Vincristine

INTRODUCTION

Indications

Used alone and in combination with other treatment modalities (antineoplastics, surgery, or radiation therapy) in treatment of: Hodgkin's disease, Leukemias, Neuroblastoma, Malignant lymphomas, Rhabdomyosarcoma, Wilms' tumor, Other tumors.

Action

Binds to proteins of mitotic spindle, causing metaphase arrest. Cell replication is stopped as a result (cell-cycle–specific for M phase). Has little or no effect on bone marrow. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Has immunosuppressive properties.

Adverse Reactions/Side Effects

CNS: agitation, insomnia, mental depression, mental status changes. EENT: cortical blindness, diplopia. Resp: bronchospasm. GI: nausea, vomiting, abdominal cramps, anorexia, constipation, ileus, stomatitis. GU: gonadal suppression, nocturia, oliguria, urinary retention. Derm: alopecia. Endo: syndrome of inappropriate antidiuretic hormone (SIADH). Hemat: anemia, leukopenia, thrombocytopenia (mild and brief). Local: phlebitis at IV site, tissue necrosis (from extravasation). Metab: hyperuricemia. Neuro: ascending peripheral neuropathy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest), difficult or labored breathing, or other prolonged or severe respiratory problems. Perform pulmonary function tests to document suspected changes in ventilation and respiration (See Appendix I).

• Monitor signs of fluid-electrolyte imbalance due to SIADH. SIADH causes increased water retention that leads to relatively low sodium concentration (hyponatremia). Symptoms include confusion, lethargy, weakness, myoclonus, and depressed reflexes. Severe or sudden onset may also cause seizures, ataxia, nystagmus, tremor, dysarthria, dysphagia, and coma. Notify physician if these signs occur.

• 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.

• Be alert for signs of peripheral neuropathy or neuritis, including numbness, tingling, and decreased muscle strength. Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Monitor signs of agitation, mental depression, and changes in mental status including confusion, disorientation, and impaired memory. Notify physician if these symptoms become problematic.

• Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report phlebitis or other prolonged or excessive injection site reactions to the physician.

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 bronchospasm, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (respiratory symptoms, blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward ...