Isoniazid于膀胱癌case之处方讨论课件

Isoniazid於膀胱癌case

之處方討論報告者:梁心怡94-1-6Isoniazid於膀胱癌case

之處方討論報告者:梁心怡1Isoniazide100mg/tab3#QDPOX14days

MalignantneoplasmofbladderHematuria泌尿道感染,未標示位置者12/29Isoniazide100mg/tab2膀胱癌是生殖泌尿系統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現，可以經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BacilusCalmmette-Guerin(BCG)之Connaught菌株(一種牛的結核桿菌Mycobacteriumbovis的活減毒菌株)所製成的凍晶乾燥製劑.-美國FDA於1990年核准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(經尿道切除術)手術後的復發3.殘留膀胱腫瘤的治療膀胱癌是生殖泌尿系統腫瘤中很常見的一種，其中表淺性膀胱癌約佔3治療計劃-經膀胱投予ImmuCyst®須開始於生檢或經尿道切除術(TUR)後7-14days。包括inductiontherapyandmaintenancetherapy。inductiontherapy(誘導療程)

-qwkX6wks.暫停6wks,再qwkX1~3wks。maintenancetherapy(維持療程)

-開始治療後6個月,q6mthX1~3wks,直到第36個月為止。治療計劃4Isoniazid于膀胱癌case之处方讨论课件5BCG免疫治療劑相關的不良反應與治療建議症狀或症候群治療(1)刺激性膀胱症狀<48小時症狀治療(2)刺激性膀胱症狀>48小時症狀治療延遲下一次ImmuCyst®療程至症狀消除為止。若一週內症狀能未消除，可投與isoniazid300mgqd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，且尿液培養呈現陰性反應為止(4)其他生殖泌尿系統不良反應:症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isoniazid300mgqd和rifampin600mgqd3-6months(5)fever<38.5OC;持續＜４８hrs使用acetaminophen做症狀治療(6)皮膚發癢，關節痛，或遷移性關節炎使用antihistmines或NSAIDS若無效，停用ImmuCyst®

，並投與isoniazide300mgqd3months(7)全身性的BCG反應不具敗血性休克症候群停用ImmuCyst®

，尋求傳染病諮詢。投與isoniazide300mgqd，RIF600mgqdandEMB1000mgqd6months(8)全身性的BCG反應具有敗血性休克症候群同(7)考慮短時間投與高劑量corticosteroids治療BCG免疫治療劑相關的不良反應與治療建議症狀或症候群治療(16ISONIAZIDETHERAPEUTICUSESINMICROMEX

ISONIAZIDTHERAPEUTICUSES

ACETYLATORSTATUSDETERMINATION

BLADDERCANCER-PREVENTIONOFTOXICITY

CEREBELLARTREMOR

HUNTINGTON'SDISEASE

MULTIPLESCLEROSIS

MYCOBACTERIALINFECTIONS-NON-TUBERCULOUS

TUBERCULOSIS-INHIV-INFECTEDPERSONS

TUBERCULOSIS-LATENT

TUBERCULOSIS-PULMONARY

ISONIAZIDETHERAPEUTICUSESIN7CLINICALAPPLICATIONS

THERAPEUTICUSES

BLADDERCANCER-PREVENTIONOFTOXICITY

1.OVERVIEW:FDAAPPROVAL:Adult,no;pediatric,noEFFICACY:Adult,possiblyeffectiveDOCUMENTATION:Adult,poor

2.SUMMARY:

IsoniazidmaybeusefulinreducinglocaladverseeffectsassociatedwithBCGbladderinstillationsinpatientswithsuperficialbladdercancer.CLINICALAPPLICATIONS8IsoniazidadministeredconcomitantlywithbladderinstillationsofbacillusCalmette-Guerin(BCG)significantlyreducedlocalBCG-relatedadverseeffectsinadultpatientswithsuperficialbladdercancer.Inthisrandomized,prospective,double-blindstudy,160patientsreceivedisoniazid300milligrams(mg)orplacebodailyfor3daysaftereachof6consecutiveweeklyBCGbladderinstillations(81mg).Allpatientsunderwenttransurethraltumorresectionorbladderbiopsies1to3weekspriortoinitiatingBCGtreatment.Localeffects,includingdysuria,hematuria,andincreasedmicturationfrequency,occurredlessfrequentlyinisoniazid-treatedpatients(35%versus48%,plessthan0.01).Thismaybearesultofdecreasedexposuretolivebacilli.Systemicsideeffects,suchasfeverandnausea,wereunaffectedbytheadditionofisoniazid.Treatmentwithdrawalsduetoadverseeffects,aswellastumorrecurrencesovera2-yearfollow-upperiod,werenotdifferentbetweengroups(AlKhalifa,2000).Isoniazidadministeredconcomi9ISONIAZIDMECHANISMOFACTIONINMICROMEDEX-Isoniazidisasyntheticantimycobacterialagentwhichisbacteriocidalforbothextracellularandintracellularorganisms.Thedrugisthoughttoactbyinterferingwithcellwallmycolicacidsynthesis(AMA,1986).Isoniazidisthehydrazidederivativeofisonicotinicacid.Whileisoniazidisbacteriostaticfor"restingbacilli",itisbactericidalforrapidlydividingorganisms.Incontrasttostreptomycin,anotherantitubercularagent,isoniazidpenetratescellseasilyandisequallyeffectiveagainstintracellularbacilliasitisagainstthosegrowinginculturemedia(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免疫治療劑經膀胱灌注所引起的不良反應。ISONIAZIDMECHANISMOFACTIONI10Metformin500mg/tab1#POTIDX7daysAmoxacillin500mg/cap1#POQIDX7daysBacillusCalmette-Guerin(BCG)81mg/vail1vialIVCTSTDMMalignantneoplasmofbladder11/24Metformin500mg/tab11Tranexamicacid250mg/cap2#POTIDX3daysAlfuzosinXL10mg/tab1#POHSX3days

11/29Tranexamicacid250mg/cap12Tranexamicacid250mg/cap2#POTIDX3daysAlfuzosinXL10mg/tab1#POHSX3daysAmoxacillin500mg/cap1#POTIDX3daysHematuria12/3Tranexamicacid250mg/cap13Isoniazide100mg/tab3#QDPOX7daysHematuria12/23Isoniazide100mg/tab14Isoniazide100mg/tab3#QDPOX14days

MalignantneoplasmofbladderHematuria泌尿道感染,未標示位置者12/29Isoniazide100mg/tab15Reference

1.Micromedex2.MIMS3.仿單Reference

1.Micromedex16Isoniazid於膀胱癌case

之處方討論報告者:梁心怡94-1-6Isoniazid於膀胱癌case

之處方討論報告者:梁心怡17Isoniazide100mg/tab3#QDPOX14days

MalignantneoplasmofbladderHematuria泌尿道感染,未標示位置者12/29Isoniazide100mg/tab18膀胱癌是生殖泌尿系統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現，可以經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BacilusCalmmette-Guerin(BCG)之Connaught菌株(一種牛的結核桿菌Mycobacteriumbovis的活減毒菌株)所製成的凍晶乾燥製劑.-美國FDA於1990年核准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(經尿道切除術)手術後的復發3.殘留膀胱腫瘤的治療膀胱癌是生殖泌尿系統腫瘤中很常見的一種，其中表淺性膀胱癌約佔19治療計劃-經膀胱投予ImmuCyst®須開始於生檢或經尿道切除術(TUR)後7-14days。包括inductiontherapyandmaintenancetherapy。inductiontherapy(誘導療程)

-qwkX6wks.暫停6wks,再qwkX1~3wks。maintenancetherapy(維持療程)

-開始治療後6個月,q6mthX1~3wks,直到第36個月為止。治療計劃20Isoniazid于膀胱癌case之处方讨论课件21BCG免疫治療劑相關的不良反應與治療建議症狀或症候群治療(1)刺激性膀胱症狀<48小時症狀治療(2)刺激性膀胱症狀>48小時症狀治療延遲下一次ImmuCyst®療程至症狀消除為止。若一週內症狀能未消除，可投與isoniazid300mgqd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，且尿液培養呈現陰性反應為止(4)其他生殖泌尿系統不良反應:症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isoniazid300mgqd和rifampin600mgqd3-6months(5)fever<38.5OC;持續＜４８hrs使用acetaminophen做症狀治療(6)皮膚發癢，關節痛，或遷移性關節炎使用antihistmines或NSAIDS若無效，停用ImmuCyst®

，並投與isoniazide300mgqd3months(7)全身性的BCG反應不具敗血性休克症候群停用ImmuCyst®

，尋求傳染病諮詢。投與isoniazide300mgqd，RIF600mgqdandEMB1000mgqd6months(8)全身性的BCG反應具有敗血性休克症候群同(7)考慮短時間投與高劑量corticosteroids治療BCG免疫治療劑相關的不良反應與治療建議症狀或症候群治療(122ISONIAZIDETHERAPEUTICUSESINMICROMEX

ISONIAZIDTHERAPEUTICUSES

ACETYLATORSTATUSDETERMINATION

BLADDERCANCER-PREVENTIONOFTOXICITY

CEREBELLARTREMOR

HUNTINGTON'SDISEASE

MULTIPLESCLEROSIS

MYCOBACTERIALINFECTIONS-NON-TUBERCULOUS

TUBERCULOSIS-INHIV-INFECTEDPERSONS

TUBERCULOSIS-LATENT

TUBERCULOSIS-PULMONARY

ISONIAZIDETHERAPEUTICUSESIN23CLINICALAPPLICATIONS

THERAPEUTICUSES

BLADDERCANCER-PREVENTIONOFTOXICITY

1.OVERVIEW:FDAAPPROVAL:Adult,no;pediatric,noEFFICACY:Adult,possiblyeffectiveDOCUMENTATION:Adult,poor

2.SUMMARY:

IsoniazidmaybeusefulinreducinglocaladverseeffectsassociatedwithBCGbladderinstillationsinpatientswithsuperficialbladdercancer.CLINICALAPPLICATIONS24IsoniazidadministeredconcomitantlywithbladderinstillationsofbacillusCalmette-Guerin(BCG)significantlyreducedlocalBCG-relatedadverseeffectsinadultpatientswithsuperficialbladdercancer.Inthisrandomized,prospective,double-blindstudy,160patientsreceivedisoniazid300milligrams(mg)orplacebodailyfor3daysaftereachof6consecutiveweeklyBCGbladderinstillations(81mg).Allpatientsunderwenttransurethraltumorresectionorbladderbiopsies1to3weekspriortoinitiatingBCGtreatment.Localeffects,includingdysuria,hematuria,andincreasedmicturationfrequency,occurredlessfrequentlyinisoniazid-treatedpatients(35%versus48%,plessthan0.01).Thismaybearesultofdecreasedexposuretolivebacilli.Systemicsideeffects,suchasfeverandnausea,wereunaffectedbytheadditionofisoniazid.Treatmentwithdrawalsduetoadverseeffects,aswellastumorrecurrencesovera2-yearfollow-upperiod,werenotdifferentbetweengroups(AlKhalifa,2000).Isoniazidadministeredconcomi25ISONIAZIDMECHANISMOFACTIONINMICROMEDEX-Isoniazidisasyntheticantimycobacterialagentwhichisbacteriocidalforbothextracellularandintracellularorganisms.Thedrugisthoughttoactbyinterferingwithcellwallmycolicacidsynthesis(AMA,1986).Isoniazidisthehydrazidederivativeofisonicotinicacid.Whileisoniazidisbacteriostaticfor"restingbacilli",itisbactericidalforrapidlydividingorganisms.Incontrasttostreptomycin,anotherantitubercularagent,isoniazidpenetratescellseasilyandisequallyeffectiveagainstintracellularbacilliasitisagainstthosegrowinginculturemedia(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免疫治療劑經膀胱灌注所引起的不良反應。ISONIAZIDMECHANISMOFACTIONI2