Basiliximab

INTRODUCTION

Indications

Prevention of acute organ rejection in patients undergoing renal transplantation; used with corticosteroids and cyclosporine.

Action

Binds to and blocks specific interleukin-2 (IL-2) receptor sites on activated T lymphocytes. Therapeutic Effects: Prevention of acute organ rejection following renal transplantation.

Adverse Reactions/Side Effects

Noted for patients receiving corticosteroids and cyclosporine in addition to basiliximab

CNS: dizziness, headache, insomnia, weakness. EENT: abnormal vision, cataracts. Resp: coughing. CV: HEART FAILURE, edema, hypertension, angina, arrhythmias, hypotension. GI: abdominal pain, constipation, diarrhea, dyspepsia, moniliasis, nausea, vomiting, GI bleeding, gingival hyperplasia, stomatitis. Derm: acne, wound complications, hypertrichosis, pruritus. Endo: hyperglycemia, hypoglycemia. F and E: acidosis, hypercholesterolemia, hyperkalemia, hyperuricemia, hypocalcemia, hypokalemia, hypophosphatemia. Hemat: bleeding, coagulation abnormalities. MS: back pain, leg pain. Neuro: tremor, neuropathy, paresthesia. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, infection, weight gain, chills.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of hypersensitivity 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.

• Watch for signs of heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

• Monitor signs of GI bleeding (abdominal pain, vomiting blood, blood in stools, black/tarry stools) or other coagulation problems (bleeding gums, nosebleed, excessive bruising). Report these signs to the physician or nursing staff immediately.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any ECG abnormalities or signs of arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

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

• Monitor signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Be alert for signs of paresthesia and neuropathy, including numbness, tingling, and muscle weakness. Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

• Monitor neuromuscular signs of acid-base imbalance (acidosis, alkalosis) or electrolyte imbalances (hypocalcemia, hypokalemia, hyperkalemia, hypomagnesemia, hypophosphatemia, hyponatremia), ...