Anthrax Immune Globulin IV (Human)
Jeneng merek: Anthrasil
Kelas obat:
Agen Antineoplastik
Panganggone Anthrax Immune Globulin IV (Human)
Anthrax immune globulin IV (manungsa) nduweni kegunaan ing ngisor iki:
Anthrax immune globulin IV (manungsa) dituduhake kanggo perawatan anthrax inhalasi ing pasien diwasa lan bocah kanthi kombinasi obat antibakteri sing cocog.
Anthrax immune globulin IV (manungsa) nduweni watesan ing ngisor iki:
Efektifitas anthrax immune globulin IV (manungsa) mung adhedhasar studi khasiat sing ditindakake ing model kewan anthrax inhalasi. p>
Anthrax immune globulin IV (manungsa) ora duwe aktivitas antibakteri langsung.
Anthrax immune globulin IV (manungsa) ora ngliwati alangan getih-otak lan ora nyegah utawa nambani meningitis.
Ora ana panaliten babagan anthrax immune globulin IV (manungsa) ing populasi pediatrik, geriatrik, utawa obesitas.
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Carane nggunakake Anthrax Immune Globulin IV (Human)
Umum
Anthrax immune globulin IV (manungsa) kasedhiya ing wangun dosis lan kekuatan ing ngisor iki:
Botol siji-sijine sing ngemot potensi minimal ≥60 unit kanthi uji netralisasi racun ( TNA).
Dosis
Sampeyan penting panyedhiya label pabrikan dikonsultasi kanggo informasi sing luwih rinci babagan dosis lan administrasi obat iki. Ringkesan dosis:
Pilih dosis awal adhedhasar keruwetan klinis; kasus sing abot bisa njamin nggunakake 14 vial (840 unit) ing wong diwasa utawa 2-14 vial (adhedhasar bobot) ing pasien bocah sing bobote >5 kg.
Setel dosis lan nimbang redosing adhedhasar keruwetan klinis lan respon. kanggo perawatan.
Tabel 1. Dosis lan Tingkat Infus Anthrax Immune Globulin IV (Manusia)1Kelompok Pasien
Dosis
Tingkat Infus Miwiti (30 menit pisanan)
Tingkat Infus Tambahan Yen Ditoleransi (saben 30 menit)
Tingkat Infus Maks
Dewasa (≥17 taun) )
7 vial (420 unit)
0,5 mL/menit
1 mL/menit
2 mL/menit
Pediatrik
<1 taun nganti ≤16 taun
1-7 vial (60-420 unit) adhedhasar bobot pasien (pirsani Tabel 2)
0,01 mL/kg/menit (ora ngluwihi tingkat diwasa)
0,02 mL/kg/menit
0,04 mL/kg/menit (ora ngluwihi tingkat diwasa)
Pilih dosis awal adhedhasar keruwetan klinis. Dosis bisa tikel kaping pindho kanggo kasus abot ing pasien pediatrik sing bobote >5 kg.
Tabel 2. Dosis Pediatrik Anthrax Immune Globulin IV (Manusia) Adhedhasar Bobot1Bobot Badan (kg)
Vial saben dosis
Bobot Badan (kg)
Bobot saben dosis
<5
1
25 nganti <35
4
<10
1
35 nganti < 50
5
10 nganti <18
2
50 nganti <60
6
18 nganti <25
3
≥60
7
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Hipersensitivitas
Reaksi hipersensitivitas bisa kedadeyan karo anthrax immune globulin IV (manungsa).
Administrasi anthrax immune globulin IV (manungsa) ing setelan sing cocog karo peralatan, obat-obatan (kalebu epinefrin) lan personel sing dilatih ing manajemen hipersensitivitas, anafilaksis, lan kejut kasedhiya.
Ngawasi kabeh pasien kanggo tandha lan gejala reaksi alergi akut (contone, urtikaria, pruritus, eritema, angioedema, bronkospasme kanthi wheezing. utawa watuk, stridor, edema laring, hipotensi, tachycardia) sajrone lan sawise infus anthrax immune globulin IV (manungsa). Ing kasus reaksi hipersensitivitas sing abot, mungkasi administrasi anthrax immune globulin IV (manungsa) langsung lan ngurus perawatan darurat sing cocog.
Anthrax immune globulin IV (manungsa) ngemot jumlah tilak IgA (kurang saka utawa padha karo 40 mcg saben ml). Pasien sing duwe antibodi sing dikenal kanggo IgA bisa uga duwe risiko luwih gedhe ngalami hipersensitivitas lan reaksi anafilaksis. Anthrax immune globulin IV (manungsa) dikontraindikasi ing pasien sing duwe antibodi marang IgA lan riwayat reaksi hipersensitivitas.
Gangguan Tes Glukosa Darah
Anthrax immune globulin IV (manungsa) ngandhut maltosa. Maltose wis dituduhake menehi tingkat glukosa getih sing salah ing jinis sistem tes glukosa getih tartamtu (contone, kanthi sistem adhedhasar glukosa dehidrogenase pyrroloquinolinequinone (GDH-PQQ) utawa metode glukosa-pewarna-oxidoreductase). Amarga ana potensial kanggo maca glukosa sing salah (utawa maca glukosa normal sing salah nalika ana hipoglikemia), mung gunakake sistem tes sing spesifik glukosa kanggo nguji utawa ngawasi tingkat glukosa getih ing pasien sing nampa anthrax immune globulin IV (manungsa). p>
Deleng informasi produk sistem tes glukosa getih, kalebu strip tes, kanggo nemtokake manawa sistem kasebut cocog kanggo digunakake karo produk parenteral sing ngemot maltosa. Yen ana kahanan sing durung mesthi, hubungi pabrikan sistem pangujian kanggo nemtokake manawa sistem kasebut cocog kanggo digunakake karo produk parenteral sing ngandhut maltosa.
Trombosis
Trombosis bisa kedadeyan sawise perawatan karo produk imun globulin, kalebu anthrax immune globulin IV (manungsa). Faktor risiko kalebu faktor risiko kardiovaskuler, umur tuwa, gangguan output jantung, kelainan hypercoagulable, wektu imobilisasi sing suwe, riwayat trombosis arteri utawa vena, panggunaan estrogen, kateter vaskular pusat sing ana ing njero, lan/utawa hiperviskositas sing dikenal utawa dicurigai. Trombosis bisa kedadeyan tanpa anané faktor risiko sing dikawruhi. Timbang risiko potensial lan keuntungan saka anthrax immune globulin IV (manungsa) marang terapi alternatif kanggo kabeh pasien sing dianggep anthrax immune globulin IV (manungsa). trombosis, nimbang penilaian awal viskositas getih ing pasien sing duwe risiko hiperviskositas, kalebu sing duwe cryoglobulin, kilomikronemia puasa / triasilgliserol (trigliserida) sing dhuwur banget, utawa gammopathies monoklonal.
Ing pasien kanthi faktor risiko sing entuk manfaat administrasi anthrax immune globulin IV (manungsa) ngluwihi risiko potensial trombosis, ngatur anthrax immune globulin IV (manungsa) kanthi tingkat infus minimal sing bisa ditindakake. Mesthekake hidrasi sing nyukupi ing pasien sadurunge administrasi. Ngawasi tandha lan gejala trombosis.
Disfungsi/gagal ginjal akut
Disfungsi ginjal akut, gagal ginjal akut, nefropati osmotik, nekrosis tubular akut, nefropati tubulus proksimal, lan pati bisa kedadeyan nalika nggunakake produk intravena immunoglobulin, kalebu globulin imun antraks. IV (manungsa). Gunakake anthrax immune globulin IV (manungsa) kanthi ati-ati ing pasien kanthi tingkat insufisiensi ginjel sing wis ana lan ing pasien sing duwe risiko ngalami insufisiensi ginjel (kalebu, nanging ora winates kanggo diabetes mellitus, umur luwih saka 65 taun, nyuda volume. , paraproteinemia, sepsis, lan pasien sing nampa obat-obatan nefrotoksik sing dikenal), administrasi ing tingkat minimal infus sing bisa ditindakake. Priksa manawa pasien ora nyuda volume sadurunge infus anthrax immune globulin IV (manungsa). Aja ngluwihi tingkat infus sing disaranake, lan tindakake jadwal infus kanthi rapet. Pemantauan berkala fungsi ginjel lan output urin penting kanggo pasien sing dianggep duwe risiko tambah gagal ginjal akut. Kaji fungsi ginjel, kalebu pangukuran nitrogen urea getih (BUN) lan kreatinin serum, sadurunge infus awal anthrax immune globulin IV (manungsa) lan ing interval sing cocog sawise iku. Yen fungsi ginjel rusak, coba mandhegake anthrax immune globulin IV (manungsa).
Paling kasus insufisiensi ginjel sawise administrasi produk immunoglobulin wis kedadeyan ing pasien sing nampa dosis total sing ngemot 400 mg saben kg sukrosa utawa luwih. Anthrax immune globulin IV (manungsa) ora ngandhut sukrosa.
Tindakan Tingkat Infus
Reaksi sing ora becik (kayata hawa adhem, mriyang, sirah, mual lan muntah) bisa uga ana hubungane karo tingkat infus. Tindakake tarif infus sing disaranake (pirsani Dosis lan Administrasi). Ngawasi kanthi rapet lan ngati-ati pasien lan tandha-tandha vital kanggo gejala apa wae sajrone wektu infus lan langsung sawise infus.
Hemolisis
Anemia hemolitik lan hemolisis bisa berkembang sawise administrasi anthrax immune globulin IV (manungsa). Anthrax immune globulin IV (manungsa) bisa ngemot antibodi golongan getih sing bisa tumindak minangka hemolisin lan ngindhuksi lapisan in vivo sel getih abang karo imun globulin, nyebabake reaksi antiglobulin langsung positif lan hemolisis. Hemolisis akut, kalebu hemolisis intravaskular, wis dilaporake sawise administrasi globulin imun lan anemia hemolitik sing telat bisa berkembang amarga panyerapan sel getih abang. Hemolisis sing abot bisa nyebabake disfungsi/gagal ginjal.
Faktor risiko ing ngisor iki bisa digandhengake karo perkembangan hemolisis: dosis dhuwur (contone, >2 g saben kg), diwenehake minangka administrasi siji utawa dibagi. liwat sawetara dina, lan klompok getih non-O). Faktor pasien individu liyane, kayata negara inflamasi sing ndasari (kaya sing bisa dibayangke, contone, protein C-reaktif sing dhuwur utawa tingkat sedimentasi eritrosit), wis dihipotesisake nambah risiko hemolisis), nanging perane ora mesthi.
Monitor anthrax immune globulin IV (manungsa) panampa kanggo tandha klinis lan gejala hemolisis. Coba tes laboratorium sing cocog kanggo pasien sing duwe risiko sing luwih dhuwur, kalebu pangukuran hemoglobin utawa hematokrit sadurunge infus lan sajrone kira-kira 36 nganti 96 jam lan maneh kira-kira pitung nganti 10 dina sawise infus. Yen tandha-tandha lan/utawa gejala hemolisis utawa penurunan hemoglobin utawa hematokrit sing signifikan sawise infus, tindakake tes laboratorium konfirmasi tambahan.
Gejala Meningitis Aseptik (AMS)
AMS bisa uga ana hubungane karo administrasi produk imun globulin, kalebu anthrax immune globulin IV (manungsa). AMS biasane digandhengake karo dosis total dhuwur (> 2 g saben kg) lan diwiwiti sajrone sawetara jam nganti rong dina sawise perawatan. Penghentian perawatan wis nyebabake remisi AMS sajrone sawetara dina tanpa sekuele.
AMS ditondoi dening gejala lan pratandha ing ngisor iki: sirah abot, kaku nuchal, ngantuk, mriyang, fotofobia, gerakan mripat sing nyeri, lan mual. lan muntah. Pasinaon cairan serebrospinal (CSF) asring positif kanthi pleositosis nganti pirang-pirang ewu sel saben milimeter kubik, utamane saka seri granulositik, lan kanthi tingkat protein sing dhuwur nganti pirang-pirang atus mg saben dL, nanging asil kultur negatif. Nindakake pemeriksaan neurologis sing rinci ing pasien sing nuduhake gejala lan pratandha kasebut, kalebu studi CSF, kanggo ngilangi penyebab meningitis liyane (utamane meningitis anthrax).
Monitoring: Tes Laboratorium
Pertimbangake pemantauan rutin fungsi ginjel lan output urin ing pasien sing dianggep tambah risiko ngalami gagal ginjal akut. Kaji fungsi ginjel, kalebu pangukuran BUN lan bun serum, sadurunge infus awal anthrax immune globulin IV (manungsa) lan ing interval sing pas sawise iku. viskositas getih ing pasien kanthi risiko hiperviskositas, kalebu sing duwe cryoglobulin, kilomikronemia pasa/triasilgliserol (trigliserida) sing dhuwur banget, utawa gammopathies monoklonal.
Yen ana tandha lan/utawa gejala hemolisis sawise infus anthrax immune globulin IV (manungsa), nindakake tes laboratorium sing cocog kanggo konfirmasi.
Yen dicurigai cedera paru-paru akut sing gegandhengan karo transfusi (TRALI), tindakake tes sing cocog kanggo anané antibodi anti-HLA lan anti-neutrofil ing produk.
Gangguan Tes Laboratorium
Anthrax immune globulin IV (manungsa) ngandhut maltosa, sing bisa disalahake minangka glukosa dening jinis sistem tes glukosa getih tartamtu (contone, sing adhedhasar GDH-PQQ utawa metode glukosa-pewarna-oksidaseduktase). Amarga ana potensial kanggo maca glukosa sing salah, gunakake mung sistem tes sing spesifik glukosa kanggo nguji utawa ngawasi tingkat glukosa getih ing pasien sing nampa anthrax immune globulin (manungsa). (Deleng Interferensi karo Tes Glukosa Darah ing Caution: Warnings / Precautions.)
Antibodi sing ana ing anthrax immune globulin IV (manungsa) bisa ngganggu sawetara tes serologis. Sawise administrasi imun globulin kaya anthrax immune globulin IV (manungsa), paningkatan sementara antibodi sing ditransfer kanthi pasif ing getih pasien bisa nyebabake asil positif ing tes serologis (umpamane tes Coombs). (Deleng Hemolisis ing Caution: Warnings/Precautions.)
Urinalisis sawise administrasi anthrax immune globulin IV (manungsa) bisa nyebabake glukosa mundhak. Amarga iki minangka efek transien sing dikawruhi, tes kudu diulang maneh kanggo nemtokake manawa tumindak luwih lanjut dibutuhake.
Cedera Paru Akut sing gegandhengan karo Transfusi (TRALI)
Edem paru nonkardiogenik bisa kedadeyan ing pasien sing nampa produk imun globulin, kalebu anthrax immune globulin IV (manungsa). TRALI ditondoi kanthi gangguan pernapasan sing abot, edema paru, hipoksemia, fungsi ventrikel kiwa normal, lan mriyang lan biasane kedadeyan sajrone siji nganti enem jam sawise transfusi.
Pantau panampa kanggo reaksi salabetipun paru. Yen TRALI dicurigai, tindakake tes kanggo anané antibodi anti-HLA lan anti-neutrofil ing prodhuk kasebut. TRALI bisa dikelola nggunakake terapi oksigen kanthi dhukungan ventilator sing nyukupi.
Transmisi Agen Infèksi saka Plasma Manungsa
Amarga anthrax immune globulin IV (manungsa) digawe saka plasma manungsa, bisa uga nggawa risiko nularake agen infèksi sing ditularaké getih, kalebu virus, varian Creutzfeldt. -Jakob penyakit (vCJD) agen, lan, miturut teori, penyakit Creutzfeldt-Jakob (CJD) agen. Ora ana kasus panularan penyakit virus, vCJD, utawa CJD sing digandhengake karo panggunaan anthrax immune globulin IV (manungsa).
Kabeh infeksi sing dianggep bisa ditularake dening produk iki kudu dilaporake dening dokter utawa panyedhiya perawatan kesehatan liyane menyang Emergent BioSolutions ing 800-768-2304.
Populasi Spesifik
KandhutanOra ana data manungsa kanggo nemtokake anane utawa ora ana risiko sing ana gandhengane karo anthrax immune globulin IV (manungsa).
LaktasiOra ana data sing bisa ditaksir. ana utawa ora ana anthrax immune globulin IV (manungsa) ing susu manungsa, efek ing bayi sing disusui, utawa efek ing produksi / ekskresi susu.
Panggunaan PediatrikKeamanan lan efektifitas anthrax immune globulin IV (manungsa) ing populasi pediatrik (umur ≤16 taun) durung diteliti. Skala allometrik digunakake kanggo nurunake regimen dosis kanggo nyedhiyakake pasien pediatrik kanthi paparan sing bisa dibandhingake karo paparan sing diamati ing wong diwasa sing nampa 420 unit lan 840 unit. Dosis kanggo pasien pediatrik adhedhasar bobot awak.
Panggunaan GeriatrikKeamanan lan efektifitas anthrax immune globulin IV (manungsa) ing populasi geriatrik (>65 taun) durung diteliti.
Insufficiency RenalGunakake anthrax immune globulin IV (manungsa) kanthi ati-ati ing pasien kanthi tingkat insufisiensi ginjel sing wis ana sadurunge lan ing pasien sing duwe risiko ngalami insufisiensi ginjel (kalebu, nanging ora diwatesi karo diabetes mellitus, umur). luwih saka 65 taun, nyuda volume, paraproteinemia, sepsis, lan pasien sing nampa obat nefrotoksik sing dikenal) lan menehi infus kanthi tingkat minimal sing bisa ditindakake.
Pasthekake yen pasien ora nyuda volume sadurunge anthrax immune globulin IV (manungsa). ) infus. Aja ngluwihi tingkat infus sing disaranake, lan tindakake jadwal infus kanthi rapet. (Deleng Dosis lan Administrasi.)
Gunakake ing Populasi ObesitasKeamanan lan efektifitas anthrax immune globulin IV (manungsa) ing populasi lemu durung diteliti.
Efek Samsaya Awon
Reaksi salabetipun sing paling umum kanggo anthrax immune globulin IV (manungsa) diamati ing> 5% sukarelawan sehat ing uji klinis yaiku sirah, nyeri situs infus lan bengkak, mual, lan nyeri punggung.
Apa obatan liyane bakal mengaruhi Anthrax Immune Globulin IV (Human)
Obat Spesifik
Iku penting panyedhiya label pabrikan dikonsultasi kanggo informasi sing luwih rinci babagan interaksi karo obat iki, kalebu kamungkinan pangaturan dosis. Sorotan interaksi:
Deleng label produk kanggo informasi interaksi obat.
Disclaimer
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