Chiong - Clinical Pharmacy Breast Cancer

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John Miguel P.

Chiong
BS Pharmacy 3

Problem Identification Problem Identification


1.a. Create a list of potential drug therapy problems in the patient’s medication regimen.
- There is no drug therapy problem in this information given or that the patient
taken.

1.b. Given this clinical information, what is this patient’s clinical stage of breast cancer?
- The stage of breast cancer in this patient’s clinical is stage 3. In stage 3, the
tumor is 2 cm in diameter and has begun to spread to adjacent lymph nodes. In
this patient’s information for her left breast, “Notable for a 2.5-cm mass at the 6
o’clock position, approximately 3 cm from the nipple margin, not fixated to skin;
no nipple retraction or discharge is visualized; the massis exquisitely tender to
palpation; 1.5 cm, nontender, palpable mass in the axilla noted.”

Desired Outcome Desired Outcome


2.a. What is the primary goal for cancer treatment in this patient?
- Cancer growth can be slowed or stopped. The primary goal for cancer treatment
is keeping cancer from returning. Taking care of the symptoms of an incurable
malignancy. It is awareness of the symptoms and the importance of screening
are essential approaches to lower the risk.

2.b. What is the prognosis for this patient based on tumor size and nodal status?
- Breast cancer that has spread to lymph nodes is more likely to recur and has a
worse prognosis than breast cancer that has not gone to any lymph nodes. The
number of cancerous lymph nodes is also significant. The more positive lymph
nodes there are, the more likely it is that breast cancer will recur. In this patient’s
case stated “Suspicious lymph nodes are noted in the axilla. The largest node
measures 1.8 1.8 1.4 cm”. Also, Left axillary lymph node: metastatic
adenocarcinoma consistent with breast primary and Left infraclavicular lymph
node: metastatic adenocarcinoma consistent with breast primary.
2.c. In addition to the stage of disease, what other factors are important for determining
the prognosis for breast cancer?
- Risk factors can be genetic, but some lifestyle variables, such as alcohol
consumption, make it more likely.

Radiation exposure
- Radiation treatment for a cancer that is not breast cancer raises the
chance of developing breast cancer later in life.
Hormone treatments
- Hormone replacement treatment (HRT) and oral birth control pills have
been related to breast cancer owing to elevated estrogen levels.
Hormone treatments
- Researchers determined in 2012 that exposure to some carcinogens and
endocrine disruptors, such as those found in the workplace, might be
connected to breast cancer. Working night shifts was proposed to raise the
risk of breast cancer by experts in 2007, however more current study
shows that this is improbable.

Therapeutic Alternatives Therapeutic Alternatives


3. List the treatment modalities available for this patient’s breast cancer, and discuss
their advantages and disadvantages.

Treatment will be determined by:

- the type of breast cancer


- the stage of the cancer
- sensitivity to hormones
- age, general health, and preferences of the patient

The primary therapeutic options are as follows::

- radiation therapy
- surgery
- biological therapy, or targeted drug therapy
- hormone therapy
- chemotherapy
Optimal Plan
4. Design an appropriate plan for treating this patient’s breast cancer, focusing on
pharmacologic and nonpharmacologic measures. If the plan includes chemotherapy,
identify a specific regimen, and provide your rationale for selecting it.

Pharmacologic measure:
Chemotherapy
- Chemotherapy is a medication that uses strong chemicals to
destroy rapidly developing cells in the body.Chemotherapy is most
commonly used to treat cancer because cancer cells grow and
proliferate significantly faster than the rest of the body's cells. There
are several chemotherapy medicines available. To treat a wide
range of malignancies, chemotherapy medications can be
administered alone or in combination.
Surgery
If surgery is needed, the choice will depend on the diagnosis and
the individual. Types of surgery include:
- Lumpectomy: This involves eliminating the tumor as well as
a tiny quantity of healthy tissue surrounding it. This can aid
in the prevention of cancer spread. This may be an option if
the tumor is tiny and easily separated from the surrounding
tissue.
- Mastectomy: In a simple mastectomy, the lobules, ducts,
fatty tissue, nipple, areola, and some skin are removed. Both
the lymph nodes in the armpit and the muscle from the chest
wall will be removed during a radical mastectomy.
- Sentinel node biopsy: Because breast cancer can travel
deeper via the lymphatic system and into other regions of
the body if it gets to a lymph node, removing one lymph
node can stop the disease from spreading.
- Reconstruction: A surgeon can do a reconstruction after
breast surgery to restore the breast such that it resembles
the other one. They can conduct this concurrently with a
mastectomy or at a later time. They could utilize tissue taken
from the patient's other body area or a breast implant.

Non Pharmacologic measure:


- Physical workout or physical activity, meditation, hypnosis, yoga, music
therapy, relaxation, stress management, massage and acupressure.
Which workout or physical activity was more popular suggested course of
action for managing psychological as well as physical signs. However, this
research showed that the self-managed non-pharmacological suggestions
Interventions were many but few.

Outcome Evaluation 5.a. What parameters should be monitored to evaluate the eficacy
and adverse efects of the therapy you recommended?
- The most relevant of these criteria are tumor size, histologic type, histologic
grade, axillary lymph node status, estrogen receptor status, and tumor growth
fraction. To evaluate the efficacy and adverse effects of the therapy.

Listen

CLINICAL COURSE CLINICAL COURSE


The patient tolerated your treatment plan well. Twelve months afer its completion, the
patient returns to clinic complaining of lower back pain for the past 3–4 weeks. She has
been taking hydrocodone/acetaminophen more regularly, “about two or three pills per
day.” This is a significant change since previously she reported not taking any. The
patient
is restaged with a bone scan, chest x-ray, abdominal CT, chest CT, and laboratory tests.
Bone scan reveals metastases to the lumbar spine without spinal cord compression.
Chest
x-ray is negative. Abdominal CT shows a solitary liver metastasis. Chest CT is negative
for
metastases. LFTs are within normal limits. Ca 27.29 is 100.7 units/mL. Biopsy of the
liver
lesion confirms recurrence of ER-positive, PR-positive, HER2-negative breast cancer.
The
physician concludes that this patient’s breast cancer is now metastatic to the bone and
liver. The previous therapy is discontinued, and the patient is started on palbociclib and
letrozole. The patient’s updated information is below.

Labs

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Na 140 mEq/L Hgb 12.5 g/dL WBC 6.7 × 10 /mm AST 40 IU/L
K 3.9 mEq/L Hct 36.4% Neutros 64% ALT 24 IU/L
Cl 103 mEq/L RBC 4.1 × 10 /mm Lymphs 30% LDH 502 IU/L
CO 28 mEq/L Plt 356 × 10 /mm Monos 3% T. bili 0.5 mg/dL
BUN 11 mg/dL Eos 3% CA 27.29 100.7 units/mL
SCr 0.65 mg/dL
Glu 92 mg/dL

Meds
Cardizem CD 180 mg PO once daily

33

63

33

Protonix 40 mg PO once daily

Zolof 50 mg PO once daily

Ambien CR 12.5 mg PO at bedtime PRN sleep

Hydrocodone/acetaminophen 5 mg/300 mg, one to two tablets PO Q 6 H PRN pain

Outcome Evaluation Outcome Evaluation


5.b. What is this patient’s current clinical stage of breast cancer, and what is the primary
goal for cancer treatment for this patient now?
- The clinical stage of breast cancer in this patient’s current is at stage 4. Cancer
has spread to other organs, most notably the bones, liver, brain, and lungs. The
goal of treatment is to manage any symptoms as well as the cancer.

5.c. Based on the patient’s current medication list, create a list of potential drug therapy
problems as she begins a new therapy for cancer.

Specific doses Route Dosage Frequency


Protonix PO 40 mg once daily

Ambien CR PO 12.5 mg bedtime PRN sleep

Neurontin PO 300 mg TID

Hydrocodone/aceta PO 5 mg/300 mg Q6 H PRN pain


minophen
5.d. Since the patient has developed bone metastases, what other medication should
be
added to her treatment plan? At what dose and schedule?

Specific doses Route Dosage Frequency

methotrexate IV 40 mg/m2 First and eight days

5-fluorouracil IV bolus 340-370-400 Day


mg/m2

Folinic acid IV bolus 200 mg/m2 Day


Patient Education Patient Education
6. What information should be provided to the patient regarding her new chemotherapy
for
breast cancer?
- Chemotherapy can help reduce certain symptoms in addition to treating cancer
that has spread to other parts of the body. This is particularly so in the latter
stages. Because estrogen can encourage the development of some breast
cancers, it can also reduce estrogen production. There is adverse effects of
chemotherapy may include nausea, vomiting, loss of appetite, fatigue, sore
mouth, hair loss, a slightly high susceptibility to infections.

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