Azacitidine

INTRODUCTION

Indications

Myelodysplastic syndromes, including some refractory anemias, chronic myelomonocytic leukemia.

Action

Inhibits DNA synthesis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue. GI: HEPATOTOXICITY, constipation, diarrhea, nausea, vomiting. GU: nephrotoxicity, renal tubular acidosis. Derm: ecchymosis. F and E: hypokalemia. Hemat: anemia, neutropenia, thrombocytopenia. Local: injection-site erythema. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever.

PHYSICAL THERAPY IMPLICATIONS

Evaluation and Examination

• Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

• Monitor signs of allergic reactions and 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.

• Monitor signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, and bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Monitor signs of nephrotoxicity, including blood or pus in urine, decreased urine output, weight gain from fluid retention, and fatigue. Report these signs to the physician.

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

• Monitor injection site for redness and swelling. Report prolonged or excessive injection site reactions to the physician.

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

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever or GI problems (nausea, vomiting, diarrhea, constipation).

Pharmacokinetics

Absorption: Rapidly absorbed following subcutaneous administration; 89% bioavailable.

Distribution: Unknown.

Metabolism and Excretion: 85% excreted in urine; some hepatic metabolism may occur. Less than 1% fecal elimination.

Half-life: 4 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Advanced malignant hepatic tumors; OB: Potential for congenital anomalies; Lactation: Potential for serious side effects in infants.

Use Cautiously in: Renal impairment; Liver disease; OB: Patients with childbearing potential (male and female) due to potential fetal harm; Pedi: ...