Pharmacologic: alkylating agents
Metastatic testicular and ovarian carcinoma. Advanced bladder cancer. Head and neck cancer. Cervical cancer. Lung cancer. Other tumors.
Inhibits DNA synthesis by producing cross-linking of parent DNA strands (cell-cycle phase—nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.
Adverse Reactions/Side Effects
CNS: SEIZURES, malaise, weakness. EENT: ototoxicity, tinnitus. GI: severe nausea, vomiting, diarrhea, hepatotoxicity. GU: nephrotoxicity, sterility. Derm: alopecia. F and E: hypocalcemia, hypokalemia, hypomagnesemia. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: phlebitis at IV site. Metab: hyperuricemia. Neuro: peripheral neuropathy. Misc: anaphylactoid reactions.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
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 to the physician immediately.
Monitor signs of leukopenia (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 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 signs of peripheral neuropathy such as numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.
Monitor neuromuscular signs of electrolyte imbalances (hypocalcemia, hypokalemia, hypomagnesemia), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.
Monitor signs of ototoxicity such as hearing loss, tinnitus, disturbed balance, and vertigo. Report these signs to the physician.
Assess IV site during and after IV administration, and report signs of phlebitis (local pain, swelling, inflammation).
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.
Guard against falls and trauma (hip fractures, head injury). Implement fall-prevention strategies, especially if patient exhibits balance deficits related to ototoxicity (See Appendix E).
Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.
Make sure patient and family or caregivers understand the need to report immediately allergic responses or signs of blood dyscrasias as listed above (see Examination and Evaluation).
Advise patient about the likelihood of GI reactions ...