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INTRODUCTION

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ibritumomab tiuxetan (i-bri-too-mo-mab tye-uks-i-tan)

Zevalin

Classification

Therapeutic: antineoplastics

Pharmacologic: monoclonal antibodies, radioisotopes

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Indications
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Relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma (including rituximab-resistant).

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Action
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Ibritumomab tiuxetan is a monoclonal antibody linked to a radioisotope that targets white blood cells, including malignant ones. Used in combination with rituximab as part of a two-step process using indium-111 (step 1) and yttrium-90 (step 2) ibritumomab tiuxetan. Therapeutic Effects: Decreased spread of lymphoma.

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Adverse Reactions/Side Effects
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CNS: anxiety, dizziness. EENT: rhinitis. Resp: dyspnea, increased cough, bronchospasm. GI: abdominal pain, anorexia, diarrhea, nausea, vomiting. Derm: ecchymoses, pruritus. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. MS: arthralgia. Misc: INFECTIONS, INFUSION REACTIONS, ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, secondary malignancies.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of allergic reactions and anaphylaxis. Reactions include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria, burning skin, swelling in the face). Be especially alert for these signs after drug infusion (infusion reactions). Notify physician or nursing staff immediately if these reactions occur.

  • Monitor signs of bone marrow suppression, including leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Notify physician of these signs immediately.

  • Be alert for signs of infection, including fever, sore throat, chills, nausea, vomiting, diarrhea, and localized inflammation. Notify physician or nursing staff of these signs immediately.

  • Monitor signs of secondary 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.

  • Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest) or other prolonged or severe respiratory problems (difficult or labored breathing). Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

  • 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.

  • Assess any increased joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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Interventions
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  • 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.

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Patient/Client-Related Instruction
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  • Advise ...

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