Bendamustine

INTRODUCTION

Indications

Treatment of chronic lymphocytic leukemia.

Action

Damages DNA resulting in death of rapidly replicating cells. Therapeutic Effects: Decreased proliferation of leukemic cells.

Adverse Reactions/Side Effects

CNS: fatigue, weakness. Resp: cough. GI: nausea, vomiting, diarrhea. Derm: skin reactions. Hemat: anemia, LEUKOPENIA, NEUTROPENIA, THROMBOCYTOPENIA. Metab: hyperuricemia. Misc: TUMOR LYSIS SYNDROME, allergic reactions, including anaphylaxis, fever, infusion reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of leukopenia and neutropenia (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.

• Be alert for signs of electrolyte imbalances that might indicate tumor lysis syndrome. Signs include severe muscle weakness or paralysis due to increased plasma potassium (hyperkalemia), or muscle hyperexcitability and tetany due to phosphate and calcium imbalances (hyperphosphatemia and hypocalcemia). Notify physician or nursing staff immediately if these signs occur.

• 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). Reactions may be especially prevalent during or immediately after administration (infusion reactions). Notify physician or nursing staff immediately if these reactions occur.

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 that weakness and fatigue are likely, and may be severe. Implement assistive devices (walker, crutches, cane) and appropriate safety precautions to guard against falls due to weakness.

• Instruct patient to report other bothersome side effects, including severe or prolonged cough, fever, skin reactions, or GI problems (nausea, vomiting, diarrhea).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Distributes freely into red blood cells.

Protein Binding: 94–96%.

Metabolism and Excretion: Mostly metabolized (partially by the CYP1A2 enzyme system; 90% excreted in feces; some renal elimination. Although metabolites have antineoplastic activity, levels are extremely low.

Half-life: approximately 40 minutes

Contraindications/Precautions

Contraindicated in: Hypersensitivity to bendamustine or mannitol; CCr <40 mL/min. Use ...