Pharmacologic: kinase inhibitors
Treatment of advanced renal cell carcinoma.
Acts as a tyrosine kinase inhibitor of several vascular endothelial growth factor (VEGF) receptors, platelet-derived growth factor receptor, fibroblast growth factor receptor, cytokine receptor, interleukin-2 receptor inducible T-cell kinase, leukocyte-specific protein tyrosine kinase, and transmembrane glycoprotein receptor tyrosine kinase. Overall effect is decreased angiogenesis in tumors. Therapeutic Effects: Decreased growth and spread of renal cell carcinoma.
Adverse Reactions/Side Effects
CNS: fatigue, weakness. CV: PROLONGED QT INTERVAL PROLONGATION, hypertension, chest pain. GI: GI PERFORATION/FISTULA, HEPATOTOXICITY, abdominal pain, anorexia, diarrhea, nausea, vomiting altered taste, dyspepsia. GU: proteinuria. Derm: alopecia, facial edema, palmarplantar erythrodysesthesia (hand-foot syndrome), rash, skin depigmentation. Endo: hypothyroidism. Hemat: BLEEDING, arterial thrombosis. Metab: ↑ lipase, weight loss. Misc: hair color changes (depigmentation)
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.
Watch for signs of bleeding, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and a fall in hematocrit or blood pressure (BP). Notify physician or nursing staff immediately if these signs occur.
Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual
bleeding or bruising. Report these signs to the physician or nursing staff immediately.
Watch for signs of GI perforation or fistula, including severe abdominal pain, nausea, vomiting, chills, and fever. Report these signs to the physician or nursing staff immediately.
Monitor signs of arterial thrombosis, including extreme coldness in the hands and feet, cyanosis, and muscle cramping. Notify physician immediately, and request objective tests (Doppler ultrasound, others) if thrombosis is suspected.
Assess BP and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).
Be alert for palmer-planter erythrodysesthesia, as indicated by pain, redness, and dry, scaly skin on the palms of the hands and soles of the feet. Report these signs immediately to the physician. Instruct patient to also protect the hands and feet from heat and friction, and to apply lotion to the affected areas. Superficial cold application can also temporarily reduce symptoms.
Monitor signs of hypothyroidism, including bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness. Report these signs to the physician or nursing staff.
Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.