Asparaginase

INTRODUCTION

Indications

Part of combination chemotherapy in the treatment of acute lymphocytic leukemia (ALL).

Action

Catalyst in the conversion of asparagine (an amino acid) to aspartic acid and ammonia. Depletes asparagine in leukemic cells. Therapeutic Effects: Death of leukemic cells.

Adverse Reactions/Side Effects

CNS: SEIZURES, agitation, coma, confusion, depression, dizziness, fatigue, hallucinations, headache, irritability, somnolence. GI: nausea, vomiting, anorexia, cramps, hepatotoxicity, pancreatitis, weight loss. Derm: rashes, urticaria. Endo: hyperglycemia. Hemat: coagulation abnormalities, transient bone marrow depression. Metab: hyperammonemia, hyperuricemia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity 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.

• 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 immediately to the physician.

• Watch for other signs of neurotoxicity or neurologic signs of increased ammonia levels (hyperammonemia), including agitation, confusion, headache, dizziness, mood changes, decreased alertness, and hallucinations. Notify physician if these signs occur.

• Report any abnormal bruising or bleeding or signs of bone marrow depression, including leukopenia (fever, sore throat, signs of infection), thrombocytopenia (nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Periodically assess body weight and report a rapid or unexplained weight loss.

Interventions

• 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.

Patient/Client-Related Instruction

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

• Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Functional abilities may be limited, and patient may need to use assistive devices during ambulation.

• Advise patient that rashes and other skin reactions are likely and to report severe or unexpected skin reactions to the physician.

• Advise patient about the likelihood of GI reactions such as nausea, vomiting, cramps, and abdominal pain. Instruct patient to report severe or prolonged GI problems, signs of liver toxicity (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema), or pancreatitis ...