After static injection of yew alcohol, blood pressure dropped to 70/40mmHg, the culprit is...

Case review
patient male, 59 years old, right lung adenocarcinoma after surgery to receive yew alcohol and cisplatin chemotherapy (TP program)Before chemotherapy 12, 6h injections of dexamethasone 10 mg, 30min intramuscular injection of isopropion 30 mg before chemotherapyintravenous drip of yew alcohol about 90min burst of breathing difficulties, panic, red skin, blood pressure dropped to 70/40mmHg (1mmHg - 0.133KPa)the process
Dexametisone 10mgimmediately given to the patient dexamethasone 10mg intravenously, 20min after no remissionmupper nylon 40mggiven to the patient metathrow nylon 40mg intravenous injection, while dopamine boost, 10min after the patient's symptoms slightly alleviated, but the complaint continued to panic50mgbed next to the electrocardiogram ventricular titcardi, ventricle rate 144 times /min, 50mg intravenous lytokainAfter 10min, the patient panic, breathing difficulties relief, electrocardiogram heart rate into sinus tashimicentContinue to give oxygen absorption, desensitization and other treatmentA total of 11d were hospitalized, the patient did not have a arrhythmia, the condition was stable dischargeWhy do pre-treated why still have an allergic reaction? The description of yew alcohol injections states that "for the prevention of severe allergic reactions, preventive medication may be given prior to the treatment of this drug: 12h before treatment and 6h oral dexamethasone 20mg before treatment, or 30-60min intravenous drips of dexamethasone 20 before treatment mg; give or inject 50 mg of phenhylamine (or its equivalent) in the 30-60min veins before treatment; 30-60min intravenous dintin 300mg or renittin 50mg before treatment cases, patients were given 10 mg of dexamethasone before chemotherapy, which the pharmacist believed did not reach an effective preventive dose, resulting in the occurrence of sequoia allergy Doctors should strictly follow the instructions when giving medication to patients, so as not to cause unnecessary medication errors what other chemotherapy drugs can cause cardiac toxicity? The chemotherapy drugs with cardiac toxicity are classified and summarized in the table below Table 1 Heart toxicity of chemotherapy drugs
difference between yew alcohol injection, yew alcohol liposome and albumin yew alcohol ? In the case, the patient used yew alcohol injection, although the anti-tumor activity of yew alcohol is good, but like other anti-tumor drugs, the drug's role site selection is poor, the recognition of normal cells is weak Due to its poor water solubility, Cremophor EL oil (Cremophor EL) needs to be added to help dissolve Cremophor EL can departicles, release histamines, or activate tonics leading to serious adverse reactions, such as allergic reactions and neurotoxicity Therefore, desensitization is required before the injection is used Cremophor EL can also form tiny particles in the blood that encase the yew alcohol molecule, affecting the spread of drug molecules to tissues and affecting anti-tumor effects At present, the use of non-assisted solvent sequoia on the new carrier of the medicine has obtained preliminary results, including yew alcohol lipids and injection of albumin yew alcohol the of yew alcohol liposomes The lipophilic body of yew alcohol changed the solute of yew alcohol to avoid the toxic side effects of polyoxyethie-based castor oil compound lysocoin It is a micro-follicle formed by encased in the lipid-like bimolecular layer, and the drug powder is buried in lipid particles this particle has a cell-like structure that enters the body and is mainly swallowed by the mesh endothelial system to activate the body's autoimmune function And change the distribution of the enveloped drug in the body, so that the drug mainly in the liver, spleen, lung and bone marrow and other tissue organs, so as to improve the treatment index of the drug, reduce the therapeutic dose of the drug and reduce the toxicity of the drug, improve patient tolerance injected with albumin yew alcohol Injecting with albumin yew alcohol is a new type of yew alcohol formulation of nanoparticles made of yew alcohol and albumin, with an average diameter of 130 nm of the yew alcohol particles bound with albumin The biological properties of albumin as a natural carrier of human hydrophobic molecules increase the distribution of drugs in tumor cells and reduce allergic reactions caused by the use of organic solvents such as polyoxyethylene castor oil pre-treatment treatment that does not need to prevent allergic reactions before the drug is used, and at the same time improves the maximum tolerable dose of yew alcohol and the absorption, transport and drug utilization in the human body, shortening the drip time The pretreatment and usage dosage of yew alcohol injection, yew alcohol lipid and albumin yew alcohol were compared with the following table Table 2 the pretreatment and usage of different carriers of yew alcohol is anti-tumor drugs cause heart toxicity the American Heart Assessment Commission defines cardiac toxicity of anti-tumor drugs as follows: (1) is a significant reduction in the overall function or ventricular movement of cardiomyopathy, and a decrease in the left ventricular blood aemia score (2) symptoms associated with congestive heart failure (CHF) (3) 3rd heart tone Ben Ma law, tastotic speed and other CHF-related signs (4) Left ventricular blood fraction (LVEF) decreased by 5% and 55% absolute value than the baseline, accompanied by CHF symptoms or signs, or LVEF decreased by 10% and absolute value of 55%, no symptoms or signs, and met 1 of them can be diagnosed cardiotoxicity induced by anti-tumor drugs includes left ventricular dysfunction, arrhythmia, coronary artery disease, and valve disease, which can be further developed into heart failure anti-tumor drugs cardiac toxicity and mechanism can induce cardiac toxicity of anti-tumor drugs are mainly anti-cyclotoxic drugs, alkaneagents, anti-cell microtubule agents, anti-metabolic classes, monoclonal antibodies, small moleculety tyrosine kinase inhibitors 1 The main mechanism of cardiac toxicity caused by the 1 the cyclocycling drugs the cyclotropic drugs is the production of iron-mediated reactive oxygen clusters and the promotion of oxidative stress in the heart muscle The steroid drug chelates the iron ions trigger the production of oxygen free radicals, especially hydroxyfree free radicals, resulting in oxidation of myocardial cell membrane lipids and damage to myocardial mitochondrial DNA 2 alkane agent
alkane agent mainly includes cyclophosphamide, isocyclic amide These drugs bind to negatively charged DNA sites, causing DNA strands to break and crosslink, alter the structure and function of tumor cells, and inhibit their proliferation myocardial toxicity mechanism is mainly related to toxic metabolites causing endothelial cell damage and DNA basekylation damage DNA replication and transcription processes 3 The cardiac toxicity of the of platinum is characterized by tachycardia and cardiac dysfunction Its production mechanism is mainly related to cytotoxic ity, oxidative stress and inflammation 4 Anticellular microtubule the cardiac toxicity of such drugs is often manifested in arrhythmia, and there are a few cases of thrombosis, myocardial ischemia, CHF, myocardial infarction Arrhythmia caused by yew alcohol may be associated with the release of a large amount of histamine, which affects the autonomic rhythm of the heart and heart conduction 5 Anti-metabolic drugs fluorouriche type of cardiac toxicity is second only to the ring, the most common manifestation of chest pain, can also appear arrhythmia, asymptomatic electrocardiogram change, occasionally myocarditis, heart failure, serious cases can appear cardiac shock and sudden death it may occur in a drug that causes coronary artery vascular spasms, direct damage to vascular endothelial cells, and direct damage to myocardial cells with metabolites that are toxic to the heart 6 The cardiotoxicity of the targeted drug quto-bead resistance was mostly manifested in asymptomatic LVEF decline, and in a few cases chF The incidence of meta-bead monostyrotoxicity was positively correlated with the time of use of the drug, and the incidence of combined yew alcohol, cyclocyclic chemotherapy group, advanced age group, and combined metabolic basic disease group were higher than that of single-use quortodad monoantigen group the cardiac toxicity of bevazumab is mainly hypertension, CHF, a few will occur myocardial infarction Hypertension is its most common cardiac toxicity response, which can occur at any stage of treatment and is dose-related testing of cardiac toxicity actively and effectively monitor ingestion of heart function in patients, helping to guide clinical use, optimize treatment options (chemotherapy/targeted drugs, dose intensity and density, etc.), and minimize the incidence and degree of cardiac toxicity as far as possible without affecting anti-tumor efficacy at present, there are many methods to monitor cardiac toxicity, including electrocardiogram, echocardiogram, endocardiac biopsy, biochemical markers and so on the prevention of cardiac toxicity optimization programme: control of drug doses, such as dojoobi star cumulative dose of 550 mg/m2, table soft ratio star cumulative dose of 900 mg/m2 Changing the route of administration, such as continuous intravenous infusion of amycin 96h, significantly reduced cardiotoxicity than intravenous injection, without affecting the efficacy Changing drug types, such as liposome polysofe stars, can effectively reduce cardiac toxicity right propion (DZR) is the only drug that is effective in preventing cardiac toxicity caused by cyclotropicdrugs In order to effectively prevent cardiac toxicity caused by cyclocyclic drugs, the right acryamine should be used in combination before the first use of the cyclotropic serotonin, the dose ratio of right amine and cyclocyclic cyclophium should be 10-20:1 right propofamine with a special solute sodium lactic acid configuration, then with 0.9% sodium chloride or 5% glucose injection diluted to 200 ml, rapid intravenous infusion, 30 minutes after the drip, drip immediately after the delivery of the ring drug treatment of cardiac toxicity the U.S ACC/AHA Adult Slow Heart Failure Diagnostic Guidelines, recommends that most heart failure patients use three types of drugs routinely: angiotensin conversion enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBS) and beta-receptor blockers because of heart failure/cardiomyopathy caused by cyclocyclic drugs accompanied by rapid arrhythmia, in the treatment of celiac disease caused by the drug, the clinical use of beta-blockers to treat the disease other heart protectors, including coenzyme Q10, zocanitine, N-acetylcysteine, antioxidants, and other iron chelating agents (such as deferrosand and EDTA), may also have some heart protection effect, but further study is needed to prevent cardiotoxicity caused by cyclocycling drugs Meta analysis showed that coenzyme Q10, zocanitine, N-acetyl cysteine and so on for cyclochemotherapy chemotherapy has no obvious heart protection effect, only right acryamine can benefit patients significantly, the incidence of heart failure significantly reduced author: Blue Gao-shuang Source: the Medical Oncology Channel