Muromonab-CD3

INTRODUCTION

Indications

Acute renal allograft rejection reactions in transplant patients that have occurred despite conventional antirejection therapy. Acute corticosteroid-resistant hepatic or cardiac allograft rejection reactions.

Action

A purified immunoglobulin antibody that acts as an immunosuppressant by interfering with normal T-cell function. Therapeutic Effects: Reversal of graft rejection in transplant patients.

Adverse Reactions/Side Effects

CNS: tremor, aseptic meningitis, dizziness. Resp: PULMONARY EDEMA, dyspnea, shortness of breath, wheezing. CV: chest pain. GI: diarrhea, nausea, vomiting. Misc: CYTOKINE RELEASE SYNDROME, INFECTIONS, chills, fever, hypersensitivity reactions, increased risk of lymphoma.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems or signs of pulmonary edema, including cough, wheezing, shortness of breath, chest pain, and labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) and immediately report any adverse changes in ventilation and respiratory function.

• Watch for signs of increased cytokine release from T cells that are affected by this drug (cytokine release syndrome). Signs include hypotension, high fever, chills, shivering, and malaise. Report these signs to the physician or nursing staff immediately.

• Monitor signs of aseptic meningitis, including severe headache, high fever, neck stiffness, nausea, vomiting, confusion, drowsiness, sensitivity to light, loss of appetite, skin rash, and seizures. Notify physician or nurse immediately if patient exhibits these signs.

• Be alert for signs of other infections, including fever, sore throat, mucosal lesions, chills, nausea, vomiting, diarrhea, and localized inflammation. Notify physician or nursing staff of these signs immediately.

• 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.

• Be alert for signs of hypersensitivity reactions, 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 dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

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

• Because of the risk of pulmonary edema, 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).

Patient/Client-Related Instruction

• Because of immunosuppressant effects, advise patient to guard against ...