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INTRODUCTION

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melphalan (mel-fa-lan)

Alkeran, L-PAM

OTHER NAMES:

phenylalanine mustard

Classification

Therapeutic: antineoplastics

Pharmacologic: alkylating agents

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Indications
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Alone or with other therapies for Multiple myeloma, Ovarian cancer. Unlabeled Use: Breast cancer. Prostate cancer. Testicular carcinoma. Chronic myelogenous leukemia. Osteogenic sarcoma.

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Action
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Inhibits DNA and RNA synthesis by alkylation (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Also has immunosuppressive properties.

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Adverse Reactions/Side Effects
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Resp: bronchopulmonary dysplasia, pulmonary fibrosis. GI: diarrhea, hepatitis, nausea, stomatitis, vomiting. GU: infertility. Derm: alopecia, pruritus, rashes. Endo: menstrual irregularities. Hemat: leukopenia, thrombocytopenia, anemia. Metab: hyperuricemia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS (MORE COMMON AFTER IV USE).

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions or anaphylaxis, 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 pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician immediately if patient experiences signs of pulmonary fibrosis or bronchopulmonary dysplasia (dry cough, dyspnea, chest pain, shortness of breath, abnormal breath sounds, cyanosis).

  • Watch for 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.

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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 pulmonary fibrosis, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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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.

  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, loss of appetite, and irritation in or around the mouth. Instruct patient to report severe or prolonged GI reactions, and to also report signs of drug-induced hepatitis, including abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising.

  • Advise patient that hair loss and other skin reactions (rash, pruritus) are likely. Report severe or unexpected skin reactions to the physician.

  • Advise women about possible changes in menstrual function. Instruct patient to notify health care professional about any severe or prolonged menstrual irregularities.

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Pharmacokinetics
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Absorption: Incompletely ...

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