Ko te Whakaaetanga o te Methotrexate i ia ra: He aha te tango i te pire ia wiki i ia ra he ohorere rongoa¶

Ko te Methotrexate (Trexall, Rheumatrex, Otrexup, Rasuvo, Metoject) tetahi o nga rongoa whakarereke mate-whakarereke o te ao mo rheumatoid arthritis, psoriasis, rheumatoid arthritis, lupus, me te mate o Crohn. Kaore i rite ki nga pire katoa kei roto i te whare rongoa o te manawanui, methotrexate-waha iti (7.5 mg to 25 mg, i te nuinga o te waa ka tangohia hei toru ki te tekau 2.5 mg Ko nga papa kowhai) kua tohua kia tangohia KIA KOTAHI ANAKE I TE WIKI i te ra kotahi kua tohua. No reira, i tango pohehe i te horopeta methotrexate kotahi ia wiki i ia ra - na te raruraru o te tapanga whakahaunga, he hapa mo te houhanga rongonga whakawhiti o te hohipera, he he te whakakii i te pouaka rongoa mo nga ra e 7, he iti noa ranei te heke o te hinengaro - e mohiotia ana e te Institute for Safe Medication Practices (ISMPO), te nuinga o te US, te FDA me te Whakahaere Hauora o te Ao. Ko nga hapa rongoa "maara nui" i roto i nga pakeke pakeke. Ko te tikanga, ** te horomia i te horomia kotahi-waahi nui o nga ripa methotrexate-waha (penei i te tamaiti, i te pakeke ranei e horomia ana e rua tekau 2.5 mg pire i te wa kotahi) he uaua ka pa te mate paitini** na te mea ko te kaikawe o te whao tangata (PCFT) he iti noa te nui i te wa kotahi ka puta nga whatukuhu hauora i te toenga i roto i nga haora. In stark contrast, takeing even 5 mg to 15 mg o te methotrexate ia ra mo te 4 ki te 7+ nga ra karapīpiti ka mau tonu te rongo tarukino puta noa i ia huringa wehenga pūtau, ka mau methotrexate polyglutamates ki roto i nga pūtau me te whakaoho ** aituā aplasia wheua wheua (pancytopenia me te agranulocytosis), necrotic waha me te mate whekau, mate whewhe kawa (mucositis, mate whekau) wiri septic**. Ko te mea nui ake, Kare e taea e te Acid Folic Acid (Vitamin B9) te huri i te paihana methotrexate na te mea ko te enzyme e hiahiatia ana hei whakahohe i te waikawa folic (dihydrofolate reductase, DHFR) ka aukatihia e te methotrexate; kia ora tonu te whakahaere hōhipera o mua-whakahohe **Folinic Acid (Leucovorin / Calcium Folinate) Levoleucovorin ranei , kaitaua ** konutai konutai bicarbonate urinary alkalinization, a, i te ngoikoretanga o te whatukuhu, recombinant Glucarpidase (Voraxaze).

Mena kua inu poka noa koe, tetahi hoa aroha ranei i nga pire methotrexate ia wiki mo 3 neke atu ranei nga ra i te rarangi (he moata rawa ranei te tango i te horopeta tuarua o ia wiki), ka tupu ranei te tangata e mau ana i te methotrexate ki te mamae mamae o te waha, he korokoro mata, he kirikaa, he maru, he kutu pango ranei, waea atu ki to nama whawhati tata (911 i te United States me Canada, 112) tau ohorere whaiaronga, Mana Paihana ranei, ka arotake sepsis me te ru septic, 5-fluorouracil me te capecitabine chemotherapy overdose, a paihana awhina tuatahi.

Mahia tenei inaianei¶

1. Kati i nga horopeta katoa o te Methotrexate KA mutu nga NSAID me nga PPI katoa i naianei tonu: Kaua e tango i tetahi atu papa methotrexate, werohia ranei. I taua wa ano, mau tonu ** nga raau taero anti-inflammatory nonsteroidal (NSAIDs: ibuprofen, naproxen, meloxicam, celecoxib, aspirin)**, proton pump inhibitors (PPIs: omeprazole, pantoprazole), me trimethoprim-sulfamethoxazole (Bactrim / Septra), e aukati ana i nga whatukuhu tere me te tere o te methox.
2. Haere ki te Tari Ohotata, waea atu ranei ki te Mana Paihana mena ka tangohia te methotrexate i ia ra mo te 3 neke atu ranei o nga ra karapīpiti - AHAKOA KA 100% PAI TE TANGATA: Kaua rawa e tatari kia puta mai nga tohu. I muri i te 3 ki te 5+ ra karapīpiti o te methotrexate ia ra, kei te mate wahangu tonu nga pūtau kakau o te hinu wheua me te papa o te whekau, ahakoa he iti tonu te ahua o te tatau toto o te ra tuatahi (CBC) me te taumata methotrexate serum, he "kaore e kitea." I timata wawe te Folinic Acid (Leucovorin) i mua i te puta mai o te mamae o te waha me te neutropenia ka ora.
3. Kaua rawa e whakakapia te Acid Folic Acid (Vitamin B9) mo te whakahaunga Folinic Acid (Leucovorin): Te tango i te ringaringa o te paerewa. 1 mg nga papa waikawa folic mai i te rongoa KORE e mahi, KAORE hoki e tiaki i a koe. Ko te waikawa Folic e kore e hohenga tae noa ki te whakahurihia e te enzyme dihydrofolate reductase (DHFR) - te whākōkī tika i raka e te methotrexate. Me hiahia te manawanui Folinic Acid (Leucovorin / Calcium Folinate / 5-formyltetrahydrofolate) ko Levoleucovorin ranei, ka hipa i te whākōkī DHFR kua aukatihia kia tīmata anō te kōtuitanga DNA.
4. Tirotirohia te roto o te waha, ngutu, me nga kapia mo te "Herald Ulcers" moata (Oral Stomatitis / Mucositis): Na te mea ka wehewehe nga ruma e mau ana i te waha me te korokoro ia 3 ki te 5 ra, ** te whero mamae, te wera, te papa ma/kowhai, te whewhe papau ranei kei roto i te paparinga, ngutu, te arero, te kapia e tino kaha ana ki te whakatupato ** te whakangaro i te hinu wheua me te wahi gastrointestinal (mucositis i mua i te korenga o te hinu wheua i te 24 ki te 72 haora).
5. Tirohia te pāmahana o te tangata me te rongoa i te kirika (>= 38.0 C / 100.4 F) hei Neutropenic Sepsis e whakararu ana ki te ora: I roto i te manawanui kua tango i te methotrexate ia ra (kua heke iho ranei tana mahi whatukuhu i a ia e whai ana i te methotrexate ia wiki), he kirikaa, he makariri, he korokoro, he mare, he rangirua ranei e tohu ana neutropenia febrile (kore mate-whawhai i te neutrophil broad white blood cell), me te tono rongoa rongoa mo te tari whawhati tata 60 meneti.
6. Whakatupato ki te taote rūma whawhati tata: KAUA e whakawhirinaki ki te taumata toto "iti, kino" kotahi te Serum Methotrexate i roto i te nui o te horopeta o ia ra: Nomograms o te hohipera mo nga taumata serum methotrexate (> 10 micromol/L at 24h) i tino hangaia mo ** whakapeka 24-haora teitei IV whaowhia oncology**. I roto i te manawanui i tango 10 mg ma te waha i ia ra mo nga ra e 7, ka panui pea te taumata serum methotrexate < 0.05 micromol/L i te mea whakamate ** intracellular methotrexate polyglutamates (MTX-PGs)** kei roto i te hinu wheua me nga pūtau whekau ka mate te pancytopenia. Ko te nui o te horopeta o ia ra me kaha te rongoa me te Leucovorin i runga i te hitori me nga kitenga haumanu/taiwhanga ahakoa te iti o te taumata methotrexate serum.

Rakau whakatau: Te tarai i te horonga kotahi whakapeka me te hapa whakahoroa o ia ra me te mate o te mate renal¶

flowchart TD
    Start["Ko te Methotrexate (MTX) e whakapaetia ana he nui te horopeta, he Hapa Tota, he paitini ranei"] --> ClassifyType{"Ko tehea tauira haumanu i puta?"}

    ClassifyType -->|Pattern 1: Chronic / Subacute Daily Dosing Error (Weekly Dose Taken Daily for >= 3 Days) OR Weekly Dose + Acute Kidney Injury / Bactrim Interaction| ChronicDanger["TE WHAKAMAHI TE WHAKAMAHI KAUPAPA: Nga Rore Maaramatanga Hurihuri-a-Putau Tonu Nga Rore Methotrexate Polyglutamates (MTX-PGs) I Roto i te Bone Marrow & Gut Crypts (Tuhipoka: Serum MTX Taumata Ka iti te ahua)"]

    ClassifyType -->|Pattern 2: Single Acute Oral Overdose in Healthy Child/Adult (e.g., Swallowed Multiple 2.5 mg Tablets All at Once)| AcuteOral["LOW-TO-MODERate Systemic Toxicity Morea: Intestinal Folate Transporter (PCFT) Kuhu ki runga -15-20 mg; Te taikaha kare i horomia ki roto i te whekau, ka tere te whakakore e nga whatukuhu noa"]

    ClassifyType -->|Pattern 3: Massive IV / High-Dose Oncology Overdose OR Accidental Intrathecal (Spinal) Overdose| MassiveIV_IT["TE KAUPAPA KAUPAPA KAUPAPA: - Te Inenga IV + Te Rahunga o te Renal -> Nephropathy Crystalline & Marrow Ablation - Intrathecal Overdose -> Arachnoiditis matū Whakapiki Tere, Te Epilepticus Tūnga, Koma, Mate"]

    ChronicDanger --> ImmediateWorkup["Te Mahi ED me te Mahi: 1. STOP Methotrexate, NSAIDs, PPIs, & Trimethoprim 2. Tuhia te STAT CBC me te Differential (ANC, Platelets), CMP (Creatinine, AST/ALT), & Serum MTX Taumata 3. Tirotiro Mouth for Ulcers (Mucositis) & Check Tempropenia"]

    ImmediateWorkup --> LeucovorinStart["WHAKATANGA KAUPAPA KAUPAPA KAUPAPA (LEUCOVORIN) (Kaua e Taria mo te Serum MTX Taumata; KAUA E Whakamahia te Folic Acid): - Paerewa Whakanuia Maamaa: Leucovorin 15 mg ki te 25 mg (ranei 10-15 mg/m2) IV ranei PO Ia 6 Haora - Tino Mucositis / Pancytopenia MTX2000 / Pancytopenia / E (100-150 mg ranei) IV ia 3 ki te 6 haora kia ora ra ano te tatau o te toto ka ora te mucositis"]

    LeucovorinStart --> RenalSupport["Ko te Whakakore o te Renal & Bone Marrow Rescue Paihere: 1. Agressive IV Hydration + Sodium Bicarbonate Infusions ki te pupuri i te urine pH >= 7.5 ki te 8.0 (Whakanuia te MTX Solubility 10-Fold & Prevents Renal Tubule Precipitation) 2. Filgrastim (G-CSF 5 mcg/day SCkg) (NCkg) 1,000) + Whanui-a-whanui IV Antibiotic ki te Febrile 3. GLUCARPIDASE (VORAXAZE 50 Units/kg IV mo te 5 min) ki te Acute Kidney Injury + Persistently High Serum MTX (> 1-2 micromol/L)"]

    AcuteOral --> AcuteOralCare["1. Waro Whakahohe (1 g/kg) ki te < 1-2 haora i muri i te whakaurunga 2. IV Hydration + Tirohia te 6-hour & 24-hour Serum MTX Taumata, Creatinine, & CBC 3. Homai Oral/IV Leucovorin (10-15 mg/m2 Q6H mo te 3-12 mg/m2 Q6H mo te 3-12 mg/kg) > ki te 1 Pota Pakeke / 10 kg. mg) te tamaiti ranei i kainga > 0.5 mg/kg (> 10-20 mg ranei)"]

    MassiveIV_IT --> IT_Emergency["Mena ka nui te horopeta o te Intrathecal (Spinal): WHAKATAHI NEUROSURGICAL EMERGENCY -> Whakaohia tonutia te Rumbar Puncture CSF Drainage + Isotonic Saline Ventriculolumbar CSF Lavage + Intrathecal Glucarpidase (2,000 Units IT) + IV Dexamethasone + Systemic Leucovorin Int."]

Pathophysiology: He aha te tango 10 mg Ia ra mo nga ra e 7 ka mate i te wa e horomia ana 70 mg Katoa i te wa kotahi ka pa te kino kore¶

Ko tetahi o nga meka tino whakahē i roto i te paitini haumanu he aha te mea ** he mea nui ake te roanga o te wa whakarite i te katoa o te horopeta mirikaramu** i roto i te whakakitenga methotrexate waha:

1. Kohanga Intestinal Saturable (PCFT) me te Whakamamaetanga Tere Renal o te Pota Kotahi¶

1. Te Kohanga Intestinal: Ko te methotrexate-a-waha e kore e marara noa puta noa i te pakitara whekau; me kaha te pana ki te duodenum me te jejunum e te Proton-Coupled Folate Transporter (PCFT / SLC46A1). Ko tenei kaikawe ** ka kuhu ki nga pota o runga 15 mg to 25 mg (-0.2 to 0.3 mg/kg)**.
2. Mena ka horomia e te kohungahunga, e te pakeke ranei te toru tekau 2.5 mg papa (75 mg tapeke) katoa i te meneti kotahi, ka kuhu te kaikawe whekau: ** ka heke te koiora 70% ki raro ki < 15% to 20%**, no reira ko te nuinga o nga pire ka uru ki roto i te kumete.
3. Te Whakaaturanga Plasma Poto vs. Te Huringa Pūtau-S: Ahakoa te hautanga o taua horopeta kotahi ka uru ki roto i te rerenga toto ka 80% ki te 90% ka tukuna kaore i whakarereketia e nga whatukuhu hauora i roto i te 12 ki te 24 haora. Na te mea ko te methotrexate he S-waahanga (waahanga whakahiato DNA)-motuhake he antimetabolite, he ngaru poto kotahi 12-haora o te methotrexate e pa ana ki te hautanga iti o te hinu wheua me nga pūtau kakau whekau i tupono ki te whakahiato i te DNA i roto i aua haora; ka mutu te rongoa, ka wehe noa nga toenga o nga pūtau kakau e okioki ana, ka whakahoki ano i te hinu wheua kaore he whara.

2. He aha te Dosinga ia ra (>= 3 to 7 Days) Ka Whakamatea te Intracellular Polyglutamation¶

Ina tango te manawanui i te iti 2.5 mg to 15 mg horopeta ia 24 haora (ara ia 12 haora) mo 4, 5, 7, 14 ra ranei i te rarangi:

1. 100% Bioavailability Ia Ra: No te mea he iti te horopeta o ia ra (<= 15 mg), karekau te kaikawe waikawa intestinal e kuhu - ka ngongo 70% to 90% o ia pire kotahi.
2. Te Mahi-S-Phase Tonu: Ko te pupuri i te methotrexate i roto i te rerenga toto i ia ra, ka mau katoa o nga pūtau kakau wheua wheua, te waha mucosal cell, me te pūtau crypt intestinal i te wa e uru ana ki te wahanga-S o te mitosis, ka muru i te katoa o te puna wai wehe.
3. Methotrexate Polyglutamate Intracellular (MTX-PG) Mahanga: I roto i te hinu wheua, ate, me nga pūtau whekau, ka piri te enzyme folylpolyglutamate synthetase (FPGS) ki nga mekameka o te 2 ki te 7 atu ngota ngota glutamate ki te methotrexate, ka huri hei Methotrexate Polyglutamates (MTX-PG2 mā MTX-PG7).
4. Kaore i rite ki te methotrexate kore utu i roto i te toto, KORE e taea e enei polyglutamates nui, toraro te utu ki waho i te kiriuhi o te pūtau ka mau tonu ki roto i nga ruma mo wiki i muri i te hekenga o nga taumata methotrexate serum ki te kore.
5. MTX-PGs maukati korekore Dihydrofolate Reductase (DHFR), Thymidylate Synthase (TS), me AICAR transformylase, ka mutu katoa te purine (adenine/guanine) me te pirimidine (thymidine) Te whakahiato DNA.

Whakataurite Matua: Folic Acid (Vitamin B9) vs. Folinic Acid (Leucovorin) vs. Glucarpidase (Voraxaze)¶

Rarangi Wā Haumanu o Subacute / Daily Methotrexate Overdose (He aha nga ra i ia ra)¶

Na te mea he tino pai nga turoro e tango ana i te methotrexate ia wiki i ia ra mo nga ra tuatahi, he mea nui te mohio ki te toru-waahanga haumanu haumanu:

1. Wāhanga 1: Te Wāhanga Whakaemi Roto Pūkoro Wahangū (Nga Ra 1 ki te 4 o te Totatanga o Ia Ra):
2. He pai te rongo o te manawanui, he nausea ngawari ranei, he korerexia, he ngenge ranei i te wa MTX-PGs whakaemi i roto i nga pūtau wehewehe.
3. Mahi: Mena ka mau te hapa inenga i konei (>= 3 consecutive days), timata waha, IV Leucovorin ranei (15 mg every 6 hours) me te IV hydration ka aukati tata ki te katoa o te paitini o raro.
4. Wāhanga 2: Te Herald Mucosal & Hepatorenal Phase (Ra 4 ki te 8):
5. Stomatitis Wawaha / Mucositis Te mamae: Erythema e wera ana, nga whewhe papau kei runga i nga ngutu o roto, te mucosa buccal, te arero, me te ngutu pakeke, ka horomia te wai, te huware ranei ka mamae (odynophagia).
6. Te Horohanga Psoriatic Plaque Erosion: I nga turoro me te psoriasis, ka huri ohorere nga papa kiri o mua ki te whero, te ngawari, te pupuhi, me te necrotic ("methotrexate epidermal necrosis", e rite ana ki te Stevens-Johnson Syndrome / TEN), he maha nga wa e haere tahi ana me te paheketanga photosensitive.
7. Nga tohu mo te whekau me te ate: Te ruaki, te mamae o te puku, te diarrhea wai, toto ranei (enteritis), te pikinga o nga transaminases ate (AST/ALT), me te piki ake o te creatinine serum.
8. Wāhanga 3: Aplasia Huka Wheua Mate & Neutropenic Sepsis (Ra 6 ki te 14+):
9. Na te mea ka huri haere nga toto ma (neutrophils haurua ora 6 to 8 hours) me platelets (7 to 10 days) ka kore e whakakapihia e te hinu wheua kua pakaru, ka pakaru te Complete Blood Count (CBC) i waenganui i te Ra 6 me te Ra 12:
   • ** Leukopenia Tino & Agranulocytosis (ANC < 500/mcL, maha 0/mcL)**: Ka whakawhiti te huakita me te harore puta noa i te waha whewhe me te reinga whekau ki roto i te rerenga toto, ka puta te rekereke fulminant septic, pneumonia, me te typhlitis.
   • ** Thrombocytopenia Tino (Platelets < 20,000/mcL)**: Te toto kapia ohorere, te epistaxis, te petechiae, te melena (te pango pango), me te whakaheke toto.
   • ** Anemia Tino **: Te Puke, te pupuhi, me te tachycardia.
10. (Tuhipoka: Ahakoa ka wehea mai i te nui o te horopeta, ka taea e te methotrexate te mate whakapeka idiosyncratic Hypersensitivity Pneumonitis i nga wa katoa i te wa e rongoa ana, ka puta mai he mare maroke, kirikaa, hypoxia, me te kuhu o te huhu karaihe whenua-rua).

Te Kawa Whakahaere Hohipera Taahi-a-Step mo te Methotrexate Overdose¶

1. Folinic Acid (Leucovorin) Rescue Dosing & The "2-Hour Separation Ture" from Glucarpidase¶

1. Kaua e whakaroa te Leucovorin: Whakahaerehia te horopeta tuatahi o Intravenous Folinic Acid (Leucovorin) i roto i te 1 haora o te whakaaturanga (na te mea ko te edema gastrointestinal i roto i te mucositis ka whakararu i te horonga a-waha me te kohu o te ngutu o Leucovorin ki runga ake nei. 25 to 40 mg, whakamahia i nga wa katoa te huarahi Intravenous mo te paitini ahua-ki-te-maha ranei. > 25 mg):
2. Te Hapa Whakatupato i ia ra (Asymptomatic, He ngawari ranei, He Mahinga Tango Tika, MTX Serum Iti): Leucovorin 15 mg to 25 mg (ranei 10 to 15 mg/m2) IV (PO ranei) ia 6 haora mo te iti rawa 3 ki te 7+ nga ra tae noa ki nga CBC rangatū ka whakaū i te pikinga/maua te tatauranga neutrophil me te platelet mo te 48 haora.
3. Maamaa Maamaa Maamaa (Mucositis, Leukopenia/Thrombocytopenia, AKI ranei) OR Elevated Serum MTX (> 0.1 to 1.0 micromol/L): Leucovorin 100 mg/m2 (ranei 100 mg to 150 mg) IV ia 3 ki te 6 haora (e arahina ana e te Bleyer nomogram mena he nui te horopeta nui, ka haere tonu ranei i roto i te mate paitini o ia ra, tae noa ki te ka mutu nga mate o te hematologic me nga whewhe mucosal, ahakoa i muri i te MTX serum. < 0.05 micromol/L).
4. ** Te Whakanui MTX Serum Tino (>= 10 micromol/L i te 24h ranei >= 100 micromol/L)**: Whakanuia te Leucovorin ki 1,000 mg/m2 IV ia 6 haora mā te raina pokapū (matakitaki i te konupūmā serum, i te mea he nui nga pota o te Calcium Folinate e tuku ana i nga kawenga konupūmā nui; kia ata whakapoipohia i <= 160 mg/minute huri ranei ki Levoleucovorin i 50% o te horopeta racemic).
5. Te Glucarpidase (Voraxaze) Ture Wehewehe 2-Hora:
6. Mena he ** whara whatukuhu whakapeka / whakaroa te whakakoretanga** me te methotrexate plasma teitei tonu (> 1 to 2 micromol/L) ka whiwhi Intravenous Glucarpidase (50 Units/kg IV over 5 minutes), kia mahara ko te Glucarpidase ano ka wetewete i te Leucovorin mena kei roto i te toto i te wa kotahi.
7. Ture: Kaua e hoatu te Leucovorin i roto i nga haora 2 I MUA, i te 2 haora ranei I muri i te whaowhia o Glucarpidase, katahi ka whakaara ano i te horopeta nui IV Leucovorin 2 haora i muri i te Glucarpidase.
8. (Whakatupato Taonga Taonga Taiwhanga: I muri i te hoatutanga o Glucarpidase, ka tauhohehia te kaitapaota kua mawehea DAMPA ki te hohipera paerewa immunoassay nga whakamatautau toto mo te 48 ki te 72 haora, na te ahua o te taumata o te methotrexate i roto i te serum kaore e inehia e HPLC / LC-MS/MS).

2. Paihere Tautoko Kaitakawaenga: Ko te Whakawaotanga Mimi, te G-CSF, me te Tiaki Mucositis¶

• Whakawhanaunga Mimi me te Diuresis Putanga Nui: Whakaohia te konutai konutai isotonic (150 mEq NaHCO3 i roto 1 L D5W i 150 to 250 mL/hr) ki te pupuri ** te whakaputa mimi > 2 mL/kg/hr** me ** mimi dipstick pH >= 7.5 to 8.0**; te aro turuki me te whakakapi i te te konupora me te konupora.
• Granulocyte Colony-Stimulating Factor (G-CSF / Filgrastim): I roto i nga turoro me te methotrexate-induced neutropenia (ANC < 1,000/mcL), timata tonu Filgrastim subcutaneous (5 mcg/kg/day) ki te whakatere ake i te whakaora o te neutrophil hinu wheua i roto i nga ra maha, ka whakaiti i te mate mate mai i te wiri septic.
• Nga Paturopi Awhiowhio Whanui IV mo te Neutropenia Febrile: Mena ka eke te pāmahana >= 38.0 C (100.4 F) ranei ANC < 500/mcL, tuhia kia rua nga huinga o nga ahurea toto ka timata te whakamaarama anti-pseudomonal beta-lactam (cefepime, piperacillin-tazobactam [kia tupato mena kei te rere tonu te MTX], meropenem ranei) me te vancomycin (mehemea kei te kaha o te taumata 3-4 o te mucositis waha, te pakaru kiri ranei) me te kapi antifungal.
• Wha Mucositis & Cholestyramine Tautoko: Whakarato Folinic Acid (Leucovorin) waha waha (swish me te tuwha/ horomia), viscous lidocaine/diphenhydramine/antacid horoi waha, me te whakaaro Colestyramine waha (4 grams PO every 6 hours) ranei Multi-Dose Activated Charcoal ki te here i te methotrexate e whai ana i te recirculation enterohepatic biliary i roto i te whekau.

Nga nama ohorere a rohe me nga tikanga umanga¶

Pātai auau¶

He aha e kore ai e taea e au te tango pire Acid Folic (Huaora B9) ki te tango i taku Methotrexate ia wiki ia ra mo te wiki?¶

Ko te Acid Folic (waikawa pteroylglutamic) i runga ake i te kaute, he rongoa huaora karekau he kaha ki te whakaora i nga pūtau i te wa o te horopeta o te methotrexate. Hei mahi i roto i to tinana, me whakahohe matū te waikawa folic i te tuatahi e te enzyme e kiia nei ko Dihydrofolate Reductase (DHFR) - koinei te pūmua e tika ana kua tutakina e te methotrexate me te whakakore. Hei whakaora i te hinu wheua me te arai gastrointestinal, me hoatu e nga hohipera te Folinic Acid (e kiia ana ko Leucovorin, Calcium Folinate ranei), he momo putunga kua whakahoahohia i mua i te whakakore i te whaariki DHFR kua aukatihia, ka timata tonu te whakahiato DNA.

He aha te take e mate ai te 10 mg o te Methotrexate ia ra mo nga ra e 6 (60 mg te tapeke), engari ko te tamaiti ka horomia e rua tekau ma wha nga papa 2.5 mg i te wa kotahi (60 mg katoa) he ngawari, kaore ranei he tohu?¶

Ina horomia e te tangata te 60 mg o te methotrexate-a-waha i te wa kotahi, ka kuhu te kai kawe i te kohuke i roto i te whekau iti ki te 15 ki te 20 mg, no reira ko te nuinga o nga pire taapiri kaore e uru ki roto i te toto, ka pehia e nga whatukuhu hauora te waahanga kua uru ki roto i te 12 ki te 24 haora. Na te mea ka patu noa te methotrexate i nga pūtau i te wa e kaha ana te wehewehe (te whakahiato i te DNA ki te wahanga-S), he poto te 12 haora te roa o te puaretanga ka waiho te nuinga o nga pūtau kakau wheua wheua kia kore e whara. Engari, ko te tango i te 10 mg ia ra mo nga ra e 6 ka taea e te 100% te whakauru o te whekau ia ra, me te pupuri tonu i nga taumata tarukino paitini puta noa i ia huringa wehenga pūtau mo te wiki katoa, ka mau i te methotrexate polyglutamates i roto i nga pūtau me te muru i te hinu wheua katoa me te arai whekau.

Mena ka whakaatu te whakamatautau toto o te hohipera i taku "Serum Methotrexate Taumata" he kore, karekau ranei e kitea i muri i taku tango i te methotrexate ia ra mo te wiki, ko te tikanga he haumaru ahau?¶

Kao - koinei tetahi o nga mahanga tino kino o te rongoa ohorere. Ko te whakamatautau toto o te hōhipera paerewa anake ka ine i te methotrexate kore utu e maanu ana i roto i te plasma wai o te toto, a ko nga nama tapahi nomogram i taia ki nga purongo taiwhanga e pa ana ANAKE ki te 24-haora te horopeta teitei o te whaowhia mate pukupuku. Ina tango te tangata i te methotrexate-waha iti i ia ra mo etahi ra, ka uru te methotrexate ki te hinu wheua me nga pūtau ngongo, me etahi atu hiku glutamate e piri ana ki a ia (te hanga methotrexate polyglutamates) e mau ana ki roto i nga ruma mo nga wiki i te wa e heke iho ana te taumata plasma toto ki raro i te tepenga kitenga o te taiwhanga. Ko nga turoro me nga hapa methotrexate mau tonu o ia ra, me whiwhi i te whakaoranga Intravenous Leucovorin i runga i o raatau hitori o te horopeta, te mamae o te waha, me te tatau toto - ahakoa he kore te taumata o te methotrexate serum.

He aha te take i kiia ai he haki whero ohorere i te tangata e tango ana i te Methotrexate?¶

Ka wehewehe nga pūtau epithelial i roto o nga paparinga, ngutu, kapia me te korokoro, ka whakakapi ia ratou ia 3 ki te 5 ra - tere ake i te tata ki etahi atu kiko o te tinana. Ka tae te methotrexate ki nga taumata o roto o te tinana paitini (na te hapa o te horopeta o ia ra, te hekenga o te mahi whatukuhu, te taunekeneke raau taero penei i te Bactrim), ko te kopa waha te kiko tuatahi ka mutu te wehewehe me te pakaru ki nga whewhe mata (mucositis). Ko enei mamae o te waha ka waiho hei whakaoho moata moata mo te 24-ki-72-haora kua mutu te wehewehenga o nga pūtau kakau wheua wheua o te tangata turoro, a kua tata te pa mai o te neutropenia (kore toto ma) me te thrombocytopenia.

He aha te take i tino rahuitia ai te Trimethoprim-Sulfamethoxazole (Bactrim / Septra) mo nga turoro e tango ana i te Methotrexate?¶

Ko te Trimethoprim-sulfamethoxazole (e kiia ana mo nga mate urinary tract, bronchitis, me nga mate kiri) ka whakaeke i te manawanui ki te methotrexate ma nga huarahi whakamate e rua i te wa kotahi: tuatahi, ka aukatihia e te trimethoprim te Dihydrofolate Reductase (DHFR) folate enzyme rite ki te methotrexate, ka hanga he hangahanga porowhita ma te DNA katoa. tuarua, ko nga wahanga e rua ka aukati i nga ngongo whatukuhu mai i te whakaputa i te methotrexate ki roto i te mimi me te patuki i te methotrexate i nga pūmua toto, ka piki ake nga taumata methotrexate o te toto me te kiko ki nga taumata mate ahakoa i runga i te horopeta kotahi-wiki.

Nga kaiarahi e pa ana¶

• 5-Fluorouracil (5-FU) kirīmi haumanu mo te kai mo nga kararehe me te nui o te capecitabine tangata.
• Te whakamohiotanga o te Sepsis me te ru septic me te urupare ohorere
• Te whara o te whatukuhu, te rhabdomyolysis, me te whakamatautau mimi pouri
• He kaha te whakahaere toto me te ru hemorrhagic
• Ko te awhina tuatahi mo te paihana me te whakamatautau paihana

Nga puna me nga aratohu whai mana¶

• Institute for Safe Medication Practices (ISMP): Targeted Medication Safety Safety Best Practices for Hospitals and Community Pharmacies: Preventing Fatal Daily instead of Weekly Oral Methotrexate Dosing Errors.
• Te Roopu Hauora o te Ao (WHO) me te Pokapü rongoa a te Pakeha (EMA): Te Haumaru Rongoa i roto i nga Tikanga Morearea Nui me nga Tohunga PRAC ki te Aukati i nga Hapa Whakatupato Nui me te Mate ki te Methotrexate.
• Nga Maimoatanga Extracorporeal i roto i te Poisoning (EXTRIP) Rōpū Mahi & American College of Medical Toxicology (ACMT): Nga Aratohu Mahinga Haumanu mo te Methotrexate Poisoning: Folinic Acid (Leucovorin), Urinary Alkalinization, Glucarpidase, me High-Flux Hemodialysis.
• National Poisons Information Service (NPIS, United Kingdom) & Rongoa me nga hua Tiaki Hauora Regulatory Agency (MHRA): TOXBASE Whakahaere Haumanu o Acute and Chronic Methotrexate Overdose and Trimethoprim Drug Interactions.
• Te Whakahaere Kai me te Taakaro o te United States (FDA): Te Whakatakoto i nga Korero me nga Matohi Haumaru mo te Methotrexate, Leucovorin Calcium, me te Voraxaze (Glucarpidase).

Ko tenei aratohu mo nga kaupapa korero me te kore e whakakapi i te aromatawai hauora ngaio, te korero mo te Mana Paihana, me te tiaki mate mate o te hohipera. Na te mea ka taea e nga hapa whakangao methotrexate o ia ra te whakaroa, te ngoikore o te hinu wheua me te ohorere, ka tino taunaki matou ki te tango i tetahi awhina tuatahi me te akoranga CPR kua whakamanahia i roto i te International Federation of Red Cross and Red Crescent Societies (IFRC), to hapori Whero Whero o te motu, St John Ambulance, tetahi kaiwhakarato rohe whaimana.