kar-MUS-teen
High Alert
Absorption: IV administration results in complete bioavailability; following implantation, action is primarily local.
Distribution: Highly lipid soluble; readily penetrates CSF.
Half-Life: 15–75 min.
Contraindicated in:
Use Cautiously in:
Lung disease (↑ risk of pulmonary fibrosis)
;Derm: alopecia
GI: hepatotoxicity, nausea, vomiting, anorexia, diarrhea, esophagitis
GU: ↓fertility (men), renal failure
Hemat:
, LEUKOPENIA, THROMBOCYTOPENIALocal: pain at IV site
Resp: PULMONARY FIBROSIS
Drug-drug:
Monitor for myelosuppression. Assess for bleeding (bleeding gums; bruising; petechiae; guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur; monitor for increased fatigue, dyspnea, and orthostatic hypotension.
Assess respiratory status for dyspnea or cough. Obtain pulmonary function tests at baseline and frequently during therapy. Pulmonary toxicity usually occurs after high cumulative doses or several courses of therapy but may also occur following 1–2 courses of low doses. Symptoms may be rapid or gradual in onset; damage may be reversible or irreversible. Delayed pulmonary fibrosis may occur years after therapy. Patients receiving a cumulative dose >1400 mg/m2 are at ↑ risk of pulmonary toxicity. Notify health care provider promptly if symptoms occur.
Lab Test Considerations:
Monitor CBC with differential and platelet count before and weekly for at least 6 wk following each dose. The nadir of thrombocytopenia occurs in 4–5 wk; the nadir of leukopenia in 5–6 wk. Recovery usually occurs in 6–7 wk but may take 10–12 wk after prolonged therapy. Withhold dose and notify physician if platelet count <100,000/mm3 or leukocyte count <4000/mm3. Anemia is usually mild.
IV Administration:
Instruct patient to notify health care provider if fever; chills; sore throat; signs of infection; lower back or side pain; difficult or painful urination; bleeding gums; bruising; petechiae; or blood in urine, stool, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor. Patients should be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs.
Instruct patient to notify health care provider if shortness of breath or ↑ cough occurs.