Carfilzomib Case Study

You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve. You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization. PTT is more properly written

The immaturity of the data is underscored by the disposition at the time of analysis. Patients were more likely to have discontinued based on adverse events than to have had disease progress or be continuing therapy. Although tolerability looked better when only patients receiving tremelimumab 1 mg were analyzed, even in that group, 30% of patients had a related grade > 3 adverse event, with 16% of patients discontinuing due to an adverse event and 4% dying from the study therapy. For comparison, in the studies that led to approval of pembrolizumab and nivolumab, grade > 3 related adverse events were seen in 7-10.5%, adverse events led to discontinuation of study therapy in 0.2-3.8% and death was related to study treatment in 0-0.3%.2, 3, 4

24-hour urine collection revealed proteinuria (550 mg). A peripheral blood smear revealed rouleaux formation. CT scans of the chest, abdomen and pelvis revealed no obvious malignancy. Quantitative immunoglobulins were significant for elevated IgA (2415 mg/dl) and concurrent suppression of IgG and IgM levels. Quantitative serum light chain measurement revealed normal levels of kappa and lambda, with an elevated Kappa:Lambda ratio at 2:1. SPEP, UPEP, and serum immunofixation revealed IgA-Kappa Multiple Myeloma (MM). Given her significant-severe, symptomatic hypercalcemia; she was treated with aggressive intravenous crystalloids and loop diuretics, calcitonin, pamidronate; and a decision to perform early hemodialysis given her extremely high calcium levels. Her calcium subsequently normalized to 10.1 mg/dl. Bone-marrow biopsy with flow cytometry revealed intracytoplasmic kappa-restricted monoclonal plasma cells that occupied 40% of the marrow. Bone survey was negative for lytic lesions. Oncology started her on a chemotherapeutic regimen consisting of Bortezomib, Lenalidomide, dexamethasone along

Leukemia broadly describes conditions that affect erythropoiesis in the bone marrow, lymphatic system, and spleen. As with all other cancers, leukemia begins from the mutation of DNA in certain cells. Classifications of leukemias are based on the age of onset and the leukocyte involved (Lewis et al. 2014, 665). The most common leukemia is chronic lymphocytic leukemia (CLL), accounting for approximately 30% of cases in the United States (Copstead and Banasik 2013, 222). The normal function of the bone marrow, spleen, and liver becomes interrupted by the invasion of malignant lymphocytes (B cells); since the B cells are functionally inactive, a patient becomes more susceptible to infections. The sluggish progression of CLL unfortunately leads to late diagnoses and poor prognosis (Lewis et al. 2014, 665). Patients that become symptomatic in later stages will experience fatigue, weight loss, anorexia, and an increased susceptibility to infection, due to abnormal antibody production. Patient specific factors such as age, disease progression, and medication side effects will determine the course of treatment (Copstead and Banasik 2013, 223). The fragile state of patients with CLL requires continuous examination of drug therapy and interventions to prevent further complications.

43 percent of alarm conditions indicated non-critical, and “generally non-actionable,” events; 38 percent of alarm conditions indicated premature ventricular complexes (PVCs), which, since a landmark 1988 Cardiac Arrhythmic Suppression Trial (CAST) study, are no longer treated; and 3.6 percent of alarm

Multiple myeloma (MM) is a rare life-threatening cancer that affects the white blood cells known as plasma cells that are found in the soft, spongy tissue at the center of the bones, called bone marrow. The plasma cells are useful in fighting infections by producing antibodies that recognize and attack germs. The plasma cells are transformed into malignant myeloma cells when there are high levels of M proteins or better known as the production of abnormal antibodies from a result of myeloma cells. These M proteins multiple and block out normally functioning antibodies and the end results are bone damage or kidney problems. An individual can have blood tests or urine tests done to determine if they have multiple myeloma. In the article, “The work of living with a rare cancer: multiple myeloma” the authors explain how this type of cancer still remains incurable, but treatable that patients can expect to live longer, approximately five to seven years than what two decades ago. This was not expected for patients diagnosed with multiple myeloma during the 1990s, since patients were expected to only live about two and a half years after being diagnosed. Treatment for multiple myeloma throughout the years has advanced greatly yet a cure is still to be discovered. This essay will focus of the causes, the sign and symptoms, how multiple myeloma is detected and diagnosed, and how multiple myeloma is treated.

Other outcomes were myocardial infarction, ischemic stroke, systemic thrombosis, venous thrombosis in other areas of the body besides the legs, and even death. The patients underwent assessment either in the clinic or by telephone at days 30, 90, 180, 270, and 360. This study was consistent with other studies in the fact that the use of rivaroxaban reduced the risk of recurrent venous thromboembolism by about 70%. Rivaroxaban was found to be more effective than aspirin for the prevention of recurrent venous thromboembolism and was associated with a smaller risk of bleeding. The primary outcome occurred in 17 out of the 1,107 individuals who received 20 mg of rivaroxaban and in 13 out of the 1,127 individuals who received 10 mg of rivaroxaban. This was compared to 50 out of the 1,131 individuals who received aspirin once a day. Rates of bleeding were 0.5% in individuals who received 20 mg of rivaroxaban, 0.4% in individuals who received 10 mg of rivaroxaban, and 0.3% in individuals who received aspirin. For patients with venous thromboembolism who continued anticoagulation the risk of a repetitive event was lower with rivaroxaban at both 20 mg and 10 mg of treatment doses rather than with

The study shows that disease-modifying medications were prescribed significantly more often in 2000 than in 1995, particularly in patients younger than 65 and in those aged 75 to 84 (Saczynski et al., 2009, p. 3). The study indicates that Beta-blockers and ACE inhibitors have been shown to improve survival and reduce hospitalizations in patients with Heart Failure. The second article mentioned about the elderly patients who have CHF not on or under dosage of Angiotensin Converting Enzyme (ACE) inhibitors. According to this article ACE inhibitors should be given for patients diagnosed asymptomatic left ventricular systolic dysfunction (LVSD) (EF<40%) and symptomatic heart failure with systolic dysfunction associated with other heart problems such as myocardial infarction, pulmonary hypertension. The suggested dosage for the CHF patients mentioned in the article and due to age-related changes in pharmacokinetic drugs, it also recommended the initial dosage must be half the standard dose and gradual increase after assessing renal function. After studying a group of elderly CHF patients revealed that higher or standard dose of ACE inhibitors reduce the risks of major clinical events. Results from the research display a decrease of hospitalizations due to cardiovascular reason, heart failure, and ischemic events in the standard-dose group. The study also found out that the adverse effects of high doses can be managed by reducing the dosage or by changing

For years health care providers have been using drugs like beta blockers or ACE inhibitors to treat patients with heart failure, but with cardiovascular disease still being a leading cause of death, it is evident that current treatments have been lacking the ability to produce adequate results. However, with the newest heart failure drug on the market a positive change has finally come for heart failure patients. The new heart failure drug reigns far more superior when compared to the treatments healthcare professionals already use and can potentially alter the foundation of heart failure treatments altogether.

Currently there is no cure for heart failure, the majority of treatments only manage the symptoms of the condition and often a combination of medications is used to tolerate these symptoms and improve quality of life. Unfortunately many medications that are given to patients with heart failure bring side effects that can sometimes lead to even more health complications. An example of a commonly prescribed drug that has a primary purpose of reducing blood pressure, thus improving heart and lung muscle function, is the Angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors dilate blood vessels and decrease the workload of the heart. When a chemical called angiotensin II is present in the bloodstream, it stimulates blood vessels to become

Aldosterone receptor antagonists are currently recommended in NYHA class II–IV CHF patients with left ventricular ejection fraction ≤35%. To be considered for therapy with these agents, patients with NYHA class II heart failure should have a previous history of cardiovascular related hospital admission or

Multiple myeloma (MM) is a cancer of plasma cells and every year 1500 Australians are diagnosed with the disease. Treatment options consist of chemotherapy alone or in combination with corticosteroids such as dexamethasone or prednisone and stem cell transplants being a last resort option in otherwise healthy individuals. In relapsed and/or refractory cases treatment includes specific antineoplastic drugs such as bortezomib, a proteasome inhibitor or immunomodulatory drugs such as thalidomide [3].

When this trial was designed, the incidence of TC chemotherapy-induced FN without G-CSF treatment was controversial . The clinical trial conducted by the US oncology group reported a 5% FN incidence and a 51% incidence of grade 4 IV neutropenia, while a meta-analysis of 902 patients treated with TC without G-CSF was 29 % (95 % confidence

The efficacy of ACE-I has been widely evaluated in clinical trials and observational studies. In 1983, Captopril multicenter research group investigated the efficacy of Captopril in a 92 cohort with heart failure refractory to digitalis and diuretic therapy. In this randomized, double blind trial, 50 patients were assigned to Captopril and 42 were assigned to placebo group. Over 2-week dosage titration and 10-week evaluation period, the Captopril group revealed improvement in exercise tolerance and specific symptoms of heart failure, including dyspnea, fatigue and orthopnea, and the reduction of edema. Captopril therapy were concluded as an effect adjunctive treatment to digitalis and diuretic drugs for patients with refractory heart failure. (14) Later on, other ACE-I, such as Enalapril, were shown to be effective in treating patients with congestive heart failure, by reducing left ventricular dimension, in randomized clinical studies.(15-17) The Heart Outcomes Prevention Evaluation Study Investigators conducted a factorial study to evaluate the ACE-I, Ramipril, for improving outcomes among patients with high risk for cardiovascular events, but without left ventricular dysfunction or heart failure. Ramipril significantly reduced the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have heart failure. (18) Cattran et al. performed a registry study in Toronto Glomerulonephritis in patients with severe immunoglobulin

Common cancer treatments such as anthracyclines and trastuzumab are associated with an increased risk of cardiotoxicity, which is responsible for significant mortality and morbidity in cancer survivors.[1, 2] Assessment of left ventricular ejection fraction (LVEF) has been, and continues to be the most widely used method for cardiotoxicity risk assessment prior to, surveillance during, and surveillance after administration of potentially cardiotoxic cancer treatment.[3]