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INTRODUCTION

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HIGH ALERT

doxorubicin hydrochloride (dox-oh-roo-bi-sin hye-droe-klor-ide)

Adriamycin PFS, Adriamycin RDF, Rubex

doxorubicin, liposomal (dox-oh-roo-bi-sin lye-poe-sohm-al) Doxil

Classification

Therapeutic: antineoplastics

Pharmacologic: anthracyclines

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Indications
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Doxorubicin hydrochloride: Alone or with other modalities in the treatment of various solid tumors, including Breast, Ovarian, Bladder, Bronchogenic carcinoma, Malignant lymphomas and leukemias. Doxorubicin, liposomal: AIDS-related Kaposi's sarcoma (KS) in patients who cannot tolerate or fail conventional therapy. Ovarian carcinoma. Multiple myeloma with bortezomib in patients who have not previously received bortezomib and have received at least one prior therapy.

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Action
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Inhibits DNA and RNA synthesis by forming a complex with DNA; action is cell-cycle S-phase–specific. Also has immunosuppressive properties. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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CNS: weakness. Resp: recall pneumonitis. CV: CARDIOMYOPATHY, ECG changes. GI: diarrhea, esophagitis, nausea, stomatitis, vomiting. GU: red urine. Derm: alopecia, palmar-plantar erythrodysesthesia (liposomal), photosensitivity. Endo: sterility, prepubertal growth failure with temporary gonadal impairment (children only). Hemat: anemia, leukopenia, thrombocytopenia. Local: phlebitis at IV site, tissue necrosis. Metab: hyperuricemia. Misc: ANAPHYLACTOID ALLERGIC REACTIONS, acute infusion-related reactions, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of cardiomyopathy, including fatigue, dizziness, palpitations, breathlessness with exertion, and peripheral and pulmonary edema. Report these signs to the physician or nursing staff immediately.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for allergy-like responses that occur during and immediately after administration (acute infusion-related events). Notify physician or nursing staff immediately if these reactions occur.

  • 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.

  • Be alert for signs of respiratory distress (dyspnea, cough, shortness of breath, fever, rales), in patients that received radiation treatments to the chest (recall pneumonitis). Report these signs to the physician immediately.

  • 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.

  • Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report signs of phlebitis, tissue necrosis, 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 chemotherapy.

  • Because of the risk of cardiomyopathy and arrhythmias, use caution during ...

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