Goserelin

INTRODUCTION

Indications

Prostate cancer in patients who cannot tolerate orchiectomy or estrogen therapy (palliative). With flutamide and radiation therapy in the treatment of locally confined stage T2b–T4 (stage B2–C) prostate cancer. Advanced breast cancer in perimenopausal and postmenopausal women (palliative). Endometriosis. Produces thinning of the endometrium before endometrial ablation for dysfunctional uterine bleeding.

Action

Acts as a synthetic form of luteinizing hormone–releasing hormone (LHRH, GnRH). Inhibits the production of gonadotropins by the pituitary gland. Initially, levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone increase. Continued administration leads to decreased production of testosterone and estradiol. Therapeutic Effects: Decreased spread of cancer of the prostate or breast. Regression of endometriosis with decreased pain. Thinning of the endometrium.

Adverse Reactions/Side Effects

CNS: headache, anxiety, depression, dizziness, fatigue, insomnia, weakness. Resp: dyspnea. CV: CEREBROVASCULAR ACCIDENT, MYOCARDIAL INFARCTION, vasodilation, chest pain, hypertension, palpitations. GI: anorexia, constipation, diarrhea, nausea, ulcer, vomiting. GU: renal insufficiency, urinary obstruction. Derm: sweating, rashes. Endo: decreased libido, erectile dysfunction, breast swelling, breast tenderness, infertility, ovarian cysts, ovarian hyperstimulation syndrome (with gonadotropins). F and E: peripheral edema. Hemat: anemia. Metab: gout, hyperglycemia, ↑ lipids. MS: ↑ bone pain, arthralgia, ↓ bone density. Misc: hot flashes, chills, fever, weight gain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Seek immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Seek immediate medical assistance for signs of cerebrovascular accident (stroke), including sudden severe headache, confusion, nausea, vomiting, and increasing neurologic loss (paralysis, numbness, speech problems, visual disturbances).

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) or other cardiopulmonary symptoms (chest pain, palpitations, difficulty breathing).

• Assess any joint or bone 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 peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles due to peripheral vasodilation.

• Monitor signs of anemia, including unusual fatigue, shortness of breath with exertion, and 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 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 ...