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INTRODUCTION

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HIGH ALERT

denileukin diftitox (den-i-loo-kin dif-ti-tox)

Ontak

Classification

Therapeutic: antineoplastics

Pharmacologic: cytotoxic proteins

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Indications
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Persistent or recurrent cutaneous T-cell lymphoma whose malignant cells express the CD25 component of the interleukin-2 (IL-2) receptor.

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Action
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A fusion protein that contains parts of diphtheria toxin fused to IL-2. Directs cytocidal action of diphtheria toxin to cells with IL-2 receptors. Therapeutic Effects: Regression of cutaneous T-cell lymphoma.

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Adverse Reactions/Side Effects
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CNS: dizziness, headache, confusion, insomnia, nervousness, weakness. EENT: loss of visual acuity, loss of color vision. Resp: cough, dyspnea, pharyngitis, rhinitis. CV: chest pain, edema, hypotension, tachycardia, arrhythmia, thrombotic events. Derm: rash, pruritus, sweating. GI: anorexia, diarrhea, nausea, vomiting, constipation, dyspepsia, dysphagia, increased transaminases. GU: albuminuria, hematuria. F and E: hypocalcemia, dehydration, hypokalemia. Hemat: anemia, leukopenia, thrombocytopenia. Local: injection site reactions. Metab: hypoalbuminemia, weight loss. MS: myalgia, arthralgia. Neuro: paresthesia. Misc: ACUTE HYPERSENSITIVITY REACTIONS, chills, fever, flu-like syndrome, infection.

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PHYSICAL THERAPY IMPLICATIONS

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

  • Monitor continually for signs of thrombotic events, including 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.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances (tachycardia, others) or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure periodically, and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, chest pain, or other symptoms.

  • Be alert for signs of neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to other anemias. Report these signs immediately to the physician or nursing staff.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of CNS toxicity, including dizziness, confusion, headache, nervousness, or sleep loss. Notify physician if these signs become problematic.

  • Monitor neuromuscular signs of electrolyte imbalances (hypocalcemia, hypokalemia), including lethargy, weakness, cramping, and muscle hyperexcitability and tetany. Notify physician immediately if these signs occur.

  • Assess any muscle or joint pain to ...

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