conjugated estrogens
Print| Trade Name(s): Premarin | |
| Group 2: Non-Antineoplastic Hazardous | AHFS Class: Estrogens |
| Formweb: conjugated estrogens | |
| Info Links: Chemotherapy Extravasation Policy | |
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | CSTD |
| Administration |  |
If splashing possible |
If inhalation possible | ||
| Waste/Disposal of drug | |
If splashing possible |
If inhalation possible |
Nursing Non-Antineoplastic or Reproductive Risk Drug PPE and Work Practices (Link to a file uploaded to Rhazdrugs or to a file on your intranet, or a shared drive.)
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) |
| Administration | |  If powder is present from non-intact tablet or capsule | ||
| Waste/Disposal of drug | |
Handling of bodily fluids and/or contaminated materials
| Drug Form | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| Intact tablet or capsule from UD package | | ||||
| Non-intact, repackaged tablet or capsule | | ||||
| Oral liquid drug or feeding tube | | ||||
| Topical drug |  |  If splashing possible |  If splashing possible | If inhalation possible | |
| Powder, solution for inhalation | | | | | |
| Vial; ampule; pre-filled syringe | | If splashing possible | If inhalation possible | ||
| Intravenous solutions | | If splashing possible | If inhalation possible | ||
| Irrigation solutions | | If splashing possible | If inhalation possible |
| Form | Receipt Packaging | Environment | Glove | Storage | Labeling |
| All Forms | No additional action | No additional action | | May be stored within normal inventory, neutral or positive | Cautionary Labeling |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Glove | Gown | Eye | Resp | Shoe | Head | Hood/Cabinet | CSTD |
(outer layer should be sterile) | |  |  |  |
LAFW |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Activity | Glove | Gown | Eye | Mask (N95/PAPR) | Shoe |
| Counting | | ||||
Manipulating (Complete in HD non-sterile room) | | | |
Pharmacy Non-Antineoplastic or Reproductive Risk Drugs PPE and Work Practices
| Form | Prep Instructions | Pneumatic Tube |
| Intact tablet/capsule from UD package | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Non-intact, repackaged tablet or capsule | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Oral liquid drug or feeding tube | Sealed plastic bag, single pair of gloves, cautionary labeling |  |
| Topical drug | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Powder, solution for inhalation | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Vial; ampule; pre-filled syringe | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Intravenous solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Irrigation solution | Sealed plastic bag, single pair of gloves, cautionary labeling | |
| Dosage Form | Risk of Exposure | Packaging | Pharmacy Manipulation | Nurse Manipulation |
| Injectable | May occur when withdrawing from vial and administration | Vial | Dispense in intact packaging or admixture in LAFW | If preparing in patient care area, utilize PPE as stated in handling guide. |
| Oral Solid | May occur when counting | Unit Dose Solid | Packaging or Counting Only | None |
| |  | | |  | |  |
| Chemotherapy rated/tested (tested to ASTM D6978-05 (2013), Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs) | Disposable
| Should be worn in situations where eye, mouth, or nasal splashing is possible (i.e., during a bladder instillation of a hazardous drug) | Goggles protect the eyes, but not the face, against spraying. | Certified N95 | Powered air purifying respirator | required for compounding sterile and nonsterile hazardous drugs | required for compounding sterile and nonsterile hazardous drugs |
| Powder-free | Shown to resist permeation by hazardous drugs
| N95 offers no protection against gases and vapors. | For events such as large spills when an IV bag breaks or a line disconnects and leaks, or where there is known or suspected airborne exposure to vapors or gases | Double booties required for HD preparation areas, top layer is doffed before exiting the HD buffer room. | |||
| Inspect for visible defects | Must close in the back (no open front) | Surgical masks do NOT provide respiratory protection from drug exposure | Hazardous drugs with potential to vaporize at room temperature: • Carmustine • Cisplatin •Cyclophosphamide • Etoposide • 5-Fluorouracil • lfosfamide • Thiotepa | ||||
| Double gloving is recommended for all activities involving hazardous drugs except for handling intact, unit-dose oral agents, when one pair of chemotherapy-tested gloves is acceptable | Long sleeves with closed cuffs that are elastic or knit | ||||||
| When wearing double gloves, tuck the cuff of the inner glove under the gown sleeve and the cuff of the outer glove over the gown sleeve. | No seams or closures that could allow hazardous drugs to pass through | ||||||
| During medication manipulation/compounding the outer layer should be sterile | In preparation areas gowns should be changed every 2-3 hours or immediately after a spill or splash | ||||||
Change gloves every 30 minutes unless permeation testing has noted shorter time limits
| Gowns worn in hazardous drug handling areas must NOT be worn to other areas |
Sequence for Donning & Doffing PPE
References: Oncology Nursing Society, NIOSH
The conjugated estrogens, equally to the normal physiological estrogen, work by agonistically binding to the estrogen receptors alpha and beta. The estrogen receptors vary in quantity and proportion according to the tissues and hence, the activity of this conjugated estrogens is very variable.2
The activity made by the conjugated estrogens is driven by the increase in the synthesis of DNA, RNA and various proteins in responsive tissues which in order will reduce the release of gonadotropin-releasing hormone, follicle-stimulating hormone and leuteinizing hormone.8
The specific mechanism of action cannot be described only in terms of total estrogenic action as the pharmacokinetic profile, the tissue specificity and the tissue metabolism is different for each component of the product.7
Reference: Drug Bank
- May cause cancer
- May damage fertility. May damage the unborn child
- May form combustible dust concentrations in air
Reference: SDS - Pfizer Inc
conjugated estrogen: NTP "known to be human carcinogen"; Black Box warning for endometrial cancer and cardiovascular risks; Long term use in women and laboratory studies increases frequency of several cancers
