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1.2.1: Develop and implement individualized treatment plans, taking into consideration specific uses and indications and dosing for drugs

TU is a 61-year-old woman with newly diagnosed metastatic breast cancer who is scheduled to receive her first dose of trastuzumab. She is 5 ft 7 inches tall and weighs 170 lbs. You receive the following order: trastuzumab 440 mg IV infusion over 1.5 hours. What is the appropriate assessment to discuss with the prescriber?

(A) Trastuzumab causes significant nausea and vomiting, warranting premedication with a serotonin antagonist antiemetic. It would be best to call the prescriber and suggest administration of an antiemetic.

(B) Trastuzumab can safely be administered as an IV bolus injection. It would be appropriate to call the prescriber and suggest the order be changed, to be administered as an IV bolus injection.

(C) Trastuzumab has been shown to be effective as an adjuvant treatment but not for treatment of metastatic disease. It would be appropriate to call the prescriber and clarify the indication for trastuzumab for this patient.

(D) The recommended initial dose of trastuzumab is 4 mg/kg (320 mg total for this patient). It would be appropriate to call the prescriber and clarify the dosage for this patient.

(E) Trastuzumab is ordered appropriately for this patient. No clarification is indicated.

The Correct Answer is: D

The standard initial dose for this patient would be 4 mg/kg or 320 mg for this patient. It would be appropriate to clarify this patient's dose (D).

Trastuzumab is not associated with nausea and vomiting that requires pretreatment antiemetic therapy (A). Trastuzumab should not be administered as an IV bolus injection (B). Trastuzumab has been shown effective as treatment for both micrometastatic and metastatic breast cancer, characterized by overexpression of HER-2 (C). Clarification of the dose ordered for this patient is warranted (E).

Topic: Breast cancer

A 62-year-old patient brings in her tamoxifen prescription for a refill. Upon reviewing her medication profile you discover that she began taking tamoxifen 20 mg daily in June 2007 for the prevention of breast cancer, and she has been having it refilled regularly since then. What, if anything, should you discuss with the patient's physician?

(A) The recommended duration of tamoxifen when prescribed to decrease the risk of breast cancer is 10 years. There is no need to clarify this patient's tamoxifen regimen.

(B) Discuss the merits of increasing the dose to 40 mg daily, based on results of a recent study documenting superior efficacy of a 40 mg daily dose.

(C) Switching this patient to an AI based ...

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