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INTRODUCTION

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bevacizumab (be-va-kiz-oo-mab)

Avastin

Classification

Therapeutic: antineoplastics

Pharmacologic: monoclonal antibodies

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Indications
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Metastatic colon or rectal carcinoma (with IV 5-fluorouracil). First-line treatment of patients with unresectable, locally advanced, recurrent or metastatic nonsquamous, non–small cell lung cancer with carboplatin and paclitaxel.

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Action
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A monoclonal antibody that binds to vascular endothelial growth factor (VEGF), preventing its attachment to binding sites on vascular endothelium, thereby inhibiting growth of new blood vessels (angiogenesis). Therapeutic Effects: Decreased metastatic disease progression and microvascular growth.

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Adverse Reactions/Side Effects
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CNS: reversible posterior leukoencephalopathy syndrome (RPLS). CV: ARTERIAL THROMBOEMBOLIC EVENTS, CHF, hypertension, hypotension. Resp: HEMOPTYSIS, nongastrointestinal fistulas, nasal septum perforation. GI: GI PERFORATION. GU: nephrotic syndrome, proteinuria. Hemat: BLEEDING. Misc: WOUND DEHISCENCE, impaired wound healing, infusion reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Continually monitor for signs of arterial thrombosis that leads to MI (sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea) or ischemic stroke (sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, visual disturbances). Seek immediate medical assistance if patient develops these signs.

  • Monitor and immediately report any bleeding problems, including coughing up blood or other abnormal bleeding (nosebleeds, bleeding gums, excessive bruising).

  • Be alert for signs of bowel perforation, including sudden severe abdominal pain accompanied by nausea, vomiting, chills, and fever. Report these signs immediately to the physician or nursing staff.

  • Monitor signs of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance); report these signs to the physician.

  • Monitor signs of reversible posterior leukoencephalopathy syndrome, including headache, confusion, seizures, and loss of vision. Early recognition and adjustment of drug dosage is important in resolving this syndrome.

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

  • Monitor and report signs of nephrotic syndrome, including edema and weight gain from fluid retention.

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Interventions
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  • Protect suture lines and wounds to prevent reopening (dehiscence). Implement physical agents whenever possible to promote wound healing.

  • For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

  • Because of the risk of MI and stroke, use extreme 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).

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Patient/Client-Related Instruction
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  • Advise patient and family or caregiver about the signs of MI and stroke (see signs above in Examination and Evaluation) and to seek immediate medical assistance if these signs develop.

  • Instruct patient ...

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