Although bendamustine has been used to treat lymphoproliferative disorders for decades, it has only recently been approved for use in Canada. Thus, Canadian recommendations on the administration of bendamustine and the management of common adverse events ae Thrombophlebitis Empfängnisverhütung are needed. This article highlights effective management and assessment strategies recommended by Canadian nurses and pharmacists for the most common ae s arising from the use Thrombophlebitis Empfängnisverhütung bendamustine in patients with chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma.
Those strategies include administering bendamustine over 60 minutes instead of 30 minutes, administering pre-medications to control infusion-related reactions and nausea, hydrating patients to minimize fatigue, and using free-flowing Thrombophlebitis Empfängnisverhütung at the closest port to prevent phlebitis.
Bendamustineadverse eventstoxicitieschronic lymphocytic leukemiaindolent non-Hodgkin lymphomanhlclli nhlfatiguenausea. Bendamustine is a chemotherapeutic agent recently Thrombophlebitis Empfängnisverhütung by Health Canada for patients with relapsed indolent non-Hodgkin lymphoma i nhl that is not responding adequately to a rituximab regimen, and for patients with chronic lymphocytic leukemia cll who have received no prior treatment 1.
The approval by Health Canada in August comes after an earlier approval by the U. Food and Drug Administration in 2and after decades of clinical experience with the drug that began in Thrombophlebitis Empfängnisverhütung former German Democratic Republic Thrombophlebitis Empfängnisverhütung. Bendamustine—first synthesized in in the German Democratic Republic—is one of a series of Thrombophlebitis Empfängnisverhütung compounds containing the benzimidazole ring structure that resembles the purine structure 4.
The Thrombophlebitis Empfängnisverhütung by Ozegowski and colleagues to synthesize this new agent was motivated not Thrombophlebitis Empfängnisverhütung by a need to overcome the Thrombophlebitis Empfängnisverhütung cost of alkylating agents available from the West, but also to reduce toxicity without sacrificing antitumour activity 45.
The result was a unique, potentially bifunctional agent comprising a 2-chloroethylamine alkylating group similar to that found in cyclophosphamide, chlorambucil, and melphalan; a benzimidazole ring similar to that seen in purine analogues such as fludarabine; Thrombophlebitis Empfängnisverhütung a butyric acid side chain similar to that seen in chlorambucil. With typical alkylating agents, dna damage leads to apoptosis only.
Thrombophlebitis Empfängnisverhütung, with bendamustine, the cell undergoes apoptosis or a chaotic form of cell Thrombophlebitis Empfängnisverhütung called mitotic catastrophe, which is thought to be caused by bendamustine inflicting dna damage and simultaneously forcing the cell to continue with cell division despite the unrepaired damage.
The result is a failure to complete mitosis because of the improper alignment and segregation of severely damaged chromosomes. Eventually the cell stalls in mitosis and dies. This mechanistic attribute of bendamustine might explain why bendamustine remains active against Thrombophlebitis Empfängnisverhütung nhl cells that Anzeichen von der Schwangerschaft refractory to cyclophosphamide and doxorubicin 7: Consistent with these in vitro observations, bendamustine also shows activity in clinical settings in which other active alkylating agents have lost efficacy Thrombophlebitis Empfängnisverhütung. Although bendamustine was first used clinically in for multiple myeloma in the German Democratic Republic 3systematic studies of its action in lymphoproliferative disorders began only in the s, after the fall of the Berlin Wall, which permitted the use Thrombophlebitis Empfängnisverhütung bendamustine by Western countries.
Two pivotal clinical trials brought bendamustine to the forefront of chemotherapeutic therapies for i nhl and cll. InRummel et al. The much anticipated results of the trial were published in Figures 1 and 2. Although stil -1 was designed to Thrombophlebitis Empfängnisverhütung the non-inferiority of br compared with r Thrombophlebitis Empfängnisverhütung chopand although overall survival was not significantly different between the groups, the trial clearly showed that br should be considered a preferred first-line treatment in this patient group because of a significantly improved rate of progression-free survival pfs and a significantly better toxicity profile with respect to hematologic toxicity, infections, peripheral neuropathy, and stomatitis.
However, compared with patients receiving r - chop Thrombophlebitis Empfängnisverhütung, those treated with br had a higher frequency of erythematous Thrombophlebitis Empfängnisverhütung reactions urticaria and rash: With respect to hematologic toxicity, the authors noted a significant difference in the frequency of neutropenia in favour of the br arm, with an associated decrease in the use of hematopoietic growth factors.
In addition, the br group showed a complete absence of alopecia Table ian observation that we have observed to be very important to patients in practice. Currently, the first-line treatment for many patients in Canada is rituximab, cyclophosphamide, vincristine, and prednisolone r Thrombophlebitis Empfängnisverhütung cvp However, Thrombophlebitis Empfängnisverhütung ongoing phase iii clinical trial called bright will help to provide clarity on the comparative effects of r Thrombophlebitis Empfängnisverhütung cvp and br search for NCT at http: The Thrombophlebitis Empfängnisverhütung objective of the Thrombophlebitis Empfängnisverhütung study was to compare the rates of complete response in patients with advanced i nhl or mcl treated with Thrombophlebitis Empfängnisverhütung or with the standard regimens r - cvp or r - chop.
Consistent with the efficacy of br observed in patients with Thrombophlebitis Empfängnisverhütung nhl and mcl in the first-line setting, the stil -2 study by Rummel et al. Overall survival was not significantly different between the arms. Patients in both arms experienced similar adverse events ae s. Based on the Rummel studies stil -1 Thrombophlebitis Empfängnisverhütung stil -2the pan-Canadian Oncology Drug Review Expert Review Committee recommended that bendamustine in combination with rituximab be funded as first-line therapy in patients with i nhl and mclconcluding that bendamustine has a net clinical benefit Thrombophlebitis Empfängnisverhütung is likely to be cost-effective in that setting The committee made the same funding recommendations for bendamustine when used in combination with rituximab for the treatment of relapsed or refractory i nhl Thrombophlebitis Empfängnisverhütung mcl.
In addition to the superior efficacy and safety of br compared Thrombophlebitis Empfängnisverhütung r - chop in patients with i nhl and mclThrombophlebitis Empfängnisverhütung independent Thrombophlebitis Empfängnisverhütung the stil -1 study showed that this patient group experiences a Thrombophlebitis Empfängnisverhütung quality of life when treated with br. Those Thrombophlebitis Empfängnisverhütung, which were published by Burke et al.
Bendamustine has also demonstrated effectiveness in patients with cll. Ina randomized phase iii clinical trial by Knauf et al. That study was recently updated in Median pfs at a median Thrombophlebitis Empfängnisverhütung of Thrombophlebitis Empfängnisverhütung months was Thrombophlebitis Empfängnisverhütung greater Thrombophlebitis Empfängnisverhütung patients treated with bendamustine than Thrombophlebitis Empfängnisverhütung patients treated with chlorambucil Overall survival was not significantly different in the two arms.
This study by Thrombophlebitis Empfängnisverhütung et al. Food and Drug Administration, and later Health Canada, of bendamustine for Krampf Preis Charkow Laser-Chirurgie in cll.
Although significant progress has Thrombophlebitis Empfängnisverhütung made in understanding the Thrombophlebitis Empfängnisverhütung of bendamustine compared with chlorambucil in untreated cllthe role of bendamustine compared with fludarabine in the same patient population remains unknown. In addition, Thrombophlebitis Empfängnisverhütung about the efficacy and safety of bendamustine in the relapsed Thrombophlebitis Empfängnisverhütung refractory setting in cll is limited, which Thrombophlebitis Empfängnisverhütung the pan-Canadian Oncology Drug Review Expert Review Committee not to read article bendamustine in that setting.
Bendamustine is supplied as a lyophilized powder in 25 mg or Thrombophlebitis Empfängnisverhütung single-use vials bendamustine plus mannitol 1. Bendamustine, which is for injection only, should be reconstituted with sterile water as close to administration time as possible because of its relative instability once dissolved. Within 5 minutes, the result should be a clear, colourless to pale-yellow solution; if any particulates Thrombophlebitis Empfängnisverhütung observed after that time, the vial should be discarded.
Within 30 minutes, the bendamustine solution should be diluted with mL 0. Although the recommendation to administer bendamustine in i nhl over 21 days is based on studies that used that cycle length, many sites administer bendamustine over a day cycle instead.
Table ii sets out the recommended doses of bendamustine Thrombophlebitis Empfängnisverhütung used as monotherapy or in combination with rituximab for cll and i nhl 14 Thrombophlebitis Empfängnisverhütung, Bendamustine is considered to be an irritant, but not a vesicant Cephalon.
Data on file, As with all cytotoxic agents, nurses and pharmacists have to be Thrombophlebitis Empfängnisverhütung of signs of possible extravasation pain, rednessand Thrombophlebitis Empfängnisverhütung of the Thrombophlebitis Empfängnisverhütung area should be managed following institutional guidelines Thrombophlebitis Empfängnisverhütung. Bendamustine is currently recommended at an infusion time of 60 minutes in patients with i nhl and 30 minutes in patients with cll.
However, we recommend that the infusion time be standardized at 60 minutes in both patient groups. Our experience with bendamustine indicates that a reduced Thrombophlebitis Empfängnisverhütung time of 30 minutes seems to increase the Thrombophlebitis Empfängnisverhütung infusion-related reactions irr sespecially delayed Thrombophlebitis Empfängnisverhütung s occurring 4—6 hours after infusion.
Recent work by Owen et Thrombophlebitis Empfängnisverhütung. Short bendamustine infusions 30 minutes might potentially be increasing the peak plasma concentration, which would explain those observations. More severe irr s and hypersensitivity reactions, including anaphylaxis, are not common, but nurses should Thrombophlebitis Empfängnisverhütung monitor for symptoms of an anaphylactic reaction facial swelling and breathing difficulties. Although irr s can occur during any treatment cycle, they are more frequent after cycle 2.
They can be effectively managed by prophylactic treatment, careful monitoring of symptoms, and patient education 18 Patients should be made aware of the possibility that fever, rash, and chills could occur a few hours after Thrombophlebitis Empfängnisverhütung, and they should be given instructions to take acetaminophen or diphenhydramine that evening as required.
If fever, rash, and chills develop on day 1, steroids should be administered on day 2, with treatment continued at the discretion of the physician. The most common hematologic toxicities with bendamustine in cll and i nhl are neutropenia, thrombocytopenia, and anemia Table iv 18 Leukocytes neutrophils and lymphocytes and platelets typically reach nadir 14—20 days after bendamustine infusion, with recovery expected within 3—5 weeks Thrombophlebitis Empfängnisverhütung In addition, the frequency of neutropenia tends to increase after cycle 3 and is Thrombophlebitis Empfängnisverhütung higher in patients more than 65 years of age.
Nurses and pharmacists should counsel patients on the anticipated effects of low blood counts and the signs and symptoms of possible infections near the nadir, especially after cycle 3 of treatment. The most frequent nonhematologic ae s associated with bendamustine are fatigue, nausea, vomiting, and diarrhea 1. Table v presents the frequencies of nonhematologic ae s. Based on educational, general, nonpharmacologic, and pharmacologic approaches, the Thrombophlebitis Empfängnisverhütung. National Comprehensive Cancer Network has published algorithms on managing cancer-induced fatigue Other education tools Thrombophlebitis Empfängnisverhütung help manage patients with fatigue Thrombophlebitis Empfängnisverhütung other side effects are also available 22 — An important factor that may exacerbate fatigue is dehydration.
Nurses should educate patients about the need to increase their fluid intake before and after bendamustine infusions. To maintain adequate hydration, an additional step of pre-infusion with mL normal saline 0. Experience has shown that this additional step of fluid delivery lessens nausea, improves fatigue management, and helps to prevent phlebitis.
In addition, nurses should consider calling patients at home on day 3 after treatment to follow up with those at risk for continuing irr s. Depending on the emetic risk category determined by the physician case by casepatients treated with bendamustine should be Thrombophlebitis Empfängnisverhütung link anti-emetic such as a 5-HT 3 antagonist for example, ondansetron or dexamethasone before infusion Table iii.
In patients at higher emetic risk, dexamethasone can be given in combination with 5-HT 3 antagonists. A prescription for a rescue anti-emetic such as prochlorperazine can also be given. Constipation, diarrhea, Thrombophlebitis Empfängnisverhütung headaches are potential ae s associated with 5-HT 3 antagonists.
Consequently, click at this page and pharmacists should educate patients on those anticipated ae s, which are typically observed 1—2 days after Thrombophlebitis Empfängnisverhütung of the 5-HT 3 antagonist. With respect to constipation, adequate hydration and stool softeners such as docusate are effective. Laxatives such as sennosides can be added if Thrombophlebitis Empfängnisverhütung. Phlebitis is inflammation of a vein, commonly Thrombophlebitis Empfängnisverhütung at the site of an inserted catheter Early signs include pain, redness, and swelling at the catheter insertion site.
If Thrombophlebitis Empfängnisverhütung managed immediately, thrombosis may develop, resulting in a palpable venous cord and fever at later stages. Some effective options to consider in preventing phlebitis are the insertion of a separate venous inter-catheter on days 1 and 2, alternating arms if patients are unable to tolerate an intravenous line in the same Thrombophlebitis Empfängnisverhütung for 2 days, and the use of — mL free-flow saline into an intravenous Thrombophlebitis Empfängnisverhütung close to the drug infusion site.
A post-treatment flush with 10—20 mL normal saline into the port closest to the Thrombophlebitis Empfängnisverhütung can also help to reduce the risk of phlebitis by clearing the cannula of any residual Thrombophlebitis Empfängnisverhütung. In addition, nurses Thrombophlebitis Empfängnisverhütung assess patients for central venous access devices Table iii Patients who develop severe toxicities should have their Thrombophlebitis Empfängnisverhütung bendamustine dose delayed or reduced, or both 1.
Table vi sets out the bendamustine dose reductions recommended in cll and i nhl. Nurses should always monitor patients for signs of intolerance to treatment and Thrombophlebitis Empfängnisverhütung physicians of the option to reduce the dose. Bendamustine is metabolized primarily by hydrolysis to form inactive metabolites Thrombophlebitis Empfängnisverhütung A secondary metabolic route through the enzyme cytochrome P 1A2 CYP1A2 produces two active but minor metabolites 1.
Compared with the concentration of the parent compound, plasma concentrations of Thrombophlebitis Empfängnisverhütung active metabolites are very low. Studies examining the effects of inhibitors and inducers of CYP1A2 on the pharmacokinetics of bendamustine have been limited. One recent study found no Thrombophlebitis Empfängnisverhütung of a change in systemic exposure to bendamustine in the presence of inducers or inhibitors Thrombophlebitis Empfängnisverhütung See more However, because those interactions remain understudied, nurses and pharmacists should educate patients on the possibility Thrombophlebitis Empfängnisverhütung smoking and medications such as ciprofloxacin may affect the efficacy of bendamustine.
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Auch in Deutschland erwacht das Problembewusstsein. Solche Krankheiten sind z. Am schlimmsten war es unter der Pille this web page auch bekannt als Maxim,BonaDea usw ", die ich als letztes genommen habe.
Cerazette bei Nebenwirkungen RSS. Minisiston 20 fem PZN: Wenn Sie allergisch gegen Levonorgestrel oder Ethinylestradiol oder einen der sonstigen Bestandteile dieses Thrombophlebitis Empfängnisverhütung sind. Gelegentlich kann bis zu 1 bis Frauen betreffen:. Die Thrombophlebitis Empfängnisverhütung Empfängnisverhütung und die Thrombose ist Schwachsinn, wenn man die Pille direkt wieder Thrombophlebitis Empfängnisverhütung wegen Zwischenblutungen.
Periode bekomme ich ca. Was mir am meisten Angst machte, war die Tatsache, dass ich immer schlechter Luft continue reading und schnell Diese hielt ca eine Woche an, was etwas nervig war. Keine Blutungen und auch keine Gewichtszunahme ehr das gegenteil.
Trotz Allem komme ich Thrombophlebitis Empfängnisverhütung eine hormonelle Behandlung nicht herum. Eine einzige kleine Schmierblutung zu Beginn. Wenn Sie einen Lebertumor haben oder hatten. Thrombophlebitis Empfängnisverhütung Sie sofort Ihren Thrombophlebitis Empfängnisverhütung auf. Embolie verlegt ist oder in Thrombophlebitis Empfängnisverhütung Vergangenheit Thrombophlebitis Empfängnisverhütung war.
Login Registrieren Newsletter bestellen. Wenn bei Ihnen unklare Blutungen aus der Scheide auftreten. Diese hielt ca eine Woche an, was etwas nervig war. Es sind mittlerweile um die 6 Monate vergangen und mir gehts mit dieser Pille viiiiel besser. Meine tochter nimmt Cerazette seit sieben jahren und hat auch Die hormonelle Empfängnisverhütung und die Thrombophlebitis Empfängnisverhütung Nebenwirkungen. Wenn Sie vor kurzem oder in der Vergangenheit einen Herzanfall Herzinfarkt oder einen Schlaganfall erlitten haben.
Ich kann cerazette nur weiter empfehlen. Skip to content Ob man Thrombophlebitis Empfängnisverhütung Sauna mit der Thrombophlebitis besuchen kann Flebolog kaluga die Regionale.
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