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INTRODUCTION

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mechlorethamine (me-klor-eth-a-meen)

Mustargen

OTHER NAMES:

Nitrogen mustard

Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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Part of combination therapy of Hodgkin's disease and malignant lymphomas. Used palliatively in Bronchogenic carcinoma, Leukemias. Administered into cavities (pleural, peritoneal) to prevent reaccumulation of malignant effusions.

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Action
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Interferes with DNA and RNA synthesis by cross-linking strands (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, drowsiness, headache, vertigo, weakness. GI: nausea, vomiting, anorexia, diarrhea. GU: infertility. Derm: rashes, alopecia. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: tissue necrosis, phlebitis at IV site. Metab: hyperuricemia. Misc: reactivation of herpes zoster.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings to the physician or nursing staff immediately.

  • Monitor 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 immediately.

  • Assess balance and risk of falls, especially if patient exhibits vertigo or excessive weakness or drowsiness (See Appendix E). 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 IV injection site for pain, phlebitis, and local tissue necrosis. Report injection site reactions to the physician or nursing staff.

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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 to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, skin reactions (rash, hair loss, reactivation of herpes zoster lesions), or GI problems (nausea, vomiting, diarrhea, loss of appetite).

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Pharmacokinetics
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Absorption: Administered IV and intracavitary only. Some absorption occurs after intracavitary instillation.

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Distribution: Unknown.

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Metabolism and Excretion: Rapidly degraded in body tissues and fluids.

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Half-life: Unknown.

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TIME/ACTION PROFILE (effects on blood counts)

ROUTE ONSET PEAK DURATION
WBCs 24 hr 7–14 days 10–21 days
platelets unknown 9–16 days 20 days

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Pregnancy; Lactation.

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Use Cautiously in: Infections; Decreased bone marrow reserve; Previous radiotherapy or chemotherapy (dose reduction ...

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