Cytarabine

INTRODUCTION

Indications

IV: Used mainly in combination chemotherapeutic regimens for the treatment of leukemias and non-Hodgkin's lymphomas. Intrathecal: Treatment of lymphomatous meningitis.

Action

Inhibits DNA synthesis by inhibiting DNA polymerase (cell-cycle S-phase-specific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: CNS dysfunction (high dose), confusion, drowsiness, headache. EENT: corneal toxicity (high dose), hemorrhagic conjunctivitis (high dose). Resp: PULMONARY EDEMA (HIGH DOSE). CV: edema. GI: nausea, vomiting, hepatitis, hepatotoxicity, severe GI ulceration (high dose), stomatitis. GU: urinary incontinence. Derm: alopecia, rash. Endo: sterility. Hemat: (less with IT use): anemia, leukopenia, thrombocytopenia. Metab: hyperuricemia. Neuro: Intrathecal only: CHEMICAL ARACHNOIDITIS, abnormal gait. Misc: cytarabine syndrome, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems or signs of pulmonary edema, including cough, shortness of breath, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Watch for signs of chemical arachnoiditis, such as numbness, tingling, pain in the extremities, difficulty controlling the limbs, and an inability to sit for long periods. Notify physician immediately if these signs occur.

• Monitor and report other signs of CNS dysfunction, including confusion, anxiety, and psychosis-like symptoms.

• Monitor signs of leukopenia (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 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 any muscle or bone pain. These symptoms accompanied by fever, rash, and malaise may indicate cytarabine syndrome, and the physician should be notified.

• Assess gait and report the appearance of any abnormal gait patterns, especially after intrathecal administration.

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.

• Guard against falls and trauma such hip fractures and head injury (See Appendix E). Implement fallprevention strategies, especially if patient exhibits gait abnormalities.

• Do not apply physical agents (heat, cold, elec-trotherapeutic modalities) or massage at the subcutaneous injection site; these interventions can alter drug absorption from subcutaneous tissues.

Patient/Client-Related Instruction

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