藥訊＿June_2008

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1 : : : : mycophenolate mofetil Progressive multifocal leukoencephalopathy, PML 1.2 Olanzapinequetiapune clozapineloxapine amoxapinearipiprazole ziprasidone 2 Q&A: Q. paclitaxel250 ml 0.9% penicillin (penicillin skin test PST ) mycophenolate mofetil Progressive multifocal leukoencephalopathy, PML 例 1.2 Olanzapinequetiapineclozapine loxapineamoxapinearipiprazole ziprasidone 1

2 2. Q&A: 2

3 3. penicillin0.7-10%ig-e (anaphylaxisanaphylactic shock) %(1)ige penicillin penicillin( skin test PST) Penicillin 14-72%50-70% 1-3% 0.9%9% 0.5%(2)penicilllin1.9 penicilllin0.5(3) penicilllin Penicillin Penicillin(major determinants)(minor determinants)benzylpenicilloyl poly-l-lysine (BPL)Penicilloyl-poly-L-lysine (PPL)Benzylpenicilloyl component (BPO)PenicilloatePenilloate Penicillin GIgE75-90%(3)15-16% (4) 3

4 penicillin penicillin(pre-pen ) 2004PST penicillinpenicillin G penicillin PST penicillinige PST β-lactam PST penicillins()pst penicillins Ampicillin Inj Ampolin Oxacillin Sodium Inj Prostaphlin; Oxacillin Union Penicillin G Sodiumn Inj Cryst. Penicillin Penicillin G Benzathine Inj Retarpen Amoxycillin/Clavulanic Acid Inj. Augcin; Augmentin; Anbicyn Ampicillin/Sulbactam Inj Unasyn Piperacillin Sod Inj 2gm Pitamycin Ticarcillin/Clavulanic acid Inj Timentin Piperacillin + Tazobactam Inj Pisutam; Tazocin; Tapimycin Amoxycillin/Clavulanic Acid 1.2gm Anbicyn 4

5 Penicillin- Penicillins PST PST PST 10 IgE PST penicillin Penicillin PSTpe nicillin - lactam *IgEStevens-Johnson syndrometoxic epidermal necrolysis 5

6 cephalosporinscarbapenemspst Penicillin- PenicillinPST I ge PST *IgEStevens-Johnson syndrometoxic epidermal necrolysis 6

7 (anaphylaxisanaphylactic shock) (5-7) Epinephrine Inj 1mg/cc ml (0.5ml/0.01ml/kg0.3ml/ ) ) (1ml1: ml)3-5ml (0.1ml/kg3ml) 5( 5ml/) (Norepinephrine Dopamine)(CrystalloidColloid fluid) epinephrineβ2-agonists(salbutamol 2.5-5mg/2-4.5ml) (4-6)Methylprednisolone IV 1-2mg/kg q6-8hrs (1-2mg/kg,125mg, q6h,)prednisone 0.5mg/kg ()(Chlorpheniramine 5-10mg ) 7

8 Q&A PST7penicillin PST vancomycinpst 11,000110,000 epinephrine1:1, , Idsoe O, Guthe T, Willcox RR, et al: Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bull World Health Organ 1968; 38: Weiss ME, Adkinson NF: Immediate hypersensitivity reactions to penicillin and related antibiotics. Clin Allergy 1988; 18: Salkind AR, Cuddy PG, Foxworth JW: The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy. Jama 2001; 285: Sogn DD, Evans R, 3rd, Shepherd GM, et al: Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Arch Intern Med 1992; 152: Ellis AK, Day JH: Diagnosis and management of anaphylaxis. Cmaj 2003; 169: Lieberman P, Kemp SF, Oppenheimer J, et al: The diagnosis and management of anaphylaxis: an updated practice parameter. Allergy Cln Immunol 2005; 115:suppl:s483-s MICROMEDEX Healthcare Series 8

9 3.2. (premedication) 971~ QD ( & ) Malignant neoplasm of bronchus and lung, unspecified Cisplatin Inj 110 mg IV QD 14 NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) Cisplatin Inj 110 mg IV STAT 14 NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) Malignant neoplasm of biliary tract, part unspecified Oxaliplatin Inj 143 mg IV STAT 7 () D5W Inj 250 CC IV QD 14 (for oxaliplatin) Oxaliplatin Inj 143 mg IV STAT 7 () D5W Inj 250 CC IV STAT 14 (for oxaliplatin) 9

10 73 (Mesna Inj 400mg/4cc/amp1amp) ( & ) Ovarian cancer, myxoid leiomyosarcoma, stage IIIC Ifosfamide Inj 4 gm IV STAT 7 NaCl 0.9% Inj 500 CC IV STAT 14 (for ifosfamide) Taxol Inj 210 mg IV STAT 7 Carboplatin Inj 450 mg IV STAT 7 D5W Inj 1000 CC IV STAT 14 (for taxol & carboplatin) Mesna Inj 1 amp IV STAT 14 Ifosfamide Inj 4 gm IV STAT 7 NaCl 0.9% Inj 500 CC IV STAT 14 (for ifosfamide) Taxol Inj 210 mg IV STAT 7 Carboplatin Inj 450 mg IV STAT 7 D5W Inj 1000 CC IV STAT 14 (for taxol & carboplatin) Mesna Inj 15 amp IV STAT 14 Malignant neoplasm of bronchus and lung, unspecified Cisplatin Inj 130 mg IV STAT 14 NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) Etoposide Inj 1100 mg IV QD 3 NaCl 0.9% Inj 250 CC IV QD 3 (for etoposide) Cisplatin Inj 130 mg IV STAT 14 NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) Etoposide Inj 110 mg IV QD 3 NaCl 0.9% Inj 250 CC IV QD 3 (for etoposide) 10

11 6 ( ) Malignant neoplasm of female breast, unspecified Endoxan Inj 730 mg IV STAT 14 Fluorouracil Inj 730 mg IV STAT 7 Lipo-Dox Inj 55 mg IV STAT 7 () D5W Inj 250 CC IV STAT 14 (for fluorouracil) NaCl 0.9% Inj 250 CC IV STAT 14 (for Lipo-Dox) Endoxan Inj 730 mg IV STAT 14 Fluorouracil Inj 730 mg IV STAT 7 Lipo-Dox Inj 55 mg IV STAT 7 () D5W Inj 250 CC IV STAT 14 (for fluorouracil) D5W Inj 250 CC IV STAT 14 (for Lipo-Dox) 5 ( & ) Malignant neoplasm of female breast, nipple and areola Endoxan Inj 650 mg IV STAT 14 Lipo-Dox Inj 40 mg IV STAT 7 () Endoxan Inj 650 mg IV STAT 14 Lipo-Dox Inj 40 mg IV STAT 7 () Fluorouracil Inj 650 mg IV STAT 7 11

12 Right breast invasive ductal carcinoma, with multiple liver metastasis Fluorouracil Inj 960 mg IV QD 3 (Day 1 ~ 3) NaCl 0.9% Inj 250 CC IV QD 3(for fluorouracil) Leucovorin Inj 273 mg IV QD 3 (Day 1 ~ 3) Cisplatin Inj 96 mg IV STAT 14 (Day 4) NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) Mitoxantrone Inj 16 mg IV STAT 14 (Day 1) Fluorouracil Inj 960 mg IV QD 3 (Day 2 ~ 4) NaCl 0.9% Inj 250 CC IV QD 3(for fluorouracil) Leucovorin Inj 273 mg IV QD 3 (Day 2 ~ 4) Cisplatin Inj 96 mg IV STAT 14 (Day 5) NaCl 0.9% Inj 500 CC IV STAT 14 (for cisplatin) 102methotrexate(1) (2)(3)/ /methotrexate umleucovorin () PH methotrexatepka5.4ph methotrexate ( NaHCO3) PH7methotrexate methotrexate 12

13 MTXleucovorin New Vistas for Leucovorin in Cancer Chemotherapy. Cancer 63: ,

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$(Microsoft Word - \254\354\256i$1$.doc)$ 神奇的滅孑師太 ~~ 探討日常生活常用水溶液及植物對於消滅孑孓之成效壹研究動機春眠不覺曉, 處處蚊子咬, 夜來巴掌聲, 蚊子死多少? 夏天即將到來, 蚊子的惡夢一直困擾著我們了, 班上同學舉起手腳指著一個一個紅豆冰咒念, 真是令