Isoniazid于膀胱癌case之處方討論課件

1、Isoniazid於膀胱癌case之處方討論報告者:梁心怡 94-1-6Isoniazide100mg/tab 3# QD PO X 14 days Malignant neoplasm of bladderHematuria泌尿道感染,未標示位置者12/29膀胱癌是生殖泌尿系統(tǒng)腫瘤中很常見的一種，其中表淺性膀胱癌約佔7成左右，在治療上如果早期發(fā)現(xiàn)，可以經(jīng)尿道使用膀胱鏡刮除膀胱腫瘤(TUR-BT)，再使用抗癌藥物/BCG由膀胱灌注治療，可達到相當好的治療效果。ImmuCyst (BCG免疫治療劑) -是由Bacilus Calmmette-Guerin(BCG)之Connaught菌株(一種牛

2、的結核桿菌Mycobacterium bovis的活減毒菌株)所製成的凍 晶乾燥製劑. -美國FDA於1990 年核準BCG用於治療膀胱癌。臨床上BCG主要是用來： 1.膀胱原位癌(CIS)的治療。 2.預防表淺性膀胱癌TUR(經(jīng)尿道切除術)手術後的復發(fā) 3.殘留膀胱腫瘤的治療治療計劃 -經(jīng)膀胱投予ImmuCyst 須開始於生檢或經(jīng)尿道切除術(TUR)後7-14days。包括induction therapy and maintenance therapy。induction therapy(誘導療程) - qwk X 6 wks.暫停6wks,再qwk X 13wks。maintenance

3、 therapy(維持療程) -開始治療後6個月,q6mth X 13wks,直到第36個月為止。BCG免疫治療劑相關的不良反應與治療建議癥狀或癥候群治療(1)刺激性膀胱癥狀48小時癥狀治療延遲下一次ImmuCyst療程至癥狀消除為止。若一週內(nèi)癥狀能未消除，可投與isoniazid 300mg qd直到完全緩解為止(3)伴隨UTI(細菌性尿路感染)延遲下一次ImmuCyst療程至抗微生物療程完成後，且尿液培養(yǎng)呈現(xiàn)陰性反應為止(4)其他生殖泌尿系統(tǒng)不良反應:癥候性肉芽腫性攝護腺炎，副睪丸炎，輸尿管阻塞，或腎臟膿腫。停用ImmuCyst 投與isoniazid 300mg qd和 rifampin

4、 600mg qd 3-6 months(5)fever38.5OC; 持續(xù)hrs使用acetaminophen做癥狀治療(6)皮膚發(fā)癢，關節(jié)痛，或遷移性關節(jié)炎使用antihistmines或NSAIDS若無效，停用ImmuCyst ，並投與isoniazide 300mg qd 3months(7)全身性的BCG反應不具敗血性休克癥候群停用ImmuCyst ，尋求傳染病諮詢。投與isoniazide300mg qd ，RIF 600mg qd andEMB 1000mg qd 6months(8)全身性的BCG反應具有敗血性休克癥候群同(7)考慮短時間投與高劑量corticosteroids

5、治療ISONIAZIDE THERAPEUTIC USES IN MICROMEXISONIAZIDTHERAPEUTIC USES ACETYLATOR STATUS DETERMINATION BLADDER CANCER - PREVENTION OF TOXICITY CEREBELLAR TREMOR HUNTINGTONS DISEASE MULTIPLE SCLEROSIS MYCOBACTERIAL INFECTIONS - NON-TUBERCULOUS TUBERCULOSIS - IN HIV-INFECTED PERSONS TUBERCULOSIS - LATENT

6、TUBERCULOSIS - PULMONARY CLINICAL APPLICATIONS THERAPEUTIC USES BLADDER CANCER - PREVENTION OF TOXICITY 1. OVERVIEW: FDA APPROVAL: Adult, no; pediatric, no EFFICACY: Adult, possibly effective DOCUMENTATION: Adult, poor 2. SUMMARY: Isoniazid maybe useful in reducing local adverse effects associated w

7、ith BCG bladder instillations in patients with superficial bladder cancer .Isoniazid administered concomitantly with bladder instillations of bacillus Calmette-Guerin (BCG) significantly reduced local BCG-related adverse effects in adult patients with superficial bladder cancer. In this randomized,

8、prospective, double-blind study, 160 patients received isoniazid 300 milligrams (mg) or placebo daily for 3 days after each of 6 consecutive weekly BCG bladder instillations (81 mg). All patients underwent transurethral tumor resection or bladder biopsies 1 to 3 weeks prior to initiating BCG treatme

9、nt. Local effects, including dysuria, hematuria, and increased micturation frequency, occurred less frequently in isoniazid-treated patients (35% versus 48%, p less than 0.01). This may be a result of decreased exposure to live bacilli.Systemic side effects, such as fever and nausea, were unaffected

10、 by the addition of isoniazid. Treatment withdrawals due to adverse effects, as well as tumor recurrences over a 2-year follow-up period, were not different between groups (Al Khalifa, 2000). ISONIAZID MECHANISM OF ACTIONIN MICROMEDEX -Isoniazid is a synthetic antimycobacterial agent which is bacter

11、iocidal for both extracellular and intracellular organisms. The drug is thought to act by interfering with cell wall mycolic acid synthesis (AMA, 1986). Isoniazid is the hydrazide derivative of isonicotinic acid. While isoniazid is bacteriostatic for resting bacilli, it is bactericidal for rapidly d

12、ividing organisms. In contrast to streptomycin, another antitubercular agent, isoniazid penetrates cells easily and is equally effective against intracellular bacilli as it is against those growing in culture media (Mandell & Saude, 1985). ImmuCyst(BCG免疫治療劑)所含的為活的減毒的分枝桿菌故isoniazid可預防及治療BCG免疫治療劑經(jīng)膀胱灌注

13、所引起的不良反應。Metformin 500mg/tab 1# PO TID X 7daysAmoxacillin 500mg/cap 1# PO QID X 7daysBacillus Calmette-Guerin(BCG)81mg/vail 1vial IVCT STDMMalignant neoplasm of bladder11/24Tranexamic acid 250mg/cap 2# PO TID X 3daysAlfuzosin XL 10mg/tab 1# PO HS X 3days 11/29Tranexamic acid 250mg/cap 2# PO TID X 3daysAlfuzosin XL 10mg/tab 1# PO HS X 3daysAmoxacillin 500mg/ca