門(mén)診處方討論TEMODAL課件

門(mén)診處方討論

TEMODAL報(bào)告者:林婉薇指導(dǎo)藥師:林梅芳學(xué)姊案例協(xié)助:靜卉,安儀學(xué)姊特別感謝☆一起幫我留意處方的同事們門(mén)診處方討論

TEMODAL報(bào)告者:林婉薇1目錄門(mén)診處方案例本院現(xiàn)有劑量劑型作用適應(yīng)癥用法用量最新健保規(guī)範(fàn)MICROMEDEX?HealthcareSeries參考文獻(xiàn)目錄門(mén)診處方案例2門(mén)診處方案例78歲,羅女士,就診科別:腦神經(jīng)外科出院診斷:Gliosarcoma(神經(jīng)膠肉瘤)用藥:Acetaminophen500mg/tab1#QID21daysHaloperidol5mg/tab1#HS21daysMgo1#QID21daysSennoside2#HS21days

Temozolomide100mg/cap1#QD21daysValproicacid500mg/tab1#BID21days門(mén)診處方案例78歲,羅女士,就診科別:腦神經(jīng)外科3其他案例比較劉先生,就診科別:腦神經(jīng)外科診斷:顳葉惡性腫瘤主要用藥:Temozolomide100mg/cap3#QD5daysTemozolomide20mg/cap1#QD5days其他案例比較劉先生,就診科別:腦神經(jīng)外科4其他案例比較吳女士,就診科別:腦神經(jīng)外科診斷:腦惡性腫瘤,放射線所致之影響主要用藥:Temozolomide100mg/cap3#HS5days其他案例比較吳女士,就診科別:腦神經(jīng)外科5TEMODAL

(Temozolomide)規(guī)格：20mg/cap顏色：白/黃色劑型：膠囊形狀：長(zhǎng)圓柱形標(biāo)記：有TEMODAL/20mg字樣規(guī)格：100mg/cap顏色：白/粉紅色劑型：膠囊形狀：長(zhǎng)圓柱形標(biāo)記：有TEMODAL/100mg字樣TEMODAL

(Temozolomide)規(guī)格：20mg/6TEMODAL作用具抗腫瘤活性,含有imidazotetrazine環(huán)的烷基化作用劑它在全身循環(huán)中會(huì)在生理酸鹼值的狀態(tài)下,快速地透過(guò)化學(xué)轉(zhuǎn)化作用形成活性化合物MTIC(Monomethyltriazenoimidazolecarboxamide)TEMODAL作用具抗腫瘤活性,含有imidazotetra7TEMODAL適應(yīng)癥新診斷的多形神經(jīng)膠母細(xì)胞瘤,與放射治療同步進(jìn)行,然後作為輔助性治療給予標(biāo)準(zhǔn)治療後復(fù)發(fā)性或惡化之惡性神經(jīng)膠質(zhì)瘤,例如多形神經(jīng)膠母細(xì)胞瘤或退行性星狀細(xì)胞瘤TEMODAL適應(yīng)癥新診斷的多形神經(jīng)膠母細(xì)胞瘤,與放射治療同8TEMODAL用法用量一.新診斷的多形神經(jīng)膠母細(xì)胞瘤的成年病人

TEMODAL用法用量一.新診斷的多形神經(jīng)膠母細(xì)胞瘤的成年病9同步治療期

1.TEMODAL口服投與42天（75mg/㎡體表面積/day),與放射治療同步進(jìn)行2.接著給予六個(gè)療程的輔助性TEMODAL3.42天同步治療期的TEMODAL劑量可持續(xù)至最長(zhǎng)49天☆條件：絕對(duì)嗜中性白血球計(jì)數(shù)≧15億個(gè)/L血小板計(jì)數(shù)≧1000億個(gè)/LCTC非血液學(xué)毒性（禿髮,噁心,嘔吐除外）≦第一級(jí)＊治療期間每週需測(cè)量一次全血球計(jì)數(shù)

同步治療期

1.TEMODAL口服投與42天（75mg/㎡10輔助性治療期4.完成TEMODAL與放射治療同步治療之後四週,再給予六個(gè)療程的TEMODAL輔助性治療a.第一個(gè)（輔助性）療程的劑量是TEMODAL口服150mg/㎡體表面積,每天1次,投與5天,接著23天不用服藥b.開(kāi)始第二個(gè)療程時(shí),如果符合☆便可將治療劑量增加為200mg/㎡體表面積＊如果劑量在第二個(gè)療程沒(méi)有增加,以後的療程就不應(yīng)該增加劑量c.以後每個(gè)療程最初5天的劑量要保持在200mg/㎡體表面積,除非毒性出現(xiàn)＊在治療期間,第22天（投與第1次TEMODAL劑量的21天後）要測(cè)量全血球計(jì)數(shù)輔助性治療期4.完成TEMODAL與放射治療同步治療之後四11二.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的成人1.先前未曾接受過(guò)化療的病人:每28天為一個(gè)療程,投與5天,每天1次,口服TEMODAL200mg/㎡體表面積2.先前接受過(guò)化療的病人:在第一個(gè)療程投與初始劑量TEMODAL150mg/㎡體表面積,在第二個(gè)療程的第一天,如果絕對(duì)嗜中性白血球計(jì)數(shù)≧15億個(gè)/L,血小板計(jì)數(shù)≧1000億個(gè)/L,便可將治療劑量增加為200mg/㎡體表面積二.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的成人1.先前未曾接受過(guò)化療12三.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的兒童病人1.三歲或更大的兒童病人:每28天為一個(gè)療程,投與5天,每天1次,口服TEMODAL200mg/㎡體表面積2.先前接受過(guò)化療的兒童病人:在第一個(gè)療程投與初始劑量150mg/㎡體表面積,投與5天,如果沒(méi)有毒性,在第二個(gè)療程便可以將治療劑量增加為200mg/㎡體表面積,投與5天＊可以持續(xù)使用至疾病進(jìn)行治療期最長(zhǎng)為2年三.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的兒童病人1.三歲或更大的兒13

「全民健康保險(xiǎn)藥品給付規(guī)定」修正規(guī)定

第9章抗癌瘤藥物Antineoplasticsdrugs

（自97年1月1日起實(shí)施）修正後給付規(guī)定9.25.temozolomide(如Temodal)：（94/3/1、97/1/1）1.限用於經(jīng)手術(shù)或放射線治療後復(fù)發(fā)之AA(anaplasticastrocytoma)或GBM(Glioblastomamultiforme)之病人?！?.新診斷的多型性神經(jīng)膠母細(xì)胞瘤，與放射線治療同步進(jìn)行，然後作為輔助性治療。（97/1/1）3.需經(jīng)事前審查核準(zhǔn)後使用。備註：劃線部份為新修訂之規(guī)定。原給付規(guī)定9.25.temozolomide(如Temodal)：(94/3/1)1.限用於經(jīng)手術(shù)或放射線治療後復(fù)發(fā)之AA(anaplasticastrocytoma)或GBM(Glioblastomamultiforme)之病人。2.需經(jīng)事前審查核準(zhǔn)後使用。

「全民健康保險(xiǎn)藥品給付規(guī)定」修正規(guī)定

第9章抗癌瘤藥物14TEMOZOLOMIDEAdultDosing

TEMOZOLOMIDE15Anaplasticastrocytomaofbrain,Refractory(followingdiseaseprogressiononnitrosoureaandprocarbazine):initialdose:150mg/m(2)ORALLYeverydayfor5days;cycleevery28days;iftheabsoluteneutrophilcountandplateletcountonday29(day1ofnextcycle)andday22areequaltoorgreaterthan1.5x10(9)/Land100x10(9)/Lrespectively,increasedoseto200mg/m(2)/dayfor5daysGlioblastomamultiformeofbrain,Newlydiagnosed,concomitantlywithradiotherapyandthenasmaintenance:concomitanttostandardradiotherapy:initialdose,75mg/m(2)ORALLYdailyfor42days;cycleevery28daysbeginning4weeksaftercompletionofinitialtherapyAnaplasticastrocytomaofbrai16Glioblastomamultiformeofbrain,Newlydiagnosed,concomitantlywithradiotherapyandthenasmaintenance:maintenance,cycle1:150mg/m(2)orallyoncedailyfor5daysfollowedby23dayswithouttreatment;cycles2-6(each28-days):200mg/m(2)orallydailyforthefirst5daysofthecycleifcommontoxicitycriteria(CTC)gradelessthanorequalto2(exceptforalopecia,nauseaandvomiting),absoluteneutrophilcount(ANC)greaterthanorequalto1.5x10(9)/L,andtheplateletcountisgreaterthanorequalto100x10(9)/L;Thedoseremainsat200mg/m(2)perdayforthefirst5daysofeachsubsequentcycleexceptiftoxicityoccurs;ifthedosewasnotescalatedatCycle2,escalationshouldnotbedoneinsubsequentcyclesMetastaticmelanoma,Monotherapy:200mg/m(2)ORALLYdailyfor5consecutivedays,every28days.Glioblastomamultiformeofbra17DoseAdjustments

hematologic,astrocytoma:(absoluteneutrophilcount(ANC)<1,000/mcLorplatelets<50,000/mcL):holddoseuntilANC>1,500/mcLandplatelets>100,000/mcL;thenreducedoseby50mg/m(2)/dayforsubsequentcycles,butnotbelow100mg/m(2)hematologic,astrocytoma:(absoluteneutrophilcount(ANC)1,000-1,500/mcLorplatelets50,000-100,000/mcL):holdtherapyuntilANCisgreaterthan1,500/mcLandplatelets>100,000/mcL;maintaininitialdosehematologic,astrocytoma:(absoluteneutrophilcount>1,500/mcLandplatelets>100,000/mcL):increaseormaintaindoseat200mg/m(2)/dayORALLYfor5daysforsubsequentcyclesDoseAdjustments

hematologic18hematologicandnon-hematologic(glioblastoma):concomitantphase;DISCONTINUEifabsoluteneutrophilcount(ANC)islessthan0.5x10(9)/L,ortheplateletcountislessthan10x10(9)/L,orifacommontoxicitycriteria(CTC)grade3or4non-hematologicaltoxicity(exceptforalopecia,nausea,vomiting)occurs;INTERRUPTtherapyiftheANCisatleast0.5x10(9)/Lbutlessthan1.5x10(9)/L,ortheplateletcountisatleast10x10(9)/Lbutlessthan100x10(9)/L,orifaCTCgrade2non-hematologicaltoxicity(exceptforalopecia,nausea,vomiting)occurshematologicandnon-hematologi19hematologicandnon-hematologic(glioblastoma):maintenancephase;REDUCEdoseby50milligrams/squaremeter/day(mg/m(2)/day)iftheabsoluteneutrophilcount(ANC)islessthan1x10(9)/L,theplateletcountislessthan50x10(9)/L,orifacommontoxicitycriteria(CTC)grade3non-hematologicaltoxicity(exceptforalopecia,nausea,vomiting)occurs;DISCONTINUEtherapyifadosereductiontolessthan100mg/m(2)/dayisrequired,aCTCgrade4non-hematologicaltoxicity(exceptforalopecia,nausea,vomiting)occurs,orifthesameCTCgrade3toxicityoccursafterdosereductionhematologicandnon-hematologi20資料來(lái)源義大藥劑科網(wǎng)站.tw/ph/index01.htmTEMODAL藥品仿單MICROMEDEX?HealthcareSeries資料來(lái)源義大藥劑科網(wǎng)站http://www2.edah.or21感謝各位的☆耐心聆聽(tīng)☆感謝各位的☆耐心聆聽(tīng)☆22門(mén)診處方討論

TEMODAL報(bào)告者:林婉薇指導(dǎo)藥師:林梅芳學(xué)姊案例協(xié)助:靜卉,安儀學(xué)姊特別感謝☆一起幫我留意處方的同事們門(mén)診處方討論

TEMODAL報(bào)告者:林婉薇23目錄門(mén)診處方案例本院現(xiàn)有劑量劑型作用適應(yīng)癥用法用量最新健保規(guī)範(fàn)MICROMEDEX?HealthcareSeries參考文獻(xiàn)目錄門(mén)診處方案例24門(mén)診處方案例78歲,羅女士,就診科別:腦神經(jīng)外科出院診斷:Gliosarcoma(神經(jīng)膠肉瘤)用藥:Acetaminophen500mg/tab1#QID21daysHaloperidol5mg/tab1#HS21daysMgo1#QID21daysSennoside2#HS21days

Temozolomide100mg/cap1#QD21daysValproicacid500mg/tab1#BID21days門(mén)診處方案例78歲,羅女士,就診科別:腦神經(jīng)外科25其他案例比較劉先生,就診科別:腦神經(jīng)外科診斷:顳葉惡性腫瘤主要用藥:Temozolomide100mg/cap3#QD5daysTemozolomide20mg/cap1#QD5days其他案例比較劉先生,就診科別:腦神經(jīng)外科26其他案例比較吳女士,就診科別:腦神經(jīng)外科診斷:腦惡性腫瘤,放射線所致之影響主要用藥:Temozolomide100mg/cap3#HS5days其他案例比較吳女士,就診科別:腦神經(jīng)外科27TEMODAL

(Temozolomide)規(guī)格：20mg/cap顏色：白/黃色劑型：膠囊形狀：長(zhǎng)圓柱形標(biāo)記：有TEMODAL/20mg字樣規(guī)格：100mg/cap顏色：白/粉紅色劑型：膠囊形狀：長(zhǎng)圓柱形標(biāo)記：有TEMODAL/100mg字樣TEMODAL

(Temozolomide)規(guī)格：20mg/28TEMODAL作用具抗腫瘤活性,含有imidazotetrazine環(huán)的烷基化作用劑它在全身循環(huán)中會(huì)在生理酸鹼值的狀態(tài)下,快速地透過(guò)化學(xué)轉(zhuǎn)化作用形成活性化合物MTIC(Monomethyltriazenoimidazolecarboxamide)TEMODAL作用具抗腫瘤活性,含有imidazotetra29TEMODAL適應(yīng)癥新診斷的多形神經(jīng)膠母細(xì)胞瘤,與放射治療同步進(jìn)行,然後作為輔助性治療給予標(biāo)準(zhǔn)治療後復(fù)發(fā)性或惡化之惡性神經(jīng)膠質(zhì)瘤,例如多形神經(jīng)膠母細(xì)胞瘤或退行性星狀細(xì)胞瘤TEMODAL適應(yīng)癥新診斷的多形神經(jīng)膠母細(xì)胞瘤,與放射治療同30TEMODAL用法用量一.新診斷的多形神經(jīng)膠母細(xì)胞瘤的成年病人

TEMODAL用法用量一.新診斷的多形神經(jīng)膠母細(xì)胞瘤的成年病31同步治療期

1.TEMODAL口服投與42天（75mg/㎡體表面積/day),與放射治療同步進(jìn)行2.接著給予六個(gè)療程的輔助性TEMODAL3.42天同步治療期的TEMODAL劑量可持續(xù)至最長(zhǎng)49天☆條件：絕對(duì)嗜中性白血球計(jì)數(shù)≧15億個(gè)/L血小板計(jì)數(shù)≧1000億個(gè)/LCTC非血液學(xué)毒性（禿髮,噁心,嘔吐除外）≦第一級(jí)＊治療期間每週需測(cè)量一次全血球計(jì)數(shù)

同步治療期

1.TEMODAL口服投與42天（75mg/㎡32輔助性治療期4.完成TEMODAL與放射治療同步治療之後四週,再給予六個(gè)療程的TEMODAL輔助性治療a.第一個(gè)（輔助性）療程的劑量是TEMODAL口服150mg/㎡體表面積,每天1次,投與5天,接著23天不用服藥b.開(kāi)始第二個(gè)療程時(shí),如果符合☆便可將治療劑量增加為200mg/㎡體表面積＊如果劑量在第二個(gè)療程沒(méi)有增加,以後的療程就不應(yīng)該增加劑量c.以後每個(gè)療程最初5天的劑量要保持在200mg/㎡體表面積,除非毒性出現(xiàn)＊在治療期間,第22天（投與第1次TEMODAL劑量的21天後）要測(cè)量全血球計(jì)數(shù)輔助性治療期4.完成TEMODAL與放射治療同步治療之後四33二.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的成人1.先前未曾接受過(guò)化療的病人:每28天為一個(gè)療程,投與5天,每天1次,口服TEMODAL200mg/㎡體表面積2.先前接受過(guò)化療的病人:在第一個(gè)療程投與初始劑量TEMODAL150mg/㎡體表面積,在第二個(gè)療程的第一天,如果絕對(duì)嗜中性白血球計(jì)數(shù)≧15億個(gè)/L,血小板計(jì)數(shù)≧1000億個(gè)/L,便可將治療劑量增加為200mg/㎡體表面積二.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的成人1.先前未曾接受過(guò)化療34三.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的兒童病人1.三歲或更大的兒童病人:每28天為一個(gè)療程,投與5天,每天1次,口服TEMODAL200mg/㎡體表面積2.先前接受過(guò)化療的兒童病人:在第一個(gè)療程投與初始劑量150mg/㎡體表面積,投與5天,如果沒(méi)有毒性,在第二個(gè)療程便可以將治療劑量增加為200mg/㎡體表面積,投與5天＊可以持續(xù)使用至疾病進(jìn)行治療期最長(zhǎng)為2年三.患有復(fù)發(fā)性或進(jìn)行性神經(jīng)膠質(zhì)瘤的兒童病人1.三歲或更大的兒35

「全民健康保險(xiǎn)藥品給付規(guī)定」修正規(guī)定

第9章抗癌瘤藥物Antineoplasticsdrugs

（自97年1月1日起實(shí)施）修正後給付規(guī)定9.25.temozolomide(如Temodal)：（94/3/1、97/1/1）1.限用於經(jīng)手術(shù)或放射線治療後復(fù)發(fā)之AA(anaplasticastrocytoma)或GBM(Glioblastomamultiforme)之病人?！?.新診斷的多型性神經(jīng)膠母細(xì)胞瘤，與放射線治療同步進(jìn)行，然後作為輔助性治療。（97/1/1）3.需經(jīng)事前審查核準(zhǔn)後使用。備註：劃線部份為新修訂之規(guī)定。原給付規(guī)定9.25.temozolomide(如Temodal)：(94/3/1)1.限用於經(jīng)手術(shù)或放射線治療後復(fù)發(fā)之AA(anaplasticastrocytoma)或GBM(Glioblastomamultiforme)之病人。2.需經(jīng)事前審查核準(zhǔn)後使用。

「全民健康保險(xiǎn)藥品給付規(guī)定」修正規(guī)定

第9章抗癌瘤藥物36TEMOZOLOMIDEAdultDosing

TEMOZOLOMIDE37Anaplasticastrocytomaofbrain,Refractory(followingdiseaseprogressiononnitrosoureaandprocarbazine):initialdose:150mg/m(2)ORALLYeverydayfor5days;cycleevery28days;iftheabsoluteneutrophilcountandplateletcountonday29(day1ofnextcycle)andday22areequaltoorgreaterthan1.5x10(9)/Land100x10(9)/Lrespectively,increasedoseto200mg/m(2)/dayfor5daysGlioblastomamultiformeofbrain,Newlydiagnosed,concomitantlywithradiotherapyandthenasmaintenance:concomitanttostandardradiotherapy:initialdose,75mg/m(2)ORALLYdailyfor42days;cycleevery28daysbeginning4weeksaftercompletionofinitialtherapyAnaplasticastrocytomaofbrai38Glioblastomamultiformeofbrain,Newlydiagnosed,concomitantlywithradiotherapyandthenasmaintenance:maintenance,cycle1:150mg/m(2)orallyoncedailyfor5daysfollowedby23dayswithouttreatment;cycles2-6(each28-days):200mg/m(2)orallydailyforthefirst5daysofthecycleifcommontoxicitycriteria(CTC)gradelessthanorequalto2(exceptforalopecia,nauseaandvomiting),absoluteneutrophilcount(ANC)greaterthanorequalto1.5x10(9)/L,andtheplateletcountisgreaterthanorequalto100x10(9)/L;Thedoseremainsat200mg/m(2)perdayforthefirst5daysofeachsubsequentcycleexceptiftoxicityoccurs;ifthedosewasnotescalatedatCycle2,escalationshouldnotbedoneinsubsequentcyclesMetastaticmelanoma,Monotherapy:200mg/m(2)ORALLYdailyfor5consecutivedays,every28days.Glioblastomamultiformeofbra39DoseAdjustments

hematologic,astrocytoma:(absoluteneutrophilcount(ANC)<1,000/mcLorplatelets<50,000/mcL):holddoseuntilANC>1,500/mcLandplatelets>100,000/mcL;thenreducedoseby50mg/m(2)/dayforsubsequentcycles,butnotbelow100mg/m(2)hematologic,astrocytoma:(absoluteneutrophilcount(ANC)1,000-1,500/mcLorplatelets50,000-100,000/mcL):holdtherapyuntilANCisgreaterthan1,500/mcLandplatelets>100,000/mcL;maintaininitialdosehematologic,astrocytoma:(absoluteneutrophilcount>1,500/mcLandplatelets>100,000/mcL):increaseormaintaindoseat200mg/m(2)/dayORALLYfor5daysforsubsequentcyclesDoseAdjustments

hematologic40hematologicandnon-hematologic(glioblastoma):concomitantphase;DISCONTINUEifa