Epirubicin

INTRODUCTION

Indications

A component of adjuvant therapy for evidence of axillary tumor involvement following resection of primary breast cancer.

Action

Inhibits DNA and RNA synthesis by forming a complex with DNA. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: lethargy. CV: CARDIOTOXICITY (DOSE-RELATED). GI: nausea, vomiting, anorexia, diarrhea, mucositis. Derm: alopecia, flushing, itching, photosensitivity, radiation-recall reaction, rash, skin/nail hyperpigmentation. Endo: gonadal suppression. Hemat: LEUKOPENIA, anemia, thrombocytopenia, treatment-related leukemia/myelodysplastic syndromes. Local: injection site reactions, phlebitis at IV site, tissue necrosis. Metab: hot flashes, hyperuricemia. Misc: ANAPHYLAXIS, INFECTION.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and blood pressure, especially during exercise. Report any arrhythmias or signs of cardiotoxicity, including chest discomfort, shortness of breath, dyspnea, rales/crackles, peripheral edema, jugular venous distention, fainting, or severe fatigue and weakness.

• Be alert 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 or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

• Monitor signs of allergic reactions or 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 if these reactions occur.

• Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report signs of phlebitis, tissue necrosis, 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 cardiotoxicity and blood dyscrasias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiratory symptoms, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

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.

• Advise patient about the likelihood of GI reactions including diarrhea, nausea, vomiting, loss of appetite, and irritation in/around the mouth. Instruct patient or family and caregivers to report other severe or unexpected GI problems.

• Advise patient that rash, itching, hair loss and other skin reactions are likely. Patients and family/caregivers should be especially alert for severe skin reactions ...