Daclizumab

INTRODUCTION

Indications

Prevention of acute organ rejection during renal transplantation (with cyclosporine and corticosteroids).

Action

Binds specifically to interleukin-2 (IL-2) receptor sites on activated lymphocytes, acting as an IL-2 receptor antagonist. This prevents further activation of lymphocytes and allograft rejection. Therapeutic Effects: Prevention of renal allograft rejection.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, insomnia. Resp: PULMONARY EDEMA, coughing, dyspnea. CV: chest pain, edema, hypertension (↑ in children), hypotension, tachycardia. GI: abdominal discomfort, constipation, diarrhea (↑ in children), dyspepsia, epigastric pain, nausea, pyrosis, vomiting (↑ in children). GU: dysuria, oliguria, renal tubular necrosis. Derm: acne, impaired wound healing, pruritus (↑ in children). Hemat: thrombosis. MS: arthralgia, back pain, musculoskeletal pain. Neuro: tremor. Misc: Allergic reactions, including anaphylaxis, fever (↑ in children), postoperative pain (↑ in children), urinary and respiratory tract infections (↑ in children).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems or signs of pulmonary edema, including cough, shortness of breath, chest pain, and 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 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.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendixes G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor abnormal blood coagulation, including venous thrombosis (lower extremity swelling, warmth, erythema, tenderness) and arterial thrombosis (extreme coldness in the hands and feet, cyanosis, muscle cramping). Notify physician immediately, and request objective tests (Doppler ultrasound, others) if thrombosis is suspected.

• 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 signs of hypoglycemia (weakness, malaise, irritability, fatigue) or hyperglycemia (drowsiness, fruity breath, increased urination, unusual thirst). Patients with diabetes mellitus should check blood glucose levels frequently.

• Be alert for signs of paresthesia and neuropathy, including numbness, tingling, and muscle weakness. 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 any joint, back, or other musculoskeletal pain to rule out musculoskeletal pathology; that is, try ...