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INTRODUCTION

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HIGH ALERT

daunorubicin hydrochloride (daw-noe-roo-bi-sin hye-droe-klor-ide)

Cerubidine

daunorubicin citrate liposome (daw-noe-roo-bi-sin sy-trate lye-poe-sohm)

DaunoXome

Classification

Therapeutic: antineoplastics

Pharmacologic: anthracyclines

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Indications
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Daunorubicin hydrochloride: In combination with other antineoplastics in the treatment of leukemias. Daunorubicin citrate liposome: Management of advanced Kaposi's sarcoma in HIV-infected patients.

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Action
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Forms a complex with DNA, which subsequently inhibits DNA and RNA synthesis (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Also has immunosuppressive properties.

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Adverse Reactions/Side Effects
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CNS: DaunoXome: fatigue, headache, depression, dizziness, insomnia, malaise. EENT: rhinitis, abnormal vision, sinusitis. CV: CARDIOTOXICITY, arrhythmias. GI: nausea, vomiting, esophagitis, hepatoxicity, stomatitis. GU: red urine, gonadal suppression. Derm: alopecia, increased sweating, pruritus. Hemat: anemia, leukopenia, thrombocytopenia. Local: phlebitis at IV site. Metab: hyperuricemia. MS: DaunoXome: back pain, arthralgia, myalgia. Neuro: DaunoXome: neuropathy. Misc: allergic reactions, chills, fever, flushing, chest tightness, influenza-like symptoms.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess heart rate, ECG, and blood pressure, especially during exercise. Report any arrhythmias or other signs of cardiac toxicity, including chest discomfort, shortness of breath, dyspnea, rales/crackles, peripheral edema, jugular venous distention, fainting, or severe fatigue and weakness.

  • 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.

  • Be alert for signs of peripheral neuropathy (numbness, tingling, 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.

  • Assess any back, joint, or muscle pain, especially with the liposomal form of this drug. Attempt to rule out musculoskeletal pathology; that is, determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Monitor signs of allergic reactions, 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.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report signs of phlebitis or other 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 ...

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