Die Struktur von Tadalafil erlaubt eine selektive Bindung an die Bindungsstelle der PDE5 und minimiert gleichzeitig die Interaktion mit PDE6, was visuelle Nebenwirkungen einschränkt. Seine Verteilung im Organismus erfolgt breit, wobei das Verteilungsvolumen etwa 63 Liter beträgt. Über 90 % des Wirkstoffs sind an Plasmaproteine gebunden. Die Wirkung bleibt unabhängig von der Nahrungsaufnahme konstant. Der Abbauweg über CYP3A4 kann durch Hemmer wie Ritonavir oder Ketoconazol verlangsamt werden, was die Plasmakonzentrationen deutlich erhöht. In diesem Kontext wird cialis 20mg preis häufig in Bezug auf pharmakokinetische Wechselwirkungen erwähnt.

Jcc.hhsc.ca

25/01/2013CCO Eligibility Form Required ¨ Grey STR
CLINICAL MONITORING:
CISPLATIN-ETOPOSIDE Chemotherapy
- Oral examination upon patient complaint of a sore mouth.
CISPLATIN
1. Asymptomatic; loss of deep tendon reflexes or paresthesia (including tingling) but not interfering with function 2. Sensory alteration or paresthesia (including tingling), interfering with function, but not interfering with ADL 3. - Mix in 500mL bag Normal Saline; Infuse over 60 minutes.
Sensory alteration or paresthesia interfering with ADL 4. Disabling 5. Death ETOPOSIDE
1. Asymptomatic, detected on exam/testing only 2. Symptomatic, not - Dose < or =200mg, mix in 500mL Normal Saline; Infuse over 30-60
minutes.
3. Symptomatic, interfering with ADL 4. Life-threatening; disabling 5. - Dose > 200mg, mix in 1000mL Normal Saline; Infuse over 1 to 2 hours.
- Adjust rate if blood pressure drops.
ANTIEMETIC PRE-CHEMO REGIMEN:
- Give Etoposide BEFORE Cisplatin, to hydrate patient.
REPEAT EVERY 21 DAYS For a Total of 4 Cycles - Ondansetron 8mg PO/IV or Granisetron 1mg PO/IV PATIENT VISITS and APPOINTMENT TYPE:
ANTIEMETIC TAKE-HOME REGIMEN:
Level B/C
HYDRATION:
- Ondansetron 8mg PO BID for 2-3 days, or Granisetron 1mg PO 12 hours post chemotherapy, then 2mg PO OD for 2-3 days - Infuse 1000mL Normal Saline with 20mEq Potassium Chloride IV over 1
hour on Days 1-2.
Concurrent:
TOXICITIES:
- Physician may order 250mL of 20% Mannitol solution (50G Mannitol) IV. Hematologic
Infuse through sidearm concurrent with Cisplatin (may give Furosemide 1. If ANC < 1.5 x 109/L, or if PLT < 75 x 109/L, HOLD dose for 1 week.
Renal Failure
1. If CrCl = 0.5-1.0mL/sec, or SrCr = 136-185umol/L, REDUCE Cisplatin to - Infuse 500mL Normal Saline with 10mEq Potassium Chloride IV (2G
50% dose, and Etoposide to 75% dose.
Magnesium Sulfate may also be ordered) over 1 hour after Cisplatin on Days 2. If CrCl < 0.5mL/sec, or SrCr > 185umol/L, OMIT Cisplatin dose.
3. If CrCl < 0.2mL/sec, REDUCE Etoposide to 50% dose.
Hepatic Dysfunction
Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
1. If T.Bili = 26-51umol/L, or AST = 60-180 IU/L, REDUCE Etoposide to 25%
- WBC HB PLT ANC Cr Urea
2. If T.Bili = 52-85umol/L, REDUCE Etoposide to 50% dose.
Test Notes:
3. If T.Bili > 85umol/L, or AST > 180 IU/L, OMIT Etoposide dose.
- Baseline & routine renal function tests, especially if there are other FORMULAE:
Male: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)] Female: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)] x 0.85 Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
- WBC HB PLT ANC Cr Urea
Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose
- WBC HB PLT ANC Cr Urea

Source: http://jcc.hhsc.ca/workfiles/PHARMACY/CN-CISP-ETOP.pdf