Pentamidine

INTRODUCTION

Indications

IV: Treatment of Pneumocystis carinii pneumonia (PCP). Inhalation: Prevention of PCP in AIDS or HIV-positive patients who have had PCP or who have a peripheral CD4 lymphocyte count of ≤200/mm³. Unlabeled Use: Inhalation: Treatment of PCP.

Action

Appears to disrupt DNA or RNA synthesis in protozoa. Also has a direct toxic effect on pancreatic islet cells. Therapeutic Effects: Death of susceptible protozoa.

Adverse Reactions/Side Effects

For parenteral form, unless otherwise indicated

CNS: anxiety, headache, confusion, dizziness, hallucinations. EENT: inhalation: burning in throat. Resp: inhalation: bronchospasm, cough. CV: ARRHYTHMIAS, HYPOTENSION. GI: PANCREATITIS, abdominal pain, anorexia, drug-induced hepatitis, nausea, unpleasant metallic taste, vomiting. GU: nephrotoxicity. Derm: pallor, rash. Endo: HYPOGLYCEMIA, hyperglycemia. F and E: hyperkalemia, hypocalcemia. Hemat: anemia, leukopenia, thrombocytopenia. Local: IV—phlebitis, pruritus, urticaria at IV site; IM—sterile abscesses at IM sites. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report any rhythm disturbances or symptoms of cardiac dysfunction, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions associated with Stevens-Johnson syndrome (exfoliation, rash, dermatitis, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, oily stools. Report these signs to the physician immediately.

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Notify physician about glycemic problems, especially severe hypoglycemia that might lead to dizziness, syncope, coma, and seizures.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other 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, coagulation disorders, or other blood dyscrasias. Report these signs to the physician.

• Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest), especially when this drug is inhaled. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendix I).

• Monitor signs of electrolyte imbalances such as high plasma potassium levels (hyperkalemia) or low calcium levels (hypocalcemia), including bradycardia, fatigue, weakness, numbness, and tingling, muscle cramps, and muscle hyperexcitability and tetany. Notify physician of these signs.

• Monitor severe or prolonged confusion, anxiety, hallucinations, or other ...