Streptozocin

INTRODUCTION

Indications

Metastatic islet cell carcinoma of the pancreas. Unlabeled Use: Metastatic carcinoid tumor, Hodgkin's disease, Pancreatic adenocarcinoma, Colorectal cancer.

Action

Inhibits DNA synthesis by cross-linking DNA strands (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: confusion, lethargy, mental depression. GI: DRUG-INDUCED HEPATITIS, nausea, vomiting, diarrhea, duodenal ulcer. GU: nephrotoxicity, gonadal suppression, proteinuria. F and E: hypophosphatemia. Hemat: anemia, leukopenia, thrombocytopenia, eosinophilia. Local: phlebitis at IV site, injection-site reactions. Metab: HYPOGLYCEMIA (FIRST DOSE), hyperglycemia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain. Report these signs to the physician or nursing staff immediately.

• Be alert for signs of hypoglycemia, especially after the first dose. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Notify physician or nursing staff immediately of any hypoglycemic reactions.

• 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.

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

• Monitor signs of low phosphate levels (hypophosphatemia), including skeletal muscle dysfunction or weakness, respiratory muscle weakness, and mental status changes such as irritability and confusion that progresses to delirium and coma. Report these signs to the physician.

• Monitor and report signs of nephrotoxicity, including hematuria, increased urinary frequency, cloudy urine, and decreased urine output.

• Monitor and report signs of CNS toxicity, including confusion, decreased alertness, or severe lethargy.

• Assess IV site during and after IV administration, and report signs of phlebitis or other injection site reactions (local pain, swelling, inflammation).

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

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

• Instruct patient to report other troublesome side effects, including severe or prolonged fever or GI problems (nausea, vomiting, diarrhea, stomach pain).

Pharmacokinetics