Irinotecan

INTRODUCTION

Indications

Metastatic colorectal cancer (with 5-fluorouracil and leucovorin).

Action

Interferes with DNA synthesis by inhibiting the enzyme topoisomerase. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: dizziness, headache, insomnia, weakness. EENT: rhinitis. Resp: coughing, dyspnea. CV: edema, vasodilation. GI: DIARRHEA, ELEVATED LIVER ENZYMES, abdominal pain/cramping, anorexia, constipation, dyspepsia, flatulence, nausea, stomatitis, vomiting, abdominal enlargement, colonic ulceration. Derm: alopecia, rash, sweating. F and E: dehydration. Hemat: anemia, leukopenia, neutropenia, thrombocytopenia. Local: injection-site reactions. Metab: weight loss. MS: back pain. Misc: chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for severe diarrhea or signs of hepatotoxicity, including severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

• Watch 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 respiratory side effects, including cough, nasal irritation, or difficult, labored breathing. Report severe or troublesome respiratory problems to the physician or nursing staff.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles caused by peripheral vasodilation.

• 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.

• Assess any 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.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or substantial weight loss.

• 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.

• Make sure patient maintains adequate fluid intake to avoid dehydration, especially during exercise.

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and toavoid crowds and contact with persons ...