Cyclophosphamide

INTRODUCTION

Indications

Alone or with other modalities in the management of Hodgkin's disease, Malignant lymphomas, Multiple myeloma, Leukemias, Mycosis fungoides, Neuroblastoma, Ovarian carcinoma, Breast carcinoma and a variety of other tumors. Minimal change nephrotic syndrome in children. Unlabeled Use: Severe active rheumatoid arthritis or Wegener's granulomatosis.

Action

Interferes with DNA replication and RNA transcription, ultimately disrupting protein synthesis (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones. Also has immunosuppressant action in smaller doses.

Adverse Reactions/Side Effects

Resp: PULMONARY FIBROSIS. CV: MYOCARDIAL FIBROSIS, hypotension. GI: anorexia, nausea, vomiting. GU: HEMORRHAGIC CYSTITIS, hematuria. Derm: alopecia. Endo: gonadal suppression, syndrome of inappropriate antidiuretic hormone (SIADH). Hemat: LEUKOPENIA, thrombocytopenia, anemia. Metab: hyperuricemia. Misc: secondary neoplasms.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician or nursing staff immediately if patient experiences signs of pulmonary fibrosis (dry cough, dyspnea, shortness of breath, cyanosis).

• Assess heart rate and ECG, especially during exercise. Report any abnormal cardiac responses or signs of myocardial fibrosis such as cardiac arrhythmias, chest discomfort, shortness of breath, fainting, fatigue, or weakness.

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

• Monitor signs of bladder inflammation (hemorrhagic cystitis), including blood in the urine, increased frequency, and painful or difficult urination. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure periodically, and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor and report neurologic signs of water and electrolyte imbalances due to syndrome of inappropriate antidiuretic hormone (SIADH). Excess ADH can cause increased water retention and a relative sodium deficiency (hyponatremia). Symptoms include confusion, lethargy, weakness, myoclonus, decreased reflexes, tremor, nystagmus, dysarthria, seizures, and coma.

• Watch for signs of secondary neoplasms, including a change in bowel or bladder habits, nonhealing sores, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

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.

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