Estramustine

INTRODUCTION

Indications

Palliative treatment of advanced metastatic prostate cancer.

Action

Consists of combination of mechlorethamine, an alkylating agent, and estradiol, an estrogenic compound. Antineoplastic activity may be due to either component or the combination. Also decreases serum testosterone levels. Therapeutic Effects: Decreased spread of prostate cancer.

Adverse Reactions/Side Effects

CNS: insomnia. CV: THROMBOEMBOLISM, edema, hypertension. GI: diarrhea, nausea, anorexia, flatulence, vomiting. Derm: bruising, dry skin, pruritus, rashes. Endo: decreased libido, gynecomastia, gonadal suppression (azoospermia), hyperglycemia. Hemat: leukopenia, thrombocytopenia. MS: leg cramps. Resp: dyspnea. Misc: ANGIOEDEMA, allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rashes, raised patches of red or white skin, burning/itching skin, swelling in the face). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thrombosis is suspected.

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

• Be alert for signs of leukopenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs immediately to the physician or nursing staff.

• 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 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 leg cramps or other musculoskeletal impairments to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or physiologic problems.

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 potential cardiac problems (hypertension, thromboembolism), use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact ...