Rasburicase

INTRODUCTION

Indications

Initial management of increased uric acid levels in children with leukemia, lymphoma, or other malignancies who are being treated with antineoplastics which are expected to produce hyperuricemia.

Action

An enzyme which promotes the conversion of uric acid to allantoin, an inactive, water-soluble compound. Produced by recombinant DNA technology. Therapeutic Effects: Decreased sequelae of hyperuricemia (nephropathy, arthropathy).

Adverse Reactions/Side Effects

CNS: headache. Resp: respiratory distress. GI: abdominal pain, constipation, diarrhea, nausea, vomiting, mucositis. Derm: rash. Hemat: HEMOLYSIS, METHEMOGLOBINEMIA, neutropenia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, fever, sepsis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Be alert for signs of hemolysis (unusual fatigue, shortness of breath, dizziness, headache, coldness in your hands and feet, pale/yellow skin, chest pain), methemoglobinemia (bluish coloring of the skin, lips fingernails; headache; lack of energy), and neutropenia (fever, sore throat, signs of infection). Report these signs to the physician or nursing staff immediately.

• Assess symptoms of respiratory distress, including shortness of breath, dyspnea, and cyanosis. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

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.

Patient/Client-Related Instruction

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, fever, skin rash, or GI problems (nausea, vomiting, diarrhea, constipation, abdominal pain, inflammation in/around the mouth).

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: 18 hr.

Contraindications/Precautions

Contraindicated in: G6PD deficiency; Previous allergic reaction, hemolysis, or methemoglobinemia from rasburicase; Lactation.

Use Cautiously in: OB: Pregnancy (use only if clearly needed).

Interactions

Drug-Drug: None known.

Route/Dosage

IV (Children): 0.15 or 0.2 mg/kg daily as ...