Aldesleukin

INTRODUCTION

Indications

Management of metastatic renal cell carcinoma.

Action

Increases cellular immunity (noted as lymphocytosis and eosinophilia), increases the production of cytokines (including tumor necrosis factor, interleukin-1, and gamma interferon), and inhibits tumor growth. Therapeutic Effects: Regression of renal cell carcinoma.

Adverse Reactions/Side Effects

Resp: APNEA, RESPIRATORY FAILURE, dyspnea, pulmonary congestion, pulmonaryedema, hemoptysis, pleural effusion, pneumothorax, tachypnea, wheezing. CV: CARDIAC ARREST, CHF, MI, STROKE, arrhythmias, hypotension, tachycardia, myocardial ischemia, pericardial effusion, thrombosis. GI: BOWEL PERFORATION, diarrhea, jaundice, nausea, stomatitis, vomiting, ascites, hepatomegaly. GU: oliguria/anuria, proteinuria, dysuria, hematuria, renal failure. Derm: EXFOLIATATIVE DERMATITIS, pruritus. F and E: acidosis, hypocalcemia, hypokalemia, hypomagnesemia, hypophosphatemia, alkalosis, hyperkalemia, hyperuricemia, hyponatremia. Hemat: anemia, coagulation disorders, leukopenia, thrombocytopenia, eosinophilia, leukocytosis. Misc: CAPILLARY LEAK SYNDROME, chills, fever, weight gain, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Assess respiration, and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea), signs of respiratory failure (rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, oxygen desaturation), or other signs of acute or severe pulmonary pathology (coughing up blood, sudden severe chest pain, abnormal breath sounds). 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 CHF such as dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance; report these signs to the physician immediately.

• Assess blood pressure and report signs of capillary leak syndrome, including hypotension, generalized edema, light-headedness, fainting, and nasal congestion.

• Watch for signs of exfoliative dermatitis such as itching, scaling, redness, warmth, and rapid skin loss. Report these signs to the physician immediately.

• Monitor signs of leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician.

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

• Monitor signs of venous thrombosis and thromboembolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, ...