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INTRODUCTION

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HIGH ALERT

carmustine (kar-mus-teen)

BCNU, BiCNU, Gliadel

Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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Alone or with other treatments (surgery, radiation) in the management of: Brain tumors; Multiple myeloma; Hodgkin's disease; Other lymphomas.

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Action
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Inhibits DNA and RNA synthesis (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, especially malignant ones.

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Adverse Reactions/Side Effects
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Resp: PULMONARY FIBROSIS, pulmonary infiltrates. GI: hepatotoxicity, nausea, vomiting, anorexia, diarrhea, esophagitis. GU: renal failure. Derm: alopecia. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: pain at IV site.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician or nursing staff immediately if patient experiences signs of pulmonary fibrosis or pulmonary infiltrates (dry cough, dyspnea, chest pain, shortness of breath, cyanosis).

  • Watch for 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. Report these signs to the physician or nursing staff immediately.

  • Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician or nursing staff immediately.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions 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.

  • Because of the risk of pulmonary fibrosis and blood dyscrasias, 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).

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Patient/Client-Related Instruction
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  • Advise patient about the likelihood of GI reactions (nausea, vomiting, diarrhea, heartburn, loss of appetite). Instruct patient to also report signs of hepatotoxicity, including abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising.

  • Advise patient that hair loss and other skin reactions (rash, pruritus) are likely. Report severe or unexpected skin reactions to the physician.

  • Advise patient to guard against infection (frequent hand washing, etc.), and avoid crowds and contact with persons with contagious diseases.

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Pharmacokinetics
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Absorption: Following IV administration, absorption is complete. Following implantation, action is primarily local.

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Distribution: Highly lipid soluble; readily penetrates CSF. Enters breast milk.

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Metabolism and Excretion: Rapidly ...

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