Telbivudine

INTRODUCTION

Indications

Management of Chronic Hepatitis B with evidence of currently active disease.

Action

Converted intracellularly to the triphosphate active metabolite which inhibits DNA polymerase by acting as a nucleoside analogue. Result is inhibition of viral replication. Therapeutic Effects: ↓ progression of Chronic Hepatitis B infection.

Adverse Reactions/Side Effects

CV: fatigue, headache. GI: ↑ hepatomegaly. Hemat: neutropenia. Metab: LACTIC ACIDOSIS. MS: myopathy. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of lactic acidosis, including confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypotension, nausea, and vomiting. Notify physician immediately if these signs occur.

• Assess any musculoskeletal pain, muscle tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. These symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately.

• Monitor signs of enlarged liver (hepatomegaly) that can progress to liver dysfunction and liver failure. Signs of liver disease include anorexia, abdominal pain, abdominal swelling (ascites), severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Notify physician of these signs immediately.

• Monitor signs of neutropenia, including fever, sore throat, mucosal lesions, signs of infection, bruising, and bleeding. Report these signs to the physician.

Interventions

• implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and prevent muscle wasting associated with hepatitis B infection.

• Because of the risk of lactic acidosis and myopathy, 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).

Patient/Client-Related Instruction

• Emphasize the importance of taking telbivudine as directed even if the patient is asymptomatic. Do not take more than prescribed amount, and do not stop taking without consulting health care professional.

• inform patient that telbivudine does not cure hepatitis B or reduce the risk of transmission of hepatitis to other people. Caution patient to use a condom, and toavoid sharing needles or donating blood to prevent spreading the hepatitis B virus to others.

• Instruct patient to report other troublesome side effects such as prolonged or severe headache, fever, or fatigue.

Pharmacokinetics

Absorption: Rapidly absorbed following oral administration; bioavailability unknown.

Distribution: Widely distributed into tissues.

Metabolism and Excretion: Excreted entirely as unchanged drug; no metabolism.

Half-life: Effective—15 hr; elimination half–life—40–49 hr.