Procarbazine

INTRODUCTION

Indications

Treatment of Hodgkin's disease (with other treatment modalities). Unlabeled Use: Other lymphomas, Brain and lung tumors, Multiple myeloma, Malignant melanoma, Polycythemia vera.

Action

Appears to inhibit DNA, RNA, and protein synthesis (cell-cycle S-phase–specific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: SEIZURES, confusion, dizziness, drowsiness, hallucinations, headache, mania, mental depression, nightmares, psychosis, syncope, tremor. EENT: nystagmus, photophobia, retinal hemorrhage. Resp: cough, pleural effusions. CV: edema, hypotension, tachycardia. GI: nausea, vomiting, anorexia, diarrhea, dry mouth, dysphagia, hepatic dysfunction, stomatitis. GU: gonadal suppression. Derm: alopecia, photosensitivity, pruritus, rashes. Endo: gynecomastia. Hemat: anemia, leukopenia, thrombocytopenia. Neuro: neuropathy, paresthesia. Misc: ascites, secondary malignancy.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.

• 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 (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

• 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.

• Monitor prolonged cough or other signs of pleural effusion such as chest pain, shortness of breath, and abnormal breath sounds (See Appendices J, K). Notify physician if breathing becomes compromised.

• 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 paresthesia and peripheral neuropathy (numbness, tingling, muscle weakness). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible. Periodically reexamine these values to document drug-induced changes in peripheral nerve function.

• Monitor and report signs of CNS toxicity, including confusion, mania, tremor, hallucinations, or psychosis.

• Assess dizziness and drowsiness 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.

• Monitor signs of 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, ...