Pralatrexate

INTRODUCTION

Indications

Treatment relapsed/refractory peripheral T-cell lymphoma.

Action

Interferes with folic acid metabolism by acting as a folate analogue metabolic inhibitor that competitively inhibits dihydrofolate reductase; also acts as a competitive inhibitor for polyglutamylation by the enzyme folylpolyglutamyl synthetase. Results is inhibition of DNA synthesis. Therapeutic Effects: Death of rapidly replication cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue. EENT: epistaxis, pharyngolaryngeal pain. Resp: dyspnea, cough. CV: edema, tachycardia. GI: mucositis, nausea, abdominal pain, anorexia, constipation, diarrhea, vomiting, liver function abnormalities. Derm: pruritus, rash. F and E: dehydration, hypokalemia. Hemat: NEUTROPENIA, THROMBOCYTOPENIA, anemia. MS: back pain, extremity pain. Misc: SEPSIS, fever, night sweats

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of neutropenia (fever, sore throat, mucosal lesions, other 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 immediately.

• Be alert for signs of infection and sepsis, including high fever (>101.3 F), tachycardia, rapid/shallow breathing, abrupt change in mental status, decreased urine output, and severe hypotension. Report these signs to the physician or nursing staff immediately.

• Assess any breathing problems, and report severe or prolonged cough or difficult, labored breathing.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any back pain or extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor and report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

• Assess dizziness (See Appendix C) that might affect gait, balance, and other functional activities. 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.

Interventions

• For patients with cancer 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

• Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Advise patient and family/caregivers that fatigue and weakness are likely and may be severe. Implement assistive devices (walker, cane, wheelchair) as needed to help ...