摘要 嘉義基督教醫院藥劑科藥師蔡佩芬 許育瑋 壹 前言 1 貳 癌症患者與腎毒性之關連 (Acute kidney injury, AKI) 72-85% 2 AKI AKI AKI 3 4 (tumor lysis syndrome, TLS) AKI xanthine (glomerular filtration rate, GFR) AKI 3 31 1 Mar. 31 2015 藥學雜誌 122 65 臨床藥物治療學化療藥物引起的腎毒性
臨床藥Therapeutics of Clinical Drugs 物治療 AKI 學 ph 5 AKI GFR 6 參 鉑類藥物與烷化劑的腎毒性一 Cisplatin cisplatin 2 Cisplatin 1/3 cisplatin Cisplatin GFR 7,8 Cisplatin 50 mg/m 2 8 cisplatin 3-5 cisplatin 4 cisplatin 3-4 L 4,9 Amifostine FDA glutathione cisplatin 8 (ASCO) amifostine (910 mg/m 2 ) cisplatin 10 二 Carboplatin 與 Oxaliplatin Carboplatin 8 ifosfamide 11 oxaliplatin carboplatin cisplatin 8 三 Ifosfamide Ifosfamide acrolein chloroacetaldehyde cyclophosphamide 40 cyclophosphamide 4,8 ifosfamide 2,11 Ifosfamide 90-100 gm/m 2 4,6 mesna acrolein mesna 8 四 Cyclophosphamide Cyclophosphamide cyclophosphamide 66 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar. 31 2015
24 4 五 Nitrosoureas Nitrosoureas 3-5 4,6 (renal tubular acidosis, RTA) 4 streptozotocin semustine 3/4 > 1.4 g/m 2 Carmustine lomustine 10% 6 Nitrosoureas 4 肆 抗生素及抗代謝劑的腎毒性一 Mitomycin-C Mitomycin-C 4 (thrombotic thrombocytopenic purpura, TTP) (hemolytic uremic syndrome, HUS) 8 mitomycin-c 5-12 10% TTP HUS 60 mg HUS 4,6,11 Mitomycin-C 8 11 臨床藥物治療 4,6 mitomycin-c 20% 學 mitomycin-c 4 二 Gemcitabine Gemcitabine HUS 4 mitomycin-c 12 Gemcitabine HUS mitomycin-c BUN mitomycin-c HUS gemcitabine 11 HUS gemcitabine 12 三 Methotrexate Methotrexate (MTX) (> 1 g/ m 2 ) 7-OH-methotrexate AKI AKI MTX 2,9 MTX PH 4 (ph > 7.0) MTX 2,4,9 MTX AKI 6 probenecid salicylates sulfisoxazole 藥學雜誌 122 67 31 1 Mar. 31 2015
Therapeutics of Clinical Drugs 臨床藥物治療學 NSAID MTX imatinib 4 MTX leucovorin 11 四 Azacitidine Azacitidine 4 伍 單株抗體與多重靶標酪氨酸激酶抑制劑的腎毒性一 Bevacizumab Bevacizumab (vascular endothelial growth factor, VEGF) 4 二 Cetuximab (epidermal growth factor, EGF) EGF 6 27% cetuximab 3-4 13 三 Imatinib tyrosine kinases imatinib imatinib AKI 9 (Fanconi syndrome) imatinib 4 imatinib 4 9 四 Dasatinib dasatinib sorafenib sunitinib vatalanib axitinib 4 陸 雙磷酸鹽類的腎毒性一 Pamidronate Pamidronate (90-180 mg) AKI 6 Pamidronate (focal glomerulosclerosis, FGS) 1 pamidronate 6 90 mg 1,14 二 Zoledronic acid Zoledronic acid 68 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar. 31 2015
NSAID 15 15 pamidronate zoledronic acid 2 14 柒 結論 Toxicities Pei-Fen Tsai, Yu-Wei Hsu Department of Pharmacy, Ditmanson Medical Foundation Chia-Yi Christian Hospital Abstract Survival of cancer patients have improved by the development of chemotherapeutic agents; however, treatment with chemotherapeutic agents also increases the likelihood of renal toxicities, which may consequently complicate subsequent care. Although there are many ways to prevent renal toxicities in clinic, renal toxicities induced by chemotherapeutic agents remains an important issue in cancer patients. In addition to understanding characteristics of chemotherapeutic agents, clinicians should identify patients with high risk of renal toxicities, and provide adequate volume infusion, electrolyte repletion, and serial monitoring of renal function to decrease the risk of renal toxicities. 31 1 Mar. 31 2015 藥學雜誌 122 69 臨床藥物治療學Chemotherapeutic Agents Associated Renal
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