the PSA level. Catheter or any operations on bladder and prostate may raise PSA level Digital Rectal Exam (DRE) A digital (finger) rectal examination is done to check for problems with organs or other structures in the pelvis and lower belly. A digital rectal exam is done for men as part of a complete physical examination to check the prostate gland. Nursing Management: Explain the procedure to the patient, to gain cooperation and consent.

Document that consent has been given. Ask patient if they wish to use the toilet prior to undertaking the procedure Ensure privacy and offer assistance in undressing/positioning for examination where necessary in preparation for procedure Position patient; left lateral side with knees flexed Proper documentation of the assessment. TransRectal Ultrasonography(TRUS) - involves using a small cylinder shaped transducer, which is lubricated and inserted into the rectum, and a monitoring device. Nursing Management: Instruct patient to discontinue blood-thinning medications (e.g. aspirin, ibuprofen) for a week to 10 days before the procedure. Instruct patient to drink a few glass of water because a full bladder can improve visualization of the prostate gland. Administer enema for cleansing the bowel. After the procedure, advise the patient to refrain from sexual intercourse for 3- 5 days. Patients may experience blood in the urine (hematuria), in the semen (hematospermia), or in the stool, and a dull ache in the perineum (area between the anus and the scrotum). If the patient develops a large number of blood clots or cannot urinate, the physician should be contacted immediately. Transurethral Resection of the Prostate (TURP) is a minimally-invasive operation to remove the parts of the prostate gland that are pressing on the urethra in order to allow urine to flow more freely. is a quick, painless method of obtaining prostate cells for cytologic examination and determining the stage of disease. Nursing Management: Pre-operative Management: Inform the patient about the procedure and the expected postoperative care Incontinence or dribbling of urine up to 1 year after surgery and that Kegels exercise will help alleviate this problem Retrograde ejaculation Bowel preparation is given. Optimal cardiac, respiratory and circulatory status should be achieved to decrease risk of complications. Prophylactic antibiotics are ordered. Post-operative management: Urinary drainage is maintained and observed Maintain patency of urethral catheter. Avoid over distention of bladder Administer anti-cholinergic medications to reduce bladder spasms

Maintain bed rest for the first 24 hours Encourage early ambulation Wound care is provided to prevent infection. Administer pain medications. Promote comfort through proper positioning Administer stool softeners Reduce anxiety by providing realistic expectations about postoperative discomfort and overall progress. Encourage patient to express fears related to sexual dysfunctions and to discuss with partner. Teach measures to regain urinary control. Medical- Surgical Management Hormone Therapy Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Hormone therapy options include: Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. e.g. leuprolide (Lupron, Eligard,), goserelin (Zoladex), triptorelin (Trelstar), histrelin (Vantas) and degarelix (Firmagon) Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells e.g. bicalutamide (Casodex), flutamide, and nilutamide (Nilandron) Surgery to remove the testicles (orchiectomy) Chemotherapy for prostate cancer Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or given by mouth. These drugs enter the bloodstream and go throughout the body, making this a treatment option for men with prostate cancer that has spread (metastasized) to distant areas of their bodies may also be an option for cancers that don't respond to hormone therapy For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer includes: Docetaxel (Taxotere) Cabazitaxel (Jevtana) Mitoxantrone (Novantrone) Estramustine (Emcyt) Doxorubicin (Adriamycin)

Etoposide (VP-16) Vinblastine (Velban) Paclitaxel (Taxol) Carboplatin (Paraplatin) Vinorelbine (Navelbine) Chemotherapy Nursing Management: Assess the clients condition Assure accurate preparation of the agent Assess patients understanding of procedures Aseptic technique Personal protective equipment Wash hands before and after drug handling Limit access to drug preparation area Keep labelled drug spill kit near preparation area Radiation Therapy for prostate cancer Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation may be used: As the initial treatment for low-grade cancer that is still confined within the prostate gland. Cure rates for men with these types of cancers are about the same as those for men getting radical prostatectomy. As part of the first treatment (along with hormone therapy) for cancers that have grown outside of the prostate gland and into nearby tissues. If the cancer is not completely removed or comes back (recurs) in the area of the prostate after surgery. If the cancer is advanced, to reduce the size of the tumor and to provide relief from present and possible future symptoms. Two main types of radiation therapy can be used: external beam radiation and brachytherapy (internal radiation). Both appear to be good methods of treating prostate cancer, although there is more long-term information about the results of treatment with external beam radiation Surgery to remove the prostate Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include: Making an incision in your abdomen (Retropubic surgery) Making an incision between your anus and scrotum (Perineal surgery) Laparoscopic prostatectomy Using a robot to assist with surgery(Robotic laparoscopic surgery)

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Complications Depend On The Type Of The Prostatectomy Performed & May Include : Hemorrhage. Clot Formation. Sexual Dysfunction (Due To Damage Of The Pudendal Nerve) Sexual Activity May Resume In 6-8 Weeks. The Anatomic Changes Lead To Retrograde Ejaculation. Freezing prostate tissue Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Heating prostate tissue using ultrasound High-intensity focused ultrasound treatment uses powerful sound waves to heat prostate tissue, causing cancer cells to die. Highintensity focused ultrasound is done by inserting a small probe in your rectum. The probe focuses ultrasound energy at precise points in your prostate. High-intensity focused ultrasound treatments are being studied in clinical trials. Orchidectomy An orchidectomy (also called orchiectomy) is done to help control the growth of prostate cancer. It is an operation to remove your testicles (testes). Prostate cancer needs testosterone in order to grow. Testosterone is the male sex hormone produced by the testicles. If the testicles are removed, the level of testosterone in your blood falls very quickly. And in 9 out of 10 men (90%) the prostate cancer will stop growing and start to shrink. Staging Stage T1 Nonpalpable prostate cancer Detected only on pathologic examination Incidentally noted after Transurethral resection for benign hypertrophy (T1a and T1b) or On biopsy obtained because of an elevated PSA (T1c-the most common clinical stage at diagnosis) Stage T2 Palpable tumor Appears to be confined to the prostatic gland (T2a if one lobe, T2b if two lobes)

Stage T3 Tumor with extension through the prostatic capsule (T2a if focal, T2b if seminal vesicles are involved) Stage T4 Invasion of adjacent structures Bladder neck External urinary sphincter The rectum The levator muscles The pelvic sidewal Nodal metastases Can be microscopic and can be detected only by biopsy or lymphadenectomy, or they can be visible on imaging studies Distant metastases Predominantly to bone Occasional visceral metastases occur. Nursing Care Plan Nursing diagnosis : urinary retention related to urethral obstruction secondary to prostatic enlargment or tumor Goal: improved pattern of urinary elimination . Nursing Interventions : Determine patients usual of urinary function. Catheterize patient to determine amount of residual urine Prepare patient for surgery if indicated. Assess for signs & symptoms of urinary retention :amount & frequency of urination. Rationale : Provides a baseline for comparison and goal to work toward Determines amount of urine remaining in bladder after voiding Surgical removal of obstruction may be necessary Voiding 20 to 30 frequently and output less than intake suggests retention. Expected outcomes: -voids at normal intervals -reports absence of frequency ,urgency ,or bladder fullness -displays no palpable SupraPubic distention after voiding -maintains balanced intake and output.

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Nursing Care Plan Nursing diagnosis :deficient knowledge relate to diagnosis of: cancer ,urinary difficulties ,and treatment modalities Goal: understanding of the diagnosis modalities Nursing interventions : Encourage communication with the patient Review the anatomy of the involved area Be specific in selecting information that is relevant to the patients particular treatment plan Identify ways to reduce pressure on the operative area after Prostatectomy . A: avoid prolonged sitting , standing, walking B: avoid straining. Rationale : This is designed to establish rapport and trust. Orientation to ones anatomy is basic to understanding its function This is based on the treatment plan ; as it varies with each patient , individualization in desirable This is to prevent bleeding. Expected outcomes: -discusses his concerns and problems freely -describes activates that help or hinder recovery -ask question and shows interest in his condition. -identify ways of attaining /maintaining bladder control. PAIN Drug Study Brand name: casodex Generic name: bicalutamide Route: oral Dosage: 50 mg once daily Classification: anti-androgen Action: inhibits the action of androgens by binding to cytosol androgen receptors in the target tissue. Side effect: hot flashes, breast tenderness, headache, dizziness, hairloss, constipation, diarrhea, nausea, weakness, impotence, decrease appetite, weight loss Adverse effect: chest pain, blood in the urine, mood changes, difficulty of breathing, blurred vision, allergic reaction such as itching, wheezing, swelling of the mouth Contraindication: hypersensitivity to drug

 pregnant indication: use in combination therapy with a luteinizing hormone-releasing hormone(LHRH) analog for the treatment of stage D2 metastatic carcinoma of the prostate nursing implication: take at the same time each day with or without food take as directed and do not alter dose or discontinue without consulting prescriber. Void before taking medication Diabetics should monitor serum glucose closely and notify prescriber of changes, this medication can alter hypoglycemic requirements Brand name: zoladex Generic name: gosereline Classification: LHRH agonist Route: subcutaneous Dosage: 10.8 mg Action: Goserelin is a potent inhibitor of pituitary gonadotrophin secretion. Initially, it causes an increase in the serum levels of FSH and LH but chronic admin will lead to sustained suppression of the pituitary gonadotrophin release causing regression of the sex organs. Indication: used to treat hormone-sensitive cancers of the breast (in pre- menopausal women) and prostate. Side effect: Hot flashes, decreased libido, impotence, Headache, Vaginal dryness, Swelling of the breasts (gynecomastia), Depression, Sleepiness, Skin rash Adverse effect: Vaginal bleeding and dryness, arthralgia, paraesthesias, increase in menstrual bleeding, emotional lability, depression, insomnia, diaphoresis Contraindication: Hypersensitivity; pregnancy, lactation. nursing implication: Ensure women are aware that goserelin may cause their menstrual cycle to become irregular or menstrual periods to cease. Barrier methods of contraception should be used to prevent pregnancy while on this medication. Women who suspect they are pregnant should seek immediate medical attention, as there is a risk of goserelin causing problems to the unborn baby Do not try to aspirate with the goserelin syringe, if the needle is in a large vessel, blood will immediately appear in syringe chamber Brand name: leuprolide Generic name: lupron Route: Leuprolide is injected under the skin (subcutaneously). Lupron Depot is injected into muscle (intramuscularly). Dosage: For prostate cancer, leuprolide can be given daily or Lupron Depot can be given monthly or at 3 to 4 month intervals. The daily

dose of leuprolide is 1 mg. The 3.5 and 7.5 mg doses of Lupron Depot are injected monthly, the 11.25 and 22.5 mg doses every three months, the 30 mg dose every four months, and the 45 mg dose every 6 months. Action: acts as an agonist at pituitary GnRH receptors. By interrupting the normal pulsatile stimulation and the desensitization of the GnRH receptors; it indirectly down regulates the secretion of gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) Classification: LHRH agonist Indication: use for Prostate cancer, breast, ovarian and endometrial cancer, Also used in non-cancerous conditions such as endometriosis, infertility, benign prostatic hypertrophy (BPH). Side effect: mild burning/pain/bruising at the injection site, hot flashes (flushing), increased sweating, night sweats, tiredness, headache, upset stomach, breast changes, acne, joint/muscle aches, trouble sleeping, reduced sexual interest, vaginal discomfort/dryness, vaginal bleeding, swelling of the ankles/feet, increased urination at night, or dizziness. Adverse effect: pain or unusual sensations in your back; numbness, weakness, or tingly feeling in your legs or feet; muscle weakness or loss of use; and loss of bowel or bladder control. painful or difficult urination chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling. Contraindication: hypersensitivity, pregnant, breastfeeding, children Nursing consideration During first week of leuprolide therapy Monitor pt. being treated for initial worsening of symptoms During treatment monitor patients serum testosterone and PSA levelsperiodically, to determined response to leuprolide therapy Inform pt. w/ osteoporosis or at risk for developing it that drug may increase bone density loss Monitor pt. for possible allergic reaction Health teachings For men who have undergone radical prostatectomy, radiation therapy, or both, follow-up care is important to prevent cancer recurrence. PSA has been shown to be useful in detecting recurrences. PSA levels should be less than 0.2 ng/mL after radical prostatectomy. PSA levels should be checked every 3 months for 1 year, every 6 months for the second year, and annually after that. A man should have a physical examination, including digital rectal exam, every 3 months for 1 year, then every 6 months for a year, then yearly after that. In certain cases after radical prostatectomy, additional treatment may be required based on the final pathology report of the removed prostate or if the PSA starts increasing after surgery. This may be in the form of additional radiation treatment to the area where the prostate once was and/or hormonal treatment with LHRH agonists or antiandrogens. Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer. The following supplements should NOT be used to prevent prostate cancer: Vitamin E, Selenium, and Vitamin C.