Bortezomib

INTRODUCTION

Indications

Multiple myeloma (as initial therapy or after progression); with melphalan and prednisone). Mantle cell lymphoma after at least one other therapy.

Action

Inhibits proteasome, a regulator of intracellular protein catabolism, resulting in disruption of various intracellular processes. Cytotoxic to a variety of cancerous cells. Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.

Adverse Reactions/Side Effects

CNS: fatigue, malaise, weakness, dizziness, syncope. EENT: blurred vision, diplopia. CV: hypotension, CHF. Resp: pneumonia. GI: anorexia, constipation, diarrhea, nausea, vomiting. Hemat: BLEEDING, anemia, neutropenia, thrombocytopenia. Neuro: peripheral neuropathy. Misc: fever, tumor lysis syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

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

• Assess any breathing problems or signs of pneumonia such as cough, fever, chills, and chest pain during inspiration and expiration. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

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

• Monitor signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician.

• Monitor neuromuscular signs of electrolyte imbalances that might indicate tumor lysis syndrome. Signs include severe muscle weakness or paralysis due to increased plasma potassium (hyperkalemia) or muscle hyperexcitability and tetany due to phosphate and calcium imbalances (hyperphosphatemia and hypocalcemia). Notify physician immediately if these signs occur.

• Monitor signs of peripheral neuropathy (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

Interventions

• 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.

• Because of possible heart failure and abnormal BP responses, use caution during aerobic exercise and endurance conditioning. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.) and avoid crowds and contact with persons with ...