Cladribine

INTRODUCTION

Indications

Management of active hairy cell leukemia manifested as anemia, leukopenia, thrombocytopenia, or clinical symptoms. Unlabeled Use: chronic lymphocytic leukemia, chronic myelogenous leukemia, non-Hodgkin's lymphomas, progressive multiple sclerosis.

Action

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

Adverse Reactions/Side Effects

CNS: fatigue, headache, dizziness, insomnia, malaise, weakness. EENT: epistaxis. Resp: abnormal breath sounds, cough, dyspnea. CV: edema, tachycardia. GI: anorexia, diarrhea, nausea, vomiting, abdominal pain, constipation. Derm: rash, erythema, petechiae, pruritus, sweating. Hemat: NEUTROPENIA, anemia, thrombocytopenia. Local: injection site reactions, phlebitis, thrombosis. MS: arthralgia, myalgia. Misc: chills, fever, infection, trunk pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• 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.

• Assess any breathing problems, and report difficult/labored breathing, persistent cough, or abnormal breath sounds (See Appendix K).

• Assess any muscle, trunk, or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• 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.

• Monitor injection site for pain and irritation. Report prolonged or excessive injectionsite reactions or signs of phlebitis (redness, warmth, swelling) 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.

• Because of the risk of arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-related Instruction

• Advise patient and family/caregivers about the risk of infections, and to guard against ...