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INTRODUCTION

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HIGH ALERT

gemcitabine (jem-site-a-been)

Gemzar

Classification

Therapeutic: antineoplastics

Pharmacologic: antimetabolites, nucleoside analogues

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Indications
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Pancreatic cancer (locally advanced or metastatic). Inoperable locally advanced/metastatic non–small cell lung cancer (with cisplatin). Metastatic breast cancer (with paclitaxel). Advanced ovarian cancer that has relapsed 6 mo after completion of platinum-based therapy (with carboplatin).

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Action
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Interferes with DNA synthesis (cell-cycle phase–specific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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Resp: PULMONARY TOXICITY, dyspnea, bronchospasm. CV: ARRHYTHMIAS, CEREBROVASCULAR ACCIDENT, MI, edema, hypertension. GI: HEPATOTOXICITY, diarrhea, nausea, stomatitis, transient elevation of hepatic transaminases, vomiting. GU: HEMOLYTIC UREMIC SYNDROME, hematuria, proteinuria. Derm: alopecia, rash. Hemat: anemia, leukopenia, thrombocytopenia. Local: injection site reactions. Neuro: paresthesias. Misc: flu-like symptoms, fever, anaphylactoid reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Continually monitor for signs of MI (sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea) or stroke (sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances). Seek immediate medical assistance if patient develops these signs.

  • 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.

  • Assess any breathing problems or signs of pulmonary toxicity, including dyspnea, rales/crackles, decreased breath sounds, pleuritic friction rub, bronchospasm, tachypnea, cough, pleuritic pain, and hemoptysis. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

  • Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

  • Monitor signs of hemolytic uremic syndrome, including fatigue, irritability, abdominal pain, pale skin tones, decreased urine output, small bruises (petechiae), peripheral edema, and weight gain due to fluid retention. Report these signs to the physician immediately.

  • 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.

  • Be alert for signs of hypersensitivity and anaphylactoid 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 signs of paresthesia such as numbness and tingling. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

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