Mitoxantrone

INTRODUCTION

Indications

Acute nonlymphocytic leukemia (ANLL) in adults (with other antineoplastics). Initial chemotherapy for patients with pain associated with advanced hormone-refractory prostate cancer. Secondary (chronic) progressive, progressive relapsing, or worsening relapsing-remitting multiple sclerosis (MS).

Unlabeled Use: Breast cancer, liver cancer, and non-Hodgkin's lymphoma.

Action

Inhibits DNA synthesis (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Decreased pain in patients with advanced prostate cancer. Decreased disability and slowed progression of MS.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache. EENT: blue-green sclera, conjunctivitis. Resp: cough, dyspnea. CV: CARDIOTOXICITY, arrhythmias, ECG changes. GI: abdominal pain, diarrhea, hepatic toxicity, nausea, stomatitis, vomiting. GU: blue-green urine, gonadal suppression, renal failure. Derm: alopecia, rashes. Hemat: anemia, leukopenia, secondary leukemia, thrombocytopenia. Metab: hyperuricemia. Misc: fever, hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Assess heart rate, ECG, and blood pressure, especially during exercise (See Appendices F, G, H). Report immediately any arrhythmias or other signs of cardiac toxicity, including chest discomfort, shortness of breath, dyspnea, rales/crackles, peripheral edema, jugular venous distention, fainting, or severe fatigue and weakness.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician or nursing staff immediately.

• Watch for 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. Report these signs to the physician or nursing staff.

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 cardiotoxicity, use 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

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