Epoetin

INTRODUCTION

Indications

Anemia associated with chronic renal failure. Anemia secondary to zidovudine (AZT) therapy in HIV-infected patients. Anemia from chemotherapy in patients with nonmyeloid malignancies. Reduction of need for transfusions after surgery.

Action

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

Adverse Reactions/Side Effects

CNS: SEIZURES, headache. CV: CHF, MI, STROKE, THROMBOTIC EVENTS (ESPECIALLY WITH HEMOGLOBIN >12 G/DL), hypertension. Derm: transient rashes. Endo: restored fertility, resumption of menses. Misc: ↑ mortality and ↑ tumor growth (with hemoglobin ≥12 g/dL).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

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

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

  • Seizures as indicated by various symptoms depending on the type of seizure, such as decreased consciousness, changes in muscle tone, muscle twitches/jerking, convulsions, automatisms (lip smacking, chewing), and strange auditory, visual, and other sensations.

• Assess signs of congestive heart failure such as dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician.

• Assess blood pressure periodically. Report a sustained increase in blood pressure (hypertension) to the physician.

• Monitor signs of increased tumor growth, including a change in bowel or bladder habits, unusual bleeding or discharge, a lump in the breast or other parts of the body, chronic indigestion or difficulty in swallowing, obvious changes in a wart or mole, and persistent coughing or hoarseness. Report these signs to the physician immediately.

Interventions

• Because of the risk of thrombosis, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• If administered via subcutaneous injection, do not apply massage or physical agents (heat, cold, electrotherapeutic modalities) at or near the application site. These interventions can alter drug absorption from subcutaneous tissues.

Patient/Client-Related Instruction

• Caution patient and family/caregivers about risks of coronary thrombosis, stroke, and other thrombotic events, and review warning signs of these problems (see above under Evaluation and Examination).

• Instruct patient to report other troublesome side effects such as severe or prolonged headache or skin rash.

Pharmacokinetics

Absorption: Well absorbed after SC administration.

Distribution: Unknown.