Bicalutamide

INTRODUCTION

Indications

Treatment of metastatic prostate carcinoma in conjunction with luteinizing hormone–releasing hormone (LHRH) analogues (goserelin, leuprolide).

Action

Antagonizes the effects of androgen at the cellular level. Therapeutic Effects: Decreased spread of prostate carcinoma.

Adverse Reactions/Side Effects

CNS: weakness, dizziness, headache, insomnia. Resp: dyspnea. CV: chest pain, hypertension, peripheral edema. GI: constipation, diarrhea, nausea, abdominal pain, increased liver enzymes, vomiting. GU: hematuria, erectile dysfunction, incontinence, nocturia, urinary tract infections. Derm: alopecia, rashes, sweating. Endo: breast pain, gynecomastia. Hemat: anemia. Metab: hyperglycemia, weight loss. MS: back pain, pelvic pain, bone pain. Neuro: paresthesia. Misc: generalized pain, hot flashes, flu-like syndrome, infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Monitor cardiopulmonary symptoms such as chest pain or difficult, labored breathing. Report severe or unexpected cardiac and respiratory problems to the physician.

• 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 anemia, including unusual fatigue, shortness of breath with exertion, bruising, and pale skin. Notify physician immediately if these signs occur.

• 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.

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

• Be alert for signs of paresthesia (numbness, tingling). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Assess dizziness and weakness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). 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.

• Because of cardiopulmonary side effects, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (respiratory symptoms, blood pressure, heart ...