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INTRODUCTION

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HIGH ALERT

busulfan (byoo-sul-fan)

Busulfex, Myleran

Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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PO: Treatment of chronic myelogenous leukemia (CML) and bone marrow disorders. IV: With cyclophosphamide as a conditioning regimen before allogenic hematopoietic progenitor cell transplantation for CML.

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Action
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Disrupts nucleic acid function and protein synthesis (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly growing cells, especially malignant ones.

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Adverse Reactions/Side Effects
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Incidence and severity of adverse reactions and side effects are increased with IV use
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CNS: IV: SEIZURES, CEREBRAL HEMORRHAGE/COMA, anxiety, confusion, depression, dizziness, headache, encephalopathy, mental status changes, weakness. EENT: PO—cataracts; IVepistaxis, pharyngitis, ear disorders. CV: hepatic veno-oclusive disease (↑ allogenic transplantation). Resp: PO—PULMONARY FIBROSIS; IV alveolar hemorrhage, asthma, atelectasis, cough, hemoptysis, hypoxia, pleural effusion, pneumonia, rhinitis, sinusitis. CV: PO—CARDIAC TAMPONADE (WITH HIGH-DOSE CYCLOPHOSPHAMIDE); IVchest pain, hypotension, tachycardia, thrombosis, arrhythmias, atrial fibrillation, cardiomegaly, ECG changes, edema, heart block, hypertension, left-sided heart failure, pericardial effusion, ventricular extrasystoles. GI: PO—druginduced hepatitis, nausea, vomiting; IVabdominal enlargement, anorexia, constipation, diarrhea, dry mouth, hematemesis, nausea, rectal discomfort, vomiting, abdominal pain, dyspepsia, hepatomegaly, pancreatitis, stomatitis. GU: oliguria, dysuria, hematuria. Derm: POitching, rashes, acne, alopecia, erythema nodosum, exfoliative dermatitis, hyperpigmentation. Endo: POsterility, gynecomastia. F and E: hypokalemia, hypomagnesemia, hypophosphatemia. Hemat: BONE MARROW DEPRESSION. Local: inflammation/pain at injection site. Metab: PO and IV—hyperuricemia; IVhyperglycemia. MS: arthralgia, myalgia, back pain. Misc: allergic reactions, chills, fever, infection.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • Watch for signs of heart failure (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) or cardiac tamponade (accumulation of fluid around the heart that causes chest pain, difficulty breathing, and so forth). Report these signs to the physician immediately.

  • Monitor signs of cerebral hemorrhage, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances, or loss of consciousness. These signs require immediate medical attention.

  • Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician immediately if patient experiences signs of pulmonary fibrosis (dry cough, dyspnea, shortness of breath, cyanosis) or breathing problems that might indicate other pulmonary impairments (alveolar hemorrhage, lung collapse, asthma, pneumonia).

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased ...

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