Ifosfamide

INTRODUCTION

Indications

Germ-cell testicular carcinoma (with other agents). Used with mesna, which prevents ifosfamide-induced hemorrhagic cystitis.

Action

Following conversion to active compounds, 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.

Adverse Reactions/Side Effects

CNS: CNS toxicity (somnolence, confusion, hallucinations, coma), cranial nerve dysfunction, disorientation, dizziness. CV: cardiotoxicity. GI: nausea, vomiting, anorexia, constipation, diarrhea, hepatotoxicity. GU: hemorrhagic cystitis, dysuria, sterility, renal toxicity. Derm: alopecia. Hemat: anemia, leukopenia, thrombocytopenia. Local: phlebitis. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of CNS toxicity, including confusion, disorientation, hallucinations, decreased alertness, or cranial nerve dysfunction. Notify physician or nursing staff immediately because these symptoms can worsen and progress to coma.

• Assess heart rate, ECG, and blood pressure, especially during exercise. Report any abnormal cardiac responses or signs of cardiac toxicity, including arrhythmias, chest discomfort, shortness of breath, fainting, or fatigue/weakness.

• Monitor signs of allergic reactions, 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.

• 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.

• Monitor and report problems with urination or signs of kidney toxicity, including blood or pus in urine, decreased urine output, weight gain from fluid retention, and fatigue.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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

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 such as nausea, vomiting, diarrhea, and constipation. Instruct patient ...