Cyclosporine

INTRODUCTION

Indications

PO, IV: Prevention and treatment of rejection in renal, cardiac, and hepatic transplantation (with corticosteroids). PO: Treatment of severe active rheumatoid arthritis (Neoral only). Treatment of severe recalcitrant psoriasis in adult nonimmunocompromised patients (Neoral only). Unlabeled Use: Management of recalcitrant ulcerative colitis. Treatment of steroid-resistant nephrotic syndrome. Treatment of severe steroid-resistant autoimmune disease. Prevention and treatment of graft-versus-host disease in bone marrow transplant patients.

Action

Inhibits normal immune responses (cellular and humoral) by inhibiting interleukin-2, a factor necessary for initiation of T-cell activity. Therapeutic Effects: Prevention of rejection reactions. Slowed progression of rheumatoid arthritis or psoriasis.

Adverse Reactions/Side Effects

CNS: SEIZURES, tremor, confusion, flushing, headache, psychiatric problems. CV: hypertension. GI: diarrhea, hepatotoxicity, nausea, vomiting, abdominal discomfort, anorexia, pancreatitis. GU: nephrotoxicity. Derm: hirsutism, acne. F and E: hyperkalemia, hypomagnesemia. Hemat: anemia, leukopenia, thrombocytopenia. Metab: hyperlipidemia, hyperuricemia. Neuro: hyperesthesia, paresthesia. Misc: gingival hyperplasia, hypersensitivity reactions, infections.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor other signs of CNS toxicity, including tremor, confusion, and psychiatric disturbances. Notify physician if these changes become problematic.

• If treating rheumatoid arthritis, periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help document whether antirheumatic drug therapy is successful.

• If treating psoriasis, monitor skin responses to help document whether drug therapy is successful in resolving this condition.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Monitor signs of leukopenia (fever, sore throat, mucosal lesions, signs of infection, bruising), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Periodic blood tests may be needed to monitor WBC and RBC counts.

• Be alert for signs of paresthesia (numbness, tingling) or hyperesthesia (increased sensitivity to touch, pain). 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.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Monitor signs of high plasma potassium levels (hyperkalemia), including bradycardia, fatigue, weakness, numbness, and tingling. Likewise, monitor signs of low magnesium levels (hypomagnesemia), such as lethargy, irritability, insomnia, muscle tremors, and confusion. Notify physician of these signs.

Interventions