Lomustine

INTRODUCTION

Indications

Used alone or with other agents for primary and metastatic brain tumors, Hodgkin's disease.

Action

Inhibits DNA and RNA synthesis by alkylation (cell-cycle phase–nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: ataxia, disorientation, dysarthria, lethargy. Resp: fibrosis, pulmonary infiltrates. GI: nausea, vomiting, anorexia, hepatotoxicity, stomatitis. GU: azotemia, renal failure. Derm: alopecia. Endo: infertility. Hemat: leukopenia, thrombocytopenia, anemia. Metab: hyperuricemia. Misc: secondary malignancy (long-term use).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, and respiratory rate (See Appendices I, J, K). Notify physician or nursing staff immediately if patient experiences signs of pulmonary fibrosis or pulmonary infiltrates (dry cough, dyspnea, chest pain, shortness of breath, cyanosis).

• 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. Report these signs to the physician or nursing staff.

• Monitor and report signs of CNS toxicity including ataxia, disorientation, garbled speech, or lethargy.

• 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 or nursing staff immediately.

• Watch for signs of a secondary malignancy, including a change in bowel or bladder habits, nonhealing sores, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

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 pulmonary fibrosis, 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, loss of appetite, and irritation in or around the mouth. Instruct patient to report severe or prolonged GI problems, and to also report signs of liver toxicity, including abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, ...