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INTRODUCTION

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histrelin (his-tre-lin)

Vantas

Classification

Therapeutic: hormones

Pharmacologic: gonadotropin-releasing hormones

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Indications
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Palliative treatment of advanced prostate cancer.

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Action
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Continuous administration decreases production of gonadotropins. Therapeutic Effects: Suppression of testosterone production. Prevention of disease progression.

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Adverse Reactions/Side Effects
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CNS: seizures, headache, anxiety, depression, dizziness, insomnia, lethargy, malaise, irritability. EENT: visual disturbances. Resp: dyspnea. CV: vasodilation, edema, palpitations, tachycardia. GI: abdominal discomfort, constipation, nausea, vomiting. GU: dysuria, hematuria, polyuria, urinary retention. Derm: rash, acne, pruritis, increased sweating. Endo: breast discharge, breast pain, genital pruritis, increased breast size. Hemat: anemia. Local: itching, erythema, and swelling at implantation site. Metab: hyperlipidemia, hypercalcemia. MS: arthralgia, joint stiffness, muscle cramps, muscle stiffness, myalgia, bone pain. Neuro: tremor. Misc: ALLERGIC REACTIONS, INCLUDING ANGIOEDEMA, increased appetite, increased pain.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, raised patches of red or white skin, burning/itching skin, swelling in the face). Notify physician or nursing staff immediately if these reactions occur.

  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report increased heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles due to fluid retention or peripheral vasodilation.

  • Assess any joint, bone, or muscle and stiffness to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced (e.g., related to high calcium levels) rather than caused by anatomic or biomechanical problems.

  • Report unusual weakness and fatigue that might be due to anemia.

  • Monitor personality or behavioral changes such as anxiety, irritability, depression, or difficulty sleeping. Notify physician if these changes become problematic.

  • Assess dizziness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor implantation site for pain, itching, and swelling. Report prolonged or excessive implant-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 arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently ...

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