Idarubicin

INTRODUCTION

Indications

Acute myelogenous leukemia in adults (with other agents).

Action

Inhibits nucleic acid synthesis. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: headache, mental status changes. Resp: pulmonary toxicity, pulmonary allergic reactions. CV: ARRHYTHMIAS, CARDIOTOXICITY, CHF. GI: abdominal cramps, diarrhea, mucositis, nausea, vomiting. Derm: alopecia, photosensitivity, rashes. Endo: gonadal suppression. Hemat: BLEEDING, anemia, leukopenia, thrombocytopenia. Local: phlebitis at IV site. Metab: hyperuricemia. Neuro: peripheral neuropathy. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of cardiotoxicity and heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician or nursing staff immediately.

• 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.

• Watch for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, or a fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if these signs occur.

• Assess for signs of pulmonary toxicity or allergic reactions, including rales/crackles, decreased breath sounds, pleuritic friction rub, fatigue, tachypnea, cough, wheezing, pleuritic pain, fever, hemoptysis, and hypoxia. Notify physician or nursing staff immediately if these signs occur.

• Monitor 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 or nursing staff.

• Be alert for signs of peripheral neuropathy (numbness, tingling, 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.

• Assess confusion, agitation, or other alterations in mental status (See Appendix D). Notify physician promptly if these symptoms develop.

• Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report signs of 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 cardiotoxicity and arrhythmias, 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 ...