抗癌药物副作用之六Organtoxicities.ppt

抗癌藥物副作用之三 Mucositis 常見引起黏膜炎藥物: MTX, 5-FU, Anthracycline, Vinca alkaloid 口腔黏膜炎嚴重也會引起全身感染 Management--- ?教導病人務必注意口腔衛生 ?使用軟毛牙刷 ?用溫的生理食鹽水嗽口,不可含有酒精 ? 發生傷口潰爛,可用口內膏,若持續不好,可能會 造成水分不足,鼓勵病人維持正常水量,必要時 請醫師開抗黴菌藥,讓病人嗽口後再吞入 1. Alopecia,可逆性 2. Skin and naikl changes,可逆性 3. Irritant and vesicant reaction 抗癌藥物副作用之三 Dermatologic toxicity 化學外漏(extravasation): 抗癌藥周邊靜脈給藥時,從血管內流到周邊組織導致傷害 1. 常發生在第一個劑量後,且常是輕微或中度 2. Paclitaxel(Taxol)與Asparaginase過敏反應很高,事先可先給steroid or antihistamine,發生anaphylaxis shock可給予epinephrine 3. 人類單株抗體含有蛋白質,較傳統化療藥物造成更多過敏反應,ex:Herceptin 抗癌藥物副作用之四 Hypersensitivity 抗癌藥物副作用之五 Metabolic toxicities ＊Hypomagnesmia/hypocalcemia cisplatin ＊Acute tumor lysis syndrome (急性腫瘤溶解症候群) 1.Often occurs after C/T of ALL or lymphomas, may happen at 12-24 hrs after treatment 2.Treatment with hydration ,allopurinol,urine alkalization 抗癌藥物副作用之六 Organ toxicities 1. renal/bladder/metabolic toxicity 2. cardiac toxicity 3. pulmonary toxicity 4. hepatotoxicity 5. neurotoxicity Toxic nephropathy / hemorrhagic cystitis--- Drug Site Pathology Incidence Onset Recovery Management Cisplatin kidney Tubular necrosis 10-40% 1-4wks 2-4wks Prehydration with saline with or without mannitol and furosemid MTX Renal pelvis Tubular obstruction 5% 6-12hrs 1-7days