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INTRODUCTION

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HIGH ALERT

dacarbazine (da-kar-ba-zeen)

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Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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Treatment of metastatic malignant melanoma (single agent). Treatment of Hodgkin's disease as second-line therapy (with other agents).

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

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Adverse Reactions/Side Effects
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GI: HEPATIC NECROSIS, anorexia, nausea, vomiting, diarrhea, hepatic vein thrombosis. Derm: alopecia, facial flushing, photosensitivity, rash. Endo: gonadal suppression. Hemat: anemia, leukopenia, thrombocytopenia. Local: pain at IV site, phlebitis at IV site, tissue necrosis. MS: myalgia. Neuro: facial paresthesia. Misc: ANAPHYLAXIS, fever, flu-like syndrome, malaise.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of hepatotoxicity and hepatic necrosis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

  • Watch for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). 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. Report these signs to the physician or nursing staff.

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

  • Assess signs of parasthesia (numbness, tingling) in the face or elsewhere. Perform objective tests including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

  • Monitor IV injection site for pain, swelling, and tissue necrosis. 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.

  • Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

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

  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, and loss of appetite. Instruct patient to report severe or prolonged GI problems.

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

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Pharmacokinetics
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Absorption: IV administration results in complete bioavailability.

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Distribution: Large ...

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