Multiple Myeloma

Etiology of the Disease

Multiple Myeloma is a “malignant proliferation of plasma cells involving more than 10 percent of the bone marrow” (AFP, 1999) and is an incurable disease characterized by “wide spread bone destruction”, which affects “mostly adults over 50 years old” (BC Cancer, 2003). This disease may cause multiple bone fractures, particularly in spine and leg bones.

Pathophysiology and Symptoms of the Disease

Among the symptoms of Multiple Myeloma, the following prevail:

1. Severe bone pain, especially in the back
2. Height loss
3. Spontaneous bone fractures - back, rib, arm or leg
4. Fatigue and weakness
5. Anaemia
6. Improperly functioning kidneys
7. Excess of calcium in the blood (hypercalcemia) due to destruction and dissolution of the bone (BC Cancer, 2003)

Complications of the Disease

Multiple myeloma causes a number of health complications. Among them the most frequently developed are: bone fractures, anemia, infections and kidney failure. Careful monitoring for possible complications is a vital part of myeloma treatment.

Bone Fractures: One of the earliest symptoms of multiple myeloma is pain in the lower back and ribs. This pain results from tiny bone fractures caused by the gradual deterioration of bones’ tissue. As the disease progresses, the bones ‘become progressively weaker, leading to more fractures and osteoporosis’. (Multiple-Myeloma.com, 2003)

Hypercalcemia and Anaemia: As bone deterioration continues, high levels of calcium begin to build up in the blood. This buildup can lead to a number of kidney problems, including kidney stones and kidney failure. A lack of red blood cells, or anemia, is also a common complication: overproduction of plasma cells in the bone marrow leads to a reduction in red blood cells.

Infections: The abnormal plasma cells eventually displace (“crowd out”???) other normal plasma cells, thereby reducing the broad range of antibodies normally available to fight disease. The risks of pneumonia and other infections rise as a result.

Kidney Failure: Hypercalcemia results in more blood borne calcium than the kidney can safely filter out. The strain causes eventual kidney damage. The increased risk of infection due to myeloma puts people living with the disease at greater risk for pyelonephritis

Treatment

Currently there is no cure for multiple myeloma. Therefore the goal of multiple myeloma treatment is to slow the progression of the disease and to control symptoms.

There are four main type of treatment for multiple myeloma:

1.      Chemotherapy

2.      Radiation therapy

3.      High dose therapy (HDT) with stem cell transplant

4.      Supportive / Palliative care

Chemotherapy is the use of systemic drugs to kill cancer cells. Because chemotherapy affects the entire body, it destroys some healthy cells along with cancerous ones. “Side effects of chemotherapy could include hair loss; mouth sores; increased risk of infection, bruising, or bleeding (from gums, for instance); fatigue; loss of appetite; and nausea and vomiting” (PLWC, 2003).

Palliative care has no effect on the progression of the disease, rather it provides supportive treatment to control symptoms and improve quality of life. In most cases patients require at least one of the following: pain relief therapy, infection control therapy, hypercalcemia treatment therapy, anemia treatment and kidney protection therapy.

For this assignment I decided to cover loss of calcium and as a result - hypercalcemia as a pathological condition. To treat this condition steroid Prednisone may be prescribed to lower calcium levels in the blood. The bisphosphonates also slow bone degeneration by binding to areas of bone that have been damaged. In addition, Calcitonin is also used to slow the rate of bone tissue deterioration.

Prednisone

Prednisone is used to treat several multiple myeloma complications, such as hypercalcemia and kidneys’ inflammation. Moreover, Prednisone is a part of Melphalan and Prednisone chemotherapy (MP-therapy) which is often the initial treatment for multiple myeloma.

Name of pathological condition: hypercalcemia, inflammation

Name of selected drug: Prednisone

i.        Class: Systematic Glucocorticoids

ii.      Trade name(s): Apo-Prednisone, Deltasone, Meticorten, Orasone, others

Pharmacodynamics and Pharmacokinetics: Well absorbed from GI tract Prednisone converted to active form (Prednisolone) by the liver, therefore liver disease has great impact on bioavailability of glucocorticoids.

Why use this drug?

 

Nursing Process

 

Nursing Process	Nursing Considerations
Assessment before administering medication
Planning
Implementation
Evaluation

 

List of Resources

1. American Family Physician, April 1, 1999.  Retrieved September 1^st from www.aafp.org/afp/990401ap/1885.html
2. BC Cancer Agency. Retrieved September 1^st from http://www.bccancer.bc.ca/PPI/TypesofCancer/MultipleMyeloma/default.htm
3. Leonardo SА & Marcelo Papelbaum Retrieved September 5^th from http://www.medstudents.com.br/hemat/hemat6.htm
4. Sorenson Steven, published by eMedicine.com, December 7, 2001 Retrieved September 5^th from http://www.emedicine.com/radio/topic460.htm
5. Satheesh Kumar “Multiple Myeloma: A homeopathic approach”, Retrieved September 5th from http://www.pulsemans.com/pm.14.htm
6. The Multiple Myeloma Research Foundation, “About Myeloma”, Retrieved September 5th http://www.multiplemyeloma.org/about_myeloma
7. Joan Blade, “Renal Failure In Myeloma”, October 1, 2000, Retrieved September 5^th from http://www.myeloma.org/myeloma
8. Multiple Myeloma Cancer Centre, Retrieved September 12^th from http://www.cancercenter.com/treatmentOptions/
9. Renal Tubular Dysfunction In Malignancy, Retrieved September 12^th from cnserver0.nkf.med.ualberta.ca/cn/Schrier/Volume4/chapter5
10. Renal Tubular Acidosis Syndromes, MedScape, Southern Medical Association, 2000 Retrieved September 12^th from www.medscape.com/viewarticle/410658_3
11. Donna M. Wilson, “The Canadian Health Care System”, 1995