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Bortezomib is FDA-approved for use in the initial treatment of multiple myeloma in combination with cyclophosphamide and dexamethasone. It is also FDA-approved for use in the treatment of multiple myeloma in individuals who previously responded to bortezomib and relapsed at least six months after the completion of the prior treatment. Also, it is FDA-approved for use in the treatment of mantle cell lymphoma in individuals who have received at least one previous first-line treatment. This activity will review the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring pertinent for members of the interprofessional team for the treatment of patients with multiple myeloma. Objectives: Summarize the mechanism of action of bortezomib. Identify the approved indications for bortezomib. Review the adverse events of bortezomib. Outline interprofessional team strategies for improving care coordination and communication to advance bortezomib use and improve outcomes in cancer treatment. Access free multiple choice questions on this topic.

Bortezomib should be withheld at the onset of grade 3 non-hematological or grade 4 hematological toxicity until the toxicity resolves. Treatment is then treatment restarted at a lower adjusted dose. There is no antidote available to reverse the toxic effects of the drug. Overdose Bortezomib has a narrow therapeutic window; an overdose can occur when doubling the dose. The patient will usually present with marked thrombocytopenia and hypotension, which are very difficult to reverse. There are reports of several fatal outcomes from bortezomib overdose. If the patient experiences an overdose, close monitoring in the ICU is recommended. Aggressive hydration and maintenance of normal body temperature are vital.

Bortezomib is a drug for the treatment of multiple myeloma. Because of its narrow therapeutic index, the drug is used only by a few healthcare professionals. Ordering should be under the direction of an oncology specialist who is well-versed in the use of the drug.  The drug is administered parenterally and requires close monitoring by the nursing staff. Besides checking the CBC, the liver function involves assessment. Before starting the drug, a baseline chest X-ray is recommended. Bortezomib therapy requires a collaborative effort from the interprofessional healthcare team. The drug can cause hypotension, and the nurse must check the BP frequently. Nursing staff should report any signs of adverse events to the attending clinician immediately and check with the pharmacist. If there are any questions about the drug, one should consult with the pharmacist first. The pharmacist should also verify all dosing and consult the ordering clinician regarding any discrepancies, as well as performing full medication reconciliation. Before dispensing the drug, the pharmacist should ensure that the patient has no allergies and has been worked up for tuberculosis and perform medication reconciliation. Also, the patient must receive education regarding the potential long-term adverse effects that can occur, including neuropathy. It is through this type of interprofessional effort between physicians, nurses, and pharmacists that bortezomib therapy can achieve optimal therapeutic outcomes for patients while minimizing the potential for adverse events. [Level 5]