Pentostatin

INTRODUCTION

Indications

Treatment of hairy-cell leukemia in patients with active disease.

Action

Inhibits adenine deaminase (ADA), an enzyme that blocks the synthesis of DNA, especially in T cells of the lymphoid system. Therapeutic Effects: Decreased signs and symptoms of hairy-cell leukemia (recovery of hematologic parameters, organomegaly, and lymphadenopathy).

Adverse Reactions/Side Effects

CNS: CNS toxicity, fatigue, headache, weakness. EENT: epistaxis, keratoconjunctivitis, pharyngitis, rhinitis, sinusitis, vision changes. Resp: PULMONARY TOXICITY, bronchitis, dyspnea, pneumonia, cough, pulmonary edema. CV: MI, angina pectoris, arrhythmias, thrombophlebitis. GI: anorexia, diarrhea, hepatotoxicity, nausea, vomiting, constipation, flatulence, abdominal pain, stomatitis. GU: renal toxicity. Derm: itching, skin rash, dry skin. Hemat: anemia, leukopenia, thrombocytopenia. MS: arthralgia, myalgia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever, flu-like syndrome, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Continually monitor for signs of MI, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• 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 bronchitis, pneumonia, pulmonary edema, or pulmonary toxicity. These signs include dry cough, dyspnea, abnormal breath sounds, tightness in the throat and chest, shortness of breath, fever, and cyanosis.

• 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 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 signs of CNS neurotoxicity, including confusion, agitation, severe headache, hearing loss, visual disturbances, and decreased consciousness. Notify physician or nursing staff, especially if patient becomes unresponsive or difficult to arouse.

• Watch for signs of renal toxicity, including hematuria, increased urinary frequency, cloudy urine, and decreased urine output. Report these signs to the physician or nursing staff.

• Monitor signs of thrombophlebitis, especially at the IV injection site. Signs include localized pain, redness, or swelling in the affected area. Report these signs to the physician or nursing staff.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather ...