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INTRODUCTION

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HIGH ALERT

floxuridine (flox-yoor-i-deen)

FUDR

Classification

Therapeutic: antineoplastics

Pharmacologic: antimetabolites

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Indications
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Treatment of hepatic metastases of gastrointestinal carcinoma.

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Action
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Inhibits DNA and RNA synthesis by preventing thymidine production (cell-cycle S phase–specific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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CNS: headache, fatigue. GI: bleeding, diarrhea, gastritis, nausea, stomatitis, vomiting, anorexia, ulcer. Derm: alopecia, erythema, maculopapular rash. Endo: gonadal suppression. Hemat: anemia, leukopenia, thrombocytopenia. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician immediately.

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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.

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Patient/Client-Related Instruction
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  • Advise patient and family/caregivers about the risk of infections, to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.

  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, stomach pain, loss of appetite, and irritation of the mouth. Instruct patient to report severe or prolonged GI problems or signs of ulceration and GI bleeding (abdominal pain, vomiting blood, blood in the stools, black/tarry stools).

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, fever, or skin reactions (rash, warmth, redness, hair loss).

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Pharmacokinetics
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Absorption: Administered intra-arterially only, resulting in direct delivery to tumor sites.

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Distribution: Distributes mostly to tumor site as a result of elective intra-arterial administration.

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Metabolism and Excretion: Rapidly converted to floxuridine monophosphate (an active metabolite) and fluorouracil; 60–80% excreted by the lungs as respiratory CO. Small amounts of fluorouracil (<10–15%) excreted unchanged by the kidneys.

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Half-life: Fluorouracil—20 hr.

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TIME/ACTION PROFILE (effects on blood counts*)

ROUTE ONSET PEAK DURATION
Intra-arterial 1–9 days 9–21 days 30 days

*Noted as effects due to conversion to fluorouracil.

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Pregnancy or lactation.

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Use Cautiously in: Patients with childbearing potential; Hepatic or renal dysfunction; History of high-dose pelvic irradiation or previous use of alkylating agents; Infections; ...

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