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INTRODUCTION

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HIGH ALERT

fluorouracil (floor-oh-yoor-a-sil)

Adrucil, Efudex, Fluoroplex, 5-FU

Classification

Therapeutic: antineoplastics

Pharmacologic: antimetabolites

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Indications
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IV: Used alone and in combination with other modalities (surgery, radiation therapy, other antineoplastics) in the treatment of Colon cancer, Breast cancer, Rectal cancer, Gastric cancer, Pancreatic carcinoma. Topical: Management of multiple actinic (solar) keratoses and superficial basal cell carcinomas.

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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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More likely to occur with systemic use than with topical use

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CNS: acute cerebellar dysfunction. GI: diarrhea, nausea, stomatitis, vomiting. Derm: alopecia, maculopapular rash, local inflammatory reactions (topical only), melanosis of nails, nail loss, palmar-plantar erythrodysesthesia, phototoxicity. Endo: sterility. Hemat: anemia, leukopenia, thrombocytopenia. Local: thrombophlebitis. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of acute cerebellar dysfunction, including ataxia, nystagmus, hypotonia, tremor, and dysarthria, Notify physician or nursing staff if these signs occur.

  • Be alert for signs of blood dyscrasias such as leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bleeding gums; bruising; petechiae; blood in stools, urine; vomiting blood), 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 signs of thrombophlebitis (pain, swelling, inflammation). Report prolonged or excessive injection-site skin 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.

  • Guard against falls and trauma due to cerebellar dysfunction or severe fatigue and weakness. Implement-fall prevention strategies, especially if patient exhibits ataxia, incoordination, or other impairments that affect gait and balance (See Appendix E).

  • 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 decrease risk of infections (frequent hand washing, etc.) and avoid contact with persons with contagious diseases.

  • Advise patient that rashes and other skin reactions (hair loss, increased sensitivity to UV light, local inflammation during topical use) are likely. Report severe or unexpected skin reactions to the physician.

  • Advise patient about the risk of palmar-plantar erythrodysesthesia (hand-and-foot syndrome), as indicated by pain, redness, and dry, scaly skin on the palms of the hands and soles of the feet. Instruct patient to protect the hands and feet from heat and friction, and to apply lotion to the affected areas. Superficial cold application can also temporarily reduce symptoms.

  • Advise patient about the likelihood of GI reactions, including ...

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