Foscarnet

INTRODUCTION

Indications

Treatment of cytomegalovirus (CMV) retinitis in HIV-infected patients (alone or with ganciclovir). Treatment of acyclovir-resistant mucocutaneous herpes simplex virus (HSV) infections in immunocompromised patients.

Action

Prevents viral replication by inhibiting viral DNA-polymerase and reverse transcriptase. Therapeutic Effects: Virustatic action against susceptible viruses including CMV.

Adverse Reactions/Side Effects

CNS: SEIZURES, headache, anxiety, confusion, dizziness, fatigue, malaise, mental depression, weakness. EENT: conjunctivitis, eye pain, vision abnormalities. Resp: coughing, dyspnea. CV: chest pain, ECG abnormalities, edema, palpitations. GI: diarrhea, nausea, vomiting, abdominal pain, abnormal taste sensation, anorexia, constipation, dyspepsia. GU: renal failure, albuminuria, dysuria, nocturia, polyuria, urinary retention. Derm: increased sweating, pruritus, rash, skin ulceration. F and E: hypocalcemia, hypokalemia, hypomagne-semia, hyperphosphatemia, hypophosphatemia. Hemat: anemia, granulocytopenia, leukopenia. Local: pain/inflammation at injection site. MS: arthralgia, myalgia, back pain, involuntary muscle contraction. Neuro: ataxia, hypoesthesia, neuropathy, paresthesia, tremor. Misc: fever, chills, flu-like syndrome, lymphoma, sarcoma.

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 immediately to the physician.

• 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, dyspnea, fainting, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor signs of leukopenia and granulocytopenia (fever, sore throat, mucosal lesions, signs of infection) or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Monitor neuromuscular signs of electrolyte imbalances (hypocalcemia, hypokalemia, etc.), including headache, lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

• Monitor signs of renal failure, including decreased urine output, increased blood pressure, 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 any joint, muscle, or back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor signs of peripheral neuropathy and paresthesia (numbness, tingling, muscle weakness). Perform objective tests (nerve conduction, monofilaments) to assess and document any neuropathic changes.

• Be alert for anxiety, confusion, mental depression, or other alterations in mental status. Notify physician promptly if these symptoms develop.

• Be alert for tremor, dizziness, or ataxia that might affect gait, ...