Pamidronate

INTRODUCTION

Indications

Moderate-to-severe hypercalcemia associated with malignancy. Osteolytic bone lesions associated with multiple myeloma or breast cancer. Moderate-to-severe Paget's disease.

Action

Inhibits resorption of bone. Therapeutic Effects:Decreased serum calcium. Decreased skeletal destruction in multiple myeloma or breast cancer. Decreased skeletal complications in Paget's disease.

Adverse Reactions/Side Effects

CNS: fatigue. EENT: conjunctivitis, blurred vision, eye pain/inflammation, rhinitis. Resp: rales. CV: arrhythmias, hypertension, syncope, tachycardia. GI: nausea, abdominal pain, anorexia, constipation, vomiting. F and E: hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia, fluid overload. GU: nephrotoxicity. Hemat: leukopenia, anemia. Local: phlebitis at injection site. Metab: hypothyroidism. MS: muscle stiffness, musculoskeletal pain, osteonecrosis (primarily of jaw). Misc: fever, generalized pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any muscle pain/stiffness or bone pain. Report persistent or increased musculoskeletal pain to determine presence of bone or joint pathology, including fracture. Be especially aware of possible mouth and jaw pain due to osteonecrosis of the jaw. Bone pain may persist or increase in patients with Paget's disease, but usually subsides days to months after therapy is discontinued.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension).

• Monitor any breathing problems, and report rales or other abnormal breath sounds.

• Watch for signs of leukopenia (fever, sore throat, other 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.

• Watch for signs of hypercalcemic relapse, including bone pain, anorexia, nausea, vomiting, thirst, and lethargy. Report these signs to the physician.

• Be alert for signs of nephrotoxicity, including hematuria, increased urinary frequency, cloudy urine, and decreased urine output. Report these signs to the physician.

• Report signs of hypothyroidism, including lethargy, weight gain, bradycardia, and cold intolerance.

• Assess IV site after IV administration, and report signs of phlebitis and venous thrombosis (local pain, swelling, inflammation).

Interventions

• Protect against falls and fractures (See Appendix E). Modify home environment (remove throw rugs, improve lighting, etc.) and provide assistive devices (cane, walker) or other protective devices as needed to improve balance and prevent falls.

• Because of the risk of cardiac arrhythmias (tachycardia, other), use caution during aerobic exercise and endurance ...