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INTRODUCTION

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HIGH ALERT

carboplatin (kar-boe-pla-tin)

Paraplatin, Paraplatin-AQ

Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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Advanced ovarian carcinoma (with other agents). Palliative treatment of ovarian carcinoma unresponsive to other modalities.

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Action
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Inhibits DNA synthesis by producing cross-linking of parent DNA strands (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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CNS: weakness. EENT: ototoxicity. GI: abdominal pain, nausea, vomiting, constipation, diarrhea, hepatitis, stomatitis. GU: gonadal suppression, nephrotoxicity. Derm: alopecia, rash. F and E: hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia. Hemat: ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA. Metab: hyperuricemia. Neuro: peripheral neuropathy. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS-LIKE REACTIONS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions, including anaphylaxis. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria, burning skin). Notify physician or nursing staff immediately if these reactions occur.

  • Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Notify physician of these signs immediately.

  • Monitor neuromuscular signs of electrolyte imbalances (hypocalcemia, hypokalemia, hyponatremia, hypomagnesemia), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

  • Assess signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

  • Monitor signs of ototoxicity such as hearing loss, tinnitus, disturbed balance, and vertigo. Report these signs to the physician.

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Interventions
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  • For patients 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.

  • Guard against falls and trauma (hip fractures, head injury). Implement fall prevention strategies, especially if patient exhibits balance deficits related to ototoxicity (See Appendix E).

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Make sure patient and family or caregivers understand the need to immediately report allergic responses or signs of blood dyscrasias as listed above (see Examination and Evaluation).

  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, constipation, abdominal pain, and irritation of the oral mucosa. Instruct patient to report severe or prolonged GI problems, and to immediately report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain.

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