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INTRODUCTION

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sirolimus (sir-oh-li-mus)

Rapamune

Classification

Therapeutic: immunosuppressants

Pharmacologic: macrolides

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Indications
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Prevention of organ rejection in allogenic kidney transplantation (with corticosteroids and cyclosporine). Sirolimus is also eluted from the Cypher coronary stent used in angioplasty procedures.

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Action
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Inhibits T-lymphocyte activation/proliferation, which occurs as a response to antigenic and cytokine stimulation; antibody production is also inhibited. Therapeutic Effects: Decreased incidence and severity of organ rejection.

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Adverse Reactions/Side Effects
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Reflects combined therapy with corticosteroids and cyclosporine
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CNS: insomnia. Resp: interstitial lung disease. CV: edema, hypotension. GI: hepatic toxicity. GU: renal impairment. Derm: acne, rash, thrombocytopenic purpura. F and E: hypokalemia. Hemat: leukopenia, thrombocytopenia, anemia. Metab: hyperlipidemia. MS: arthralgias. Neuro: tremor. Misc: ↑ risk of infection, ↑ risk of lymphoma, ↑ risk of lymphocele, mucosal herpes simplex infections, ↓ wound healing, lymphocele.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess any breathing problems or signs of interstitial lung disease such as dry cough, wheezing, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

  • Be alert for signs of hepatic toxicity, 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. Report these signs to the physician immediately.

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

  • 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 any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).

  • Monitor signs of lymphoma, including swollen lymph glands, unexplained weight loss, fatigue, weakness, fever, night sweats, dyspnea, cough, and abdominal pain/bloating. Report these signs to the physician immediately.

  • Watch for signs of renal impairment, including decreased urine output, cloudy urine, and sudden weight gain due to fluid retention. Report these signs to the physician.

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

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Interventions
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  • Implement appropriate strengthening, aerobic, and other therapeutic exercises to improve function and promote recovery following organ transplants.

  • Because of the risk of interstitial lung disease, use 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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