Tocilizumab

INTRODUCTION

Indications

Treatment of adults with moderately to severely active rheumatoid arthritis who have not responded to one or more tumor necrosis factor (TNF) antagonist therapies (may be used alone or with methotrexate or other disease-modifying antirheumatic drugs [DMARDs]).

Action

Acts as in inhibitor of interleukin-6 (IL-6) receptors by binding to them. IL-6 is a mediator of various inflammatory processes. Therapeutic Effects: Slowed progression of rheumatoid arthritis

Adverse Reactions/Side Effects

CNS: headache, dizziness. EENT: nasopharyngitis. Resp: upper respiratory tract infections. CV: hypertension. GI: GASTROINTESTINAL PERFORATION, ↑ liver enzymes. Derm: rash. Hemat: NEUTROPENIA, THROMBOCYTOPENIA. Metab: ↑ lipids. Misc: SERIOUS INFECTIONS, INCLUDING TUBERCULOSIS, DISSEMINATED FUNGAL INFECTIONS, AND INFECTIONS WITH OPPORTUNISTIC PATHOGENS; HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, infusion reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for allergy-like responses that occur during and after administration (infusion reactions). Notify physician or nursing staff immediately of any signs of hypersensitivity.

• Watch for signs of infection, especially tuberculosis, pulmonary fungal infections, or other respiratory infections. Signs include fatigue, chills, fever, night sweats, loss of appetite, and pulmonary pathology (persistent cough, coughing up blood, chest pain when breathing and coughing). Report these signs to the physician or nursing staff immediately.

• Monitor and report signs of neutropenia (fever, sore throat, other signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Periodic blood tests may be needed to monitor WBC and RBC counts.

• Watch for signs of GI perforation, including severe abdominal pain, nausea, vomiting, chills, and fever. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

• 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

• Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of antirheumatic drug therapy.

• Help patients with arthritis explore other nonpharmacologic methods to reduce chronic arthritis pain, such as relaxation techniques, exercise, counseling, and so forth.

Patient/Client-Related Instruction

• Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid ...