Oprelvekin

INTRODUCTION

Indications

Prevention of severe thrombocytopenia and reduction of the need for platelet transfusions following myelosuppressive chemotherapy in patients with nonmyeloid malignancies at risk for thrombocytopenia.

Action

Stimulates production of megakaryocytes and platelets. Therapeutic Effects: Increased platelet count.

Adverse Reactions/Side Effects

These effects occurred in patients who had recently received myelosuppressive chemotherapy

CNS: dizziness, headache, insomnia, nervousness, weakness. EENT: conjunctival hemorrhage, blurred vision, changes in visual acuity, blindness, papilledema, pharyngitis, rhinitis. Resp: cough, dyspnea, pleural effusions. CV: atrial fibrillation, edema, palpitations, syncope, tachycardia, vasodilation, ventricular arrhythmias. GI: anorexia, constipation, diarrhea, dyspepsia, mucositis, nausea, oral moniliasis, vomiting, abdominal pain. Derm: alopecia, ecchymoses, rash. F and E: sodium and water retention. Local: injection site reactions. MS: bone pain, myalgia. Misc: chills, fever, infection, pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Monitor respiratory function at rest and during exercise. Notify physician if patient experiences signs of pleural effusion, including cough, shortness of breath, chest pain, or labored breathing.

• 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.

• 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.

• Assess any muscle or bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor subcutaneous injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Because of the risk of arrhythmias and pleural effusion, 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).

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

Patient/Client-Related Instruction

• Advise patient to report ...