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INTRODUCTION

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HIGH ALERT

decitabine (de-sit-a-been)

Dacogen

Classification

Therapeutic: antineoplastics

Pharmacologic: antimetabolites

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Indications
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Treatment of various myelodysplastic syndromes (MDSs).

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Action
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Inhibits DNA methyltransferase, causing apoptosis. Has more effect on rapidly replicating cells. Therapeutic Effects: Improved hematologic and clinical manifestations of MDSs.

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Adverse Reactions/Side Effects
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CNS: confusion, fatigue, insomnia, depression, lethargy. EENT: blurred vision. Resp: cough. CV: atrial fibrillation, pulmonary edema, tachycardia. GI: abdominal pain, constipation, diarrhea, stomatitis, vomiting, abnormal liver function tests. Derm: petechiae, rash. F and E edema, hypokalemia, hypomagnesemia, ascites. Hemat: BLEEDING, anemia, neutropenia, thrombocytopenia. Local: injection site irritation. Metab: hyperglycemia. MS: arthralgia, myalgia. Misc: INFECTION, fever, lymphadenopathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess signs of bleeding and hemorrhage, such as bleeding gums, nosebleed, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure. Notify physician immediately if these signs occur.

  • Assess any breathing problems or signs of pulmonary edema, including cough, shortness of breath, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be caused by anemia or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles, abdominal swelling (ascites), and/or a sudden increase in body weight due to fluid retention.

  • Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

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

  • Monitor any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia), or lethargy, irritability, insomnia, muscle tremors, and confusion associated with low magnesium levels (hypomagnesemia). Notify physician of these signs.

  • Be alert for confusion, depression, lethargy, or other alterations in mental status or behavioral affect. Notify physician if these symptoms become problematic.

  • 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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