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INTRODUCTION

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raloxifene (ra-lox-i-feen)

Evista

Classification

Therapeutic: bone resorption inhibitors

Pharmacologic: selective estrogen receptor modulators

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Indications
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Treatment and prevention of osteoporosis in postmenopausal women. Reduction of the risk of breast cancer in postmenopausal women with osteoporosis and those at high risk for invasive breast cancer.

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Action
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Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover. Therapeutic Effects: Prevention of osteoporosis in patients at risk. ↓ risk of breast cancer.

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Adverse Reactions/Side Effects
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CV: STROKE, deep vein thrombosis, pulmonary embolism, retinal vein thrombosis. MS: leg cramps. Misc: hot flashes.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of stroke, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, and visual disturbances. Seek immediate medical assistance if these signs occur.

  • Monitor signs of deep vein thrombosis (localized pain, swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

  • Watch for any changes in vision such as cloudy or blurred vision that might indicate retinal vein thrombosis. Report these changes to the physician immediately.

  • Assess leg cramps to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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Interventions
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  • Because of the risk of stroke and pulmonary embolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • Institute weight bearing and resistance exercises as tolerated to maintain or increase bone mineral density. Start with low-impact or aquatic programs in patients with extensive demineralization, and increase exercise intensity slowly to prevent fractures.

  • Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.) and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

  • For patients with cancer who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

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Patient/Client-Related Instruction
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  • Advise patient and family or caregiver about the signs of stroke and pulmonary embolism (see above under Examination and Evaluation), and to seek immediate medical assistance if these signs develop.

  • Instruct patient to report other troublesome side effects such as severe or prolonged hot flashes.

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Pharmacokinetics
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Absorption: Although well absorbed (>60%), after oral administration, extensive 1st-pass metabolism results in 2% bioavailability.

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