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INTRODUCTION

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pegfilgrastim (peg-fil-gras-tim)

Neulasta

Classification

Therapeutic: colony-stimulating factors

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Indications
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To decrease the incidence of infection (febrile neutropenia) in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics associated with a high risk of febrile neutropenia.

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Action
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Filgrastim is a glycoprotein that binds to and stimulates neutrophils to divide and differentiate. Also activates mature neutrophils. Binding to a polyethylene glycol molecule prolongs its effects. Therapeutic Effects: Decreased incidence of infection in patients who are neutropenic from chemotherapy.

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Adverse Reactions/Side Effects
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Resp: ADULT RESPIRATORY DISTRESS SYNDROME (ARDS). GI: SPLENIC RUPTURE. Hemat: SICKLE CELL CRISIS, leukocytosis. MS: medullary bone pain. Misc: ALLERGIC REACTION, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess respiration, and notify physician immediately if patient exhibits signs of respiratory distress syndrome. Signs include severe shortness of breath, rapid labored breathing, cyanosis, confusion, extreme tiredness, cough, and fever. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

  • Monitor signs of allergic reactions and anaphylaxis, 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.

  • Be alert for signs of red blood cell abnormalities such as sickle cell crisis and increased white blood cell counts (leukocytosis). Signs include including fever, weakness, weight loss, loss of appetite, dizziness, fainting, dyspnea, bleeding/bruising, or pain or tingling in the arms, legs, or abdomen. Report these signs to the physician or nursing staff immediately.

  • Watch for signs of spleen rupture, including pain and tenderness in the upper left abdomen, light-headedness, dizziness, and confusion. Report these signs to the physician or nursing staff immediately.

  • Assess any bone pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by fracture 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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  • Instruct patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

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Pharmacokinetics
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Absorption: Well absorbed following SC administration.

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Distribution: Unknown.

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Metabolism and Excretion: Unknown.

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Half-life: 15–80 hr.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
SC unknown unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to filgrastim or Escherichia coli–derived proteins.

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