Darbepoetin

INTRODUCTION

Indications

Anemia associated with chronic renal failure. Chemotherapy-induced anemia in patients with non-myeloid malignancies.

Action

Stimulates erythropoiesis (production of red blood cells). Therapeutic Effects: Maintains and may elevate red blood cell counts, decreasing the need for transfusions.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, fatigue, headache, weakness. Resp: cough, dyspnea, bronchitis. CV: CHF, MI, STROKE, THROMBOTIC EVENTS (ESPECIALLY WITH HEMOGLOBIN >12 G/DL), edema, hypertension, hypotension, chest pain. GI: abdominal pain, nausea, diarrhea, vomiting, constipation. Derm: pruritus. Hemat: pure red cell aplasia. MS: myalgia, arthralgia, back pain, limb pain. Misc: fever, allergic reactions, flu-like syndrome, sepsis, ↑ mortality and ↑ tumor growth (with hemoglobin ≥12 g/dL).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor continually, and seek immediate medical assistance if patient develops any of the following signs or syndromes:

  • Stroke, as indicated by severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, and visual disturbances.

  • Myocardial infarction, as indicated by sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

  • Congestive heart failure, as indicated by dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance.

• 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 any difficult or labored breathing problems or signs of cough or bronchitis. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• 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 signs of allergic reactions, 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 any muscle, joint, back, or limb pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness 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.

Interventions

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