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INTRODUCTION

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alefacept (a-le-fa-sept)

Amevive

Classification

Therapeutic: antipsoriatics, immunosuppressants

Pharmacologic: fusion proteins (rDNA)

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Indications
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Treatment of moderate to severe chronic plaque psoriasis in patients who are candidates for systemic therapy or phototherapy.

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Action
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Inhibits the activation of T lymphocytes by binding to specific surface antigens. Therapeutic Effects: Reduction in size and severity of psoriatic lesions.

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Adverse Reactions/Side Effects
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CNS: dizziness, chills. Derm: pruritus. GI: fatty liver, hepatitis, increase in liver enzymes, LIVER FAILURE, nausea. Hemat: LYMPHOPENIA. Local: injection site reactions. MS: myalgia. Resp: pharyngitis, cough. Misc: HYPERSENSITIVITY REACTIONS (ANGIOEDEMA, urticaria), IMMUNOSUPPRESSION, INFECTION, MALIGNANCIES.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of hypersensitivity reactions and angioedema, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Notify physician immediately if any hypersensitivity reactions occur.

  • Monitor signs of malignancy, including a change in bowel or bladder habits, nonhealing sores, 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.

  • Be alert for signs of hepatitis and liver failure, 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. Notify physician immediately if these signs occur.

  • Monitor signs of decreased lymphocytes (lymphopenia) or immunosuppression, including infections, fever, sore throat, and white patches in the throat or mouth. Report these signs to the physician immediately.

  • Assess skin for any changes in psoriasis to help document the effects of drug therapy.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess any muscle 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 injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

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Interventions
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  • Implement ultraviolet light therapy when indicated to help treat psoriasis and augment the effects of drug therapy.

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Patient/Client-Related Instruction
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  • Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  • Instruct patient to report other troublesome side effects including severe or prolonged nausea, cough, chills, or skin reactions (rash, hives, itching).

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Pharmacokinetics
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Absorption: 63% absorbed following IM administration.

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Distribution: 0.094 L/kg.

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Metabolism and Excretion: Unknown.

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