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INTRODUCTION

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oxaliplatin (ox-al-i-pla-tin)

Eloxatin

Classification

Therapeutic: antineoplastics

Pharmacologic: platinum coordination complexes

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Indications
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Used in combination with 5-fluorouracil and leucovorin in the treatment of advanced or metastatic colon or rectal cancer. Unlabeled Use: Treatment of ovarian cancer that has progressed despite treatment with other agents.

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Action
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Inhibits DNA replication and transcription by incorporating platinum into normal cross-linking (cell-cycle–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

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Adverse Reactions/Side Effects
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Adverse reactions are noted for the combination of oxaliplatin, 5-FU, and leucovorin

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CNS: fatigue. CV: chest pain, edema, thromboembolism. Resp: PULMONARY FIBROSIS, coughing, dyspnea. GI: diarrhea, nausea, vomiting, abdominal pain, anorexia, gastroesophageal reflux, stomatitis. F and E: dehydration, hypokalemia. Hemat: leukopenia, NEUTROPENIA, THROMBOCYTOPENIA, anemia. Local: injection site reactions. MS: back pain. Neuro: neurotoxicity. Misc: ANAPHYLAXIS/ANAPHYLACTOID REACTIONS, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions including anaphylaxis. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria, burning skin). Notify physician or nursing staff immediately if these reactions occur.

  • Assess any breathing problems or signs of pulmonary fibrosis such as dry cough, wheezing, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

  • Monitor signs of leukopenia/neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Notify physician of these signs immediately.

  • Monitor signs of venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of neurotoxicity, including peripheral neuropathy (numbness, tingling, weakness). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible. Periodically reexamine these values to document drug-induced changes in peripheral nerve function.

  • Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

  • Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

  • Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection 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 ...

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