美国注册护士 - RN nurse
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有关ectopic pregnancy 的药物 (流产药)
作者:木o 提交日期:2008-2-2 22:54:00 正常 | 分类: | 访问量:6551

  我在RN考题中遇到一道有关ectopic pregnancy (the fallopian tube)的题目,觉得是课本上知识点的补充,在此给大家总结一下:
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The fallopian tube has not yet ruptured,methotrexate (甲氨蝶呤)may be given,followed by leucovorin甲酰四氢叶酸,亚叶酸.


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This chemotherapeutic agent attacks the fast-growing zygote(合子) and trophoblast滋养层 cells.


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RU-486 is also effective.


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A therapy to determine whether the tube is still patent.


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————————————


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Methotrexate(MTX)


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抗肿瘤药:


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化学结构与叶酸相似,为抗叶酸代谢药。


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临床用途:儿童急性白血病和绒毛膜上皮癌,也可用于成骨肉瘤等。


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Methotrexate 最初被使用了, 作为组合化疗养生之道一部分, 对待许多种类癌症. 这是仍然中流砥柱为许多的治疗 造形术 混乱包括 深刻淋巴胚细胞的白血病


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它最近进入了用途作为一种治疗为一些 自动免疫的疾病, 包括 psoriasis, psoriatic 关节炎, 类风湿病的关节炎 (参见 疾病修改antirheumatic 药物), 并且 Crohn 的疾病. 在情况下 类风湿病的关节炎, 平行的用途与 infliximabetanercept 被显示明显改进症状。


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虽然没准许为这个征兆, methotrexate 有时也被使用(一般与的组合 misoprostol迷索前列醇【a E1 (PGE1) 类似物】) 及早终止 怀孕, 特别 宫外的怀孕.


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它可能口服给药或静脉注射(肌肉内, 静脉内intrathecal) 。 虽然每日准备偶尔地被使用, 多数患者采取每周药量, 减少某些副作用风险。


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治療絨毛膜癌時,要監測尿液中絨毛膜的親生殖腺素(chorianic gonadotropin),以便決定其療效,在經過3~4個治療日程以後,其濃度應該恢復至每24小時50IU以下,治療腦膜白血病要使用不含保存劑的溶液,其製備法可以Elliott's溶液,0.9%氯化鈉乳酸化的生理溶液或病人本身的腦脊椎液稀釋。


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Leucovorin


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methotrexate過量的解毒劑antidotes.


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Examples




leucovorin


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Leucovorin comes in intravenous (IV), intramuscular (IM) injection (shot), and oral form.


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How It Works


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Leucovorin is a derivative of folic acid. Leucovorin works differently depending on whether it is used with methotrexate (MTX) or fluorouracil (5-FU).


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  • Methotrexate: Leucovorin is given to "rescue" the gastrointestinal lining and bone marrow cells from MTX toxicity. Most of the complications and side effects of methotrexate can be either prevented or treated by using leucovorin, which is usually given 24 hours after methotrexate.

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  • Fluorouracil: Leucovorin increases the effectiveness of 5-FU, increasing the anticancer effect.

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Why It Is Used


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Leucovorin is used with either methotrexate (MTX) for the treatment of ectopic pregnancy or fluorouracil (5-FU) for colon or breast cancer.


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Side Effects


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Leucovorin is very well tolerated and has almost no side effects of its own.


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See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)


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What To Think About


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Leucovorin generally decreases the severity of side effects of MTX. It can increase the severity of the side effects of 5-FU when used with that medication.


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Methotrexate and misoprostol for abortion


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译文:甲氨蝶呤和米索前列醇流产 (仅供参考)


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Examples例子


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methotrexate甲氨蝶呤 MTX甲氨喋呤 misoprostol米索前列醇 Cytotec cytotec


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How It Works它是如何运作的


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Methotrexate and misoprostol use is a two-step method.甲氨蝶呤和米索前列醇使用是一个分两步走的方法。


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  • First, methotrexate tablets are taken by mouth or an injection of methotrexate is given by your health professional.首先,甲氨喋呤片,是由口或注射甲氨蝶呤是给你的健康专业人士。 Methotrexate interferes with the growth of the placenta , which allows it to separate from the endometrium .甲氨蝶呤干扰了生产总值的增长率相胎盘 ,允许它脱离子宫内膜 。 This is an unlabeled use of methotrexate.这是一个未标记的使用甲氨蝶呤。 For reference, see an illustration of the reproductive organs供参考,见一个插图的繁殖器官 . 。

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  • Second, tablets of misoprostol are taken by mouth or inserted vaginally, usually 5 to 7 days later.第二,粒米索前列醇,是由口或插入阴道,通常是5至7天以后。 This medicine causes uterine contractions so that your body passes the uterine contents.此药造成子宫收缩,使你的身体合格子宫内容。 The pregnancy usually ends at home within a day or two when the tissue from the uterus is passed.怀孕通常完在家里一两天或两当组织从子宫中获得通过。

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Note: Many doctors are only giving misoprostol by mouth. 注:很多医生只给米索前列醇由口入。 This is because of recent reports of a very rare, fatal infection that has affected a few women after using vaginal misoprostol. 1这是因为最近有报道的一个非常罕见的,致命的感染,这已经影响到少数妇女用后阴道米索前列醇1


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A medical abortion usually requires three visits to your health professional over several weeks.药物流产,通常需要3次到你的健康专业人士超过几个星期。 Medicines are given at the first and second visits.中成药由于在第一次和第二次访问。 The third visit is a follow-up appointment and is usually scheduled within 20 days after the second visit to make sure the abortion is complete and no complications are present.第三次访问是一项后续行动,任用和通常定在20天之后,第二次访问,以确保人工流产是否完整,以及没有严重并发症,是目前。 If a medical abortion is unsuccessful, a surgical abortion must be done to complete the process.如果药物流产失败,手术流产必须做的事情里完成这一进程。 (A fetus may not develop normally after exposure to methotrexate or misoprostol.) (一胎儿可能不正常发展后曝光,以甲氨蝶呤或米索前列醇) 。


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You may also take pain medicine by mouth for this procedure.您也可以采取非处方止痛药口,为这个程序。


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Why It Is Used因此,它的使用


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A medical abortion with methotrexate is most effective when performed within the first 7 weeks of pregnancy. 2 This offers women an early-pregnancy abortion option that doesn't involve surgery.药物流产与甲氨喋呤是最有效的时候,表现在最初的7周的妊娠。 二日妇女提供早期怀孕堕胎的选择,这并不涉及手术。


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Methotrexate is also used for treatment of an ectopic pregnancy .甲氨蝶呤也可用于治疗宫外孕


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How Well It Works它如何工作


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A medical abortion with methotrexate and misoprostol is effective over 90% of the time.药物流产与甲氨蝶呤和米索前列醇是有效的,超过90 %的时间。 When completed before 7 weeks of pregnancy, injected methotrexate is effective in 95% to 99% of cases. 2当完成前7周的妊娠,注入甲氨蝶呤是有效的在95 %至99 %的病例2


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Some studies show that injected methotrexate and vaginal misoprostol work more quickly, with fewer side effects, than when both medicines are taken by mouth. 3 But many doctors are only giving misoprostol by mouth.一些研究显示,注射甲氨蝶呤和阴道米索前列醇工作更加迅速,且副作用较小,较当这两个药物,是由口入。 3 但许多医生只给米索前列醇由口入。 This is because of recent reports of a very rare, fatal infection that has affected a few women after using vaginal misoprostol. 1这是因为最近有报道的一个非常罕见的,致命的感染,这已经影响到少数妇女用后阴道米索前列醇1


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Over 60% of pregnancies will end within the first 24 hours after taking misoprostol (a second dose of misoprostol can be used).有超过六成的怀孕会结束的第一个24小时后米索前列醇(第二次剂量米索前列醇可用于) 。 However, methotrexate and misoprostol can take up to 3 weeks to be effective, which is longer than other abortion methods. 2不过,甲氨蝶呤和米索前列醇可以采取行动三周才能有效,这是比其他的堕胎方法2


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Side Effects副作用


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This method of abortion causes symptoms similar to a miscarriage (such as severe cramping and vaginal bleeding) as tissue and clots pass from the uterus.这种方法流产的原因,症状类似流产 (如严重抽筋和阴道出血) ,作为组织和血凝块通过从子宫。


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  • Nausea.恶心。

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  • Vomiting.呕吐。

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  • Diarrhea.腹泻。

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  • Headache.头痛的问题。

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  • Dizziness.晕眩等。

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  • Chills or hot flushes (sweating and feeling overly hot).寒或潮热(出汗和情绪过于炎热) 。

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  • Shivering.寒战。

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  • Fatigue.疲劳。

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Signs of complications迹象并发症


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Less than 1% of all women who have an abortion have serious problems afterward. 4少于百分之一的所有妇女有堕胎的严重问题,随后4


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Call your health professional immediately if you have any of these symptoms after an abortion: 打电话给你的健康专业人士立即如果您有任何这些症状后,堕胎:


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  • Severe bleeding.严重出血。 Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period.医疗及手术堕胎常常导致出血是有别于正常的月经期。 Severe bleeding can mean:严重出血,可以是指:

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    • Passing clots that are bigger than a golf ball, lasting 2 or more hours.通过凝块是大于高尔夫球,持久2个或更多个小时。

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    • Soaking more than 2 large sanitary pads in an hour, for 2 hours in a row.浸泡超过2次大型卫生巾后一个多小时, 2小时,在一排。

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    • Bleeding heavily for 12 hours in a row.出血严重,为12个小时之久。

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  • Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness.有感染迹象,在你的整个身体,如头痛,肌肉痛,头晕,胸闷,或普遍感到病情。 Severe infection is possible without fever.严重感染是有可能的,没有发烧。

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  • Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat重度疼痛,在腹部这是不放心止痛药,休息,或热

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  • Hot flushes or a fever of 100.4 F or higher that lasts longer than 4 hours潮热或发烧100.4 F或更高的持续时间超过4小时

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  • Vomiting lasting more than 4 to 6 hours呕吐持久超过4至6个小时

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  • Sudden abdominal swelling or rapid heart rate突然腹部肿胀或快速心率

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  • Vaginal discharge that has increased in amount or smells bad阴道分泌物有增加金额或不良气味

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  • Pain, swelling, or redness in the genital area疼痛,肿胀,发红或在生殖器区

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Call your health professional for an appointment if you have had any of these symptoms after a recent abortion: 打电话给你的健康专业人士安排预约 ,如果你有任何这些症状,经过近期的流产:


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  • Bleeding (not spotting) for longer than 2 weeks出血(不检举)的时间超过2周

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  • New, unexplained symptoms that may be caused by medicines used in your treatment新的,原因不明的症状,可能的原因是药品的使用在你的治疗

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  • No menstrual period within 6 weeks after the procedure无月经期6个星期后,程序

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  • Signs and symptoms of depression .标志和抑郁症的症状。 Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.荷尔蒙变化后怀孕可导致产后抑郁症 ,需要治疗。

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See Drug Reference for a full list of side effects.见毒品的参考一套完整齐备的副作用。 (Drug Reference is not available in all systems.) (参考药物并不适用于所有系统) 。


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What To Think About什么想想


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Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.选择内科或外科手术,为人工流产,将取决于你的医疗史,有多少个星期怀孕你,可以有哪些选择你的居住地点,以及您的个人喜好。


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Methotrexate for medical abortions has not been evaluated in women with the following medical conditions:甲氨蝶呤医疗堕胎,并没有得到评估,在妇女与医疗下列条件:


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Avoid alcohol and aspirin while using methotrexate and misoprostol for a medical abortion. 避免饮酒和服用阿司匹林同时使用甲氨蝶呤和米索前列醇药物流产。


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Avoid folic acid supplements - folic acid (folate) can interfere with the action of methotrexate during a medical abortion. 避免叶酸补充剂 -叶酸(叶酸) ,可以干预行动甲氨蝶呤在药物流产。


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Methotrexate can be used by women with asthma .甲氨蝶呤可用于妇女与哮喘


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A medical abortion does not require surgery but methotrexate must be used in the first 7 weeks of pregnancy to be most effective.药物流产并不需要手术,但甲氨蝶呤必须用于在首7周的妊娠,以最有效的。 If methotrexate fails, a vacuum aspiration must be done as follow-up.如果甲氨蝶呤失败了,一个真空的愿望一定要做的后续行动。 If the abortion is not completed, complications can include abnormal development of the fetus.如果堕胎是没有完成,并发症可能包括发育异常的胎儿。


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After a medical abortion经过药物流产


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Expect that you may experience different emotional reactions after an abortion.期望你可以体验不同的情绪反应后做流产手术。


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Postpartum depression can be triggered by changing pregnancy hormones after an abortion. 产后抑郁症 ,可引起妊娠变化的激素后做流产手术。 If you have more than 2 weeks of postpartum depression symptoms, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your health professional about treatment.如果你有超过两个星期的产后抑郁症的症状,如疲劳,睡眠或食欲改变,或情感的悲伤,空虚,焦虑,或烦躁不安,看你的健康专业治疗。 Keep track of your symptoms with a postpartum depression checklist跟踪您的症状与产后抑郁症一览表 Do not have sexual intercourse for at least 1 week, or longer, as advised by your health professional.没有性交为至少1周或更长的时间,作为提醒你的健康专业人士。


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When you start having intercourse again, use birth control, and use condoms to prevent infection.当您开始考虑再次  ,使用生育控制,并正确使用安全套,以防止感染。 For immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom).为立即,有效的避孕节育,你可以用一个无障碍的方式(如隔膜,宫颈帽或保险套) 。 An intrauterine device (IUD) is effective immediately after it is placed in the uterus.一个宫内节育器(避孕环 )是有效后,立即把它放在子宫。 If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective.如果您已开始荷尔蒙避孕药丸,补丁,或打针后的程序,请务必使用一个备份的方法,直至荷尔蒙药今起生效。 For more information, see the topic Birth Control.如需更多资讯,请参阅专题生育控制。


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Your next regular period may come at any time within 6 weeks after the abortion.你的下次例会期间,也随时可能在6周后流产。 Be sure to contact your health professional if you do not have a period in 6 weeks.请务必联络您的健康专业人士,如果你没有一个时期,在6个星期。


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 mifeprex  (RU 486) (mifepristone)  Information (米非司酮)信息


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Mifeprex is used, together with another medication called misoprostol, to end an early pregnancy (within 49 days of the start of a woman's last menstrual period). mifeprex使用,联同另一服药所谓米索前列醇终止早孕( 49天内的一个良好的开始,女人的上月经期) 。 Since its approval in September 2000, the Food and Drug Administration has received reports of serious adverse events, including several deaths, in the United States following medical abortion with mifepristone and misoprostol.  Each time FDA receives a report of a serious adverse event or death after medical abortion with these drugs, the agency carefully analyzes the available scientific information to determine whether or not the serious adverse event or death is related to the use of the drugs.由于它的批准,在2000年9月,美国食品与药物管理局已接到报告,发生严重不良反应事件,其中包括数条人命,在美国下列药物流产米非司酮和米索前列醇,每一次林业局接到报告的严重不良事件或死亡后,药物流产与这些药物,该机构仔细分析了现有的科学资料,以确定究竟有没有严重的不良事件或死亡的是有关药物使用说明。


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As previously reported by the agency, several of the women who died in the United States died from sepsis (severe illness caused by infection of the bloodstream) after medical abortion with mifepristone and misoprostol.  Sepsis is a known risk related to any type of abortion.  Most of these women were infected with the same type of bacteria,  known as Clostridium sordellii .  The symptoms in these cases of infection were not the usual symptoms of sepsis.  We do not know whether using mifepristone and misoprostol caused these deaths. 此前曾报道,由该机构,其中数名妇女死亡,在美国死于败血症(重症疾病所造成感染的血液)后,药物流产米非司酮和米索前列醇。败血症是一个众所周知的风险有关的任何类型的人工流产。大多数妇女感染了同一类型的细菌,被称为气荚膜sordellii 。症状,在这些情况下,受感染的人不是一般的症状,败血症,我们不知道他是否用米非司酮和米索前列醇造成这些死亡。


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Patients should contact a healthcare practitioner right away if they have taken these medications for medical abortion and develop stomach pain or discomfort, or have weakness, nausea, vomiting or diarrhea with or without fever, more than 24 hours after taking the misoprostol.  These symptoms, even without a fever, may indicate sepsis.  Patients should make sure their healthcare practitioner knows they are undergoing a medical abortion. 病人应联系一名医护人员执业权利的路程,如果它们采取这些药品的药物流产和发展胃部疼痛或不适,或有虚弱,恶心,呕吐或腹泻或无发热,超过24小时后,以米索前列醇这些症状,即使没有发烧,可能表明败血症患者更应确保他们的医疗保健医生知道他们正在经历着一场药物流产。


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All providers of medical abortion and emergency room healthcare practitioners should investigate the possibility of sepsis in women who are undergoing medical abortion and present with nausea, vomiting, or diarrhea and weakness with or without abdominal pain.所有的服务提供商的药物流产和急诊室的医护人员应立即调查是否有败血症妇女正在接受药物流产,并与目前的恶心,呕吐或腹泻等弱点,或无腹痛。 These symptoms even without a fever may indicate a hidden infection.  Strong consideration should be given to obtaining a complete blood count in these patients.  Significant leukocytosis with a marked left shift and hemoconcentration may be indicative of sepsis. 这些症状的,即使没有发烧,也可能是隐性感染。强烈的,应考虑到获得一个完整的血液计数,在这些病人的显着白血球具有显着左转向和血液浓缩可能表明败血症。


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FDA recommends that healthcare practitioners have a high index of suspicion for serious infection and sepsis in patients with this presentation and consider immediately initiating treatment with antibiotics that includes coverage of anaerobic bacteria such as Clostridium sordellii . FDA的建议,卫生保健从业者都有高度怀疑为严重感染和败血症患者的这一陈述,并考虑立即着手治疗用抗生素,其中包括覆盖的厌氧细菌如梭菌sordellii


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FDA does not have sufficient information to recommend the use of prophylactic antibiotics for women having a medical abortion.  Reports of fatal sepsis in women undergoing medical abortion are very rare (approximately 1 in 100,000).  Prophylactic antibiotic use carries its own risk of serious adverse events such as severe or fatal allergic reactions.  Also, prophylactic use of antibiotics can stimulate the growth of “superbugs,” bacteria resistant to everyday antibiotics.  Finally, it is not known which antibiotic and regimen (what dose and for how long) will be effective in cases such as the ones that have occurred. 林业局没有足够的资料来建议使用预防性抗生素的妇女拥有堕胎的医疗报告的致命败血症妇女进行药物流产,是非常罕见的(约1 100000 ) 。预防性抗生素使用带有自己的严重不良事件的危险如严重或致命的过敏反应,同时,预防性抗生素的使用,可以刺激生长的"超级"细菌抗药性的抗生素,每天最后,我们并不知道其中的抗生素和水情(什么剂量和时间有多长),将有效在一些情况下,例如某人有发生。


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These recommendations are consistent with warnings in the Prescribing Information and information for the patient in the Medication Guide for Mifeprex. 这些建议与忠告,在处方信息和资料,为患者在用药指南mifeprex 。


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The approved Mifeprex regimen for a medical abortion through 49 day’s pregnancy is:核定mifeprex水情,为药物流产通过49天的怀孕是:


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  • Day One: Mifeprex Administration: 3 tablets of 200 mg of Mifeprex orally at once第一天: mifeprex当局: 3粒200毫克mifeprex口头一旦

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  • Day Three: Misoprostol Administration: 2 tablets of 200 mcg of misoprostol orally at once第三天:米索前列醇当局: 2粒心磁200米索前列醇口服一次

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  • Day 14: Post-Treatment: The patient must return to confirm that a complete termination has occurred.  If not, surgical termination is recommended to manage medical abortion treatment failures.第14天:后处理:病人必须返回证实,一个完整的终止已经发生,如果不是,手术终止建议管理药物流产造成治疗失败。

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The safety and effectiveness of other Mifeprex dosing regimens, including use of oral misoprostol tablets intravaginally, has not been established by the FDA.安全性和有效性的其他mifeprex配料regimens ,包括使用口服米索前列醇片intravaginally ,尚未建立,由林业局。


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On May 11, 2006, FDA, in conjunction with the Centers for Disease Control and Prevention (CDC) and the National Institute of Allergy and Infectious Diseases (NIAID), conducted a public workshop.于2006年5月11日,美国食品药品管理局,在与美国疾病控制中心和预防( CDC )及国立卫生研究院过敏与传染病( NIAID的) ,进行了一项公众研讨会。 This workshop, entitled “Emerging Clostridial Disease,” discussed the scientific and medical circumstances associated with reports of morbidity and mortality with Clostridium sordellii and Clostridium difficile infections.本次研讨会,题为"新兴梭菌病" ,讨论了科学和医学的情况下,与相关的报告发病率和死亡率与sordellii气荚膜梭菌艰难性感染。 Information pertaining to the Emerging Clostridial Disease Public Workshop can be found at: http://www.fda.gov/cder/meeting/clostridia_disease.htm


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#日志日期:2008-2-2 星期六(Saturday) 多云 复制链接 举报



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