Pharmacologic: podophyllotoxin derivatives
Induction therapy for refractory acute lymphoblastic leukemia in children (in combination with other agents). Unlabeled Use: Neuroblastoma, adult non-Hodgkin's lymphoma.
Damages DNA prior to mitosis (cycle-dependent and phase-specific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.
Adverse Reactions/Side Effects
CNS: acute CNS depression. CV: hypotension. GI: diarrhea, mucositis, nausea, vomiting. Derm: alopecia, rashes. Endo: gonadal suppression. Hemat: neutropenia, anemia, leukopenia, thrombocytopenia. Local: phlebitis at IV site. Neuro: peripheral neurotoxicity. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Assess levels of arousal, attention, and cognitive functioning using appropriate scales (See Appendix D). Report decreased cognitive function that might indicate acute CNS depression.
Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.
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.
Be alert for signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values using EMG and nerve conduction at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.
Monitor IV injection site for pain, swelling, and inflammation (phlebitis). Report phlebitis or other prolonged or excessive injection-site reactions to the physician or nursing staff.
Instruct 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, including nausea, vomiting, diarrhea, and irritation in or around the mouth. Instruct patient or family and caregivers to report other severe or unexpected GI problems.
Advise patient that hair loss and skin rashes are likely. Instruct patient to report severe or unexpected skin problems.
Instruct patient or family/caregivers to report other bothersome side effects such as severe or prolonged fever.
Absorption: IV administration results in complete bioavailability.
Distribution: Limited distribution into the ...