Dasatinib

INTRODUCTION

Indications

Chronic, accelerated, or myeloid or lymphoid blast phase chronic myeloid leukemia (CML)–resistant/intolerant to prior therapy. Philadelphia chromosome–positive acute lymphoblastic leukemia–resistant/intolerant to prior therapy.

Action

Inhibits tyrosine kinases resulting in inhibition of leukemic cell lines, including those resistant to imatinib. Therapeutic Effects: Decreased progression of leukemias.

Adverse Reactions/Side Effects

CNS: SEIZURES, altered affect, anxiety, confusion, depression, drowsiness, insomnia, malaise, syncope, vertigo. EENT: conjunctivitis, dry eye, tinnitus. Resp: asthma, pneumonitis. CV: CHF, MI, PULMONARY EDEMA, QTC PROLONGATION, hypertension, hypotension, palpitations. GI: abdominal pain, altered appetite, dysgeusia, dyspepsia, ileus, mucositis, nausea, vomiting. GU: RENAL FAILURE, urinary frequency. Derm: acne, alopecia, dry skin, flushing, nail disorder, photosensitivity, pigment disorder, rash, sweating, urticaria. Endo: gynecomastia. F and E: fluid retention, hypocalcemia. Hemat: BLEEDING EVENTS, anemia, neutropenia, pancytopenia, thrombocytopenia. Metab: hyperuricemia. MS: muscle inflammation/weakness. Neuro: tremor. Misc: INFECTIONS, PALMAR-PLANTAR ERYTHRODYSESTHESIA, TUMOR LYSIS SYNDROME.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• Monitor continually for signs of MI, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician.

• Assess any breathing problems or signs of pulmonary edema, including cough, shortness of breath, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

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

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Monitor signs of renal failure, including decreased urine output, increased BP, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

• Assess for signs of bleeding and hemorrhage such as bleeding gums, nosebleed, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or BP. Notify physician immediately if these signs occur.

• Be alert for palmer-planter erythrodysesthesia, as indicated by pain, redness, and dry, scaly skin on the palms of the hands and soles of the feet. Report these signs immediately to the physician. Instruct ...