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ABSTRACT
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/HWDMHPLQLORåHOHWRGUHJLVWUDFLMHSUYLK bioloških zdravil rekombinantnega izvora ter ra- VWQHJDKRUPRQDLQLQ]XOLQD7UHQXWQRMHUHJLVWULUD- QLKYHþNRWUHNRPELQDQWQLK]GUDYLOQLKXþLQNR- YLQ SUYH JHQHUDFLMH LQ YHþ NRW UHNRPELQDQWQLK ]GUDYLOGUXJHJHQHUDFLMH%LRORãND]GUDYLODXSR- rabljamo za zdravljenje raka ter imunskih in vne- WQRSRJRMHQLKEROH]QL96ORYHQLMLMH]D]GUDYOMHQMH RGREUHQLKYHþNRWELRORãNLK]GUDYLO1DVYHWRYQL UDYQLVRYOHWXQDMYHþXSRUDEOMDOLHWDQHUFHSW LQÀLNVLPDELQULWXNVLPDE
%LRORãND ]GUDYLOD VR ]HOR XþLQNRYLWD LPDMR HGLQ- VWYHQR WDUþR Y PROHNXODUQL SDWRJHQH]L RKUDQMDMR LPXQRVWL]SUHWHNORVWLRPRJRþDMRXþLQNRYLWHLPXQ- ske odzive v obdobju uporabe in se hitro odstranijo L]WHOHVD%LRORãNDLQELRORãNLPSRGREQD]GUDYL- ODVHPHGVHERMVWUXNWXUQRUD]OLNXMHMR=DUDGLNRP- SOHNVQHVHVWDYH]DSOHWHQLKSRVWRSNRYSURL]YRGQMH analize ter shranjevanja in rokovanja moramo z nji- mi ravnati še bolj previdno in dosledno kot z zdra- YLOLNLYVHEXMHMRNHPLMVNRVLQWHWL]LUDQHXþLQNRYLQH
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Metotreksat je na voljo v obliki tablet in kot razto- SLQD]DLQMLFLUDQMH%ROQLN]GUDYLORMHPOMHOHHQNUDW WHGHQVNRYHGQRLVWLGDQYWHGQX1DþLQGDMDQMDLQ RGPHUHN GRORþL ]GUDYQLN QD RVQRYL EROQLNRYHJD NOLQLþQHJDVWDQMD7DEOHWHVHEROMHUHVRUELUDMRþHMLK EROQLN]DXåLMHQDWHãþHLQ]YRGR=GUDYLORYREOL- NLDPSXO]DLQMLFLUDQMHODKNRYEUL]JDPRSRGNRåR NRWLQ]XOLQVNHLQMHNFLMHSULVODGNRUQLKEROQLNLKDOL YPLãLFR]HORUHGNRYYHQR*ODYQHSUHGQRVWLPH- totreksata v obliki raztopine za injiciranje so boljša
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pri otrocih uporabljamo za zdravljenje bolezen- skih stanj s pomanjkanjem protiteles zaradi okvare LPXQVNHJDVLVWHPD0HKDQL]PLGHORYDQMD,9,*ãH vedno niso povsem pojasnjeni in se verjetno razli- NXMHMR JOHGH QD EROH]HQVNR VWDQMH 8þLQNRYLWR MLK uporabljamo pri nekaterih avtoimunskih in revmat- VNLKEROH]QLK'DMHPRMLKYLQWUDYHQVNLLQIX]LMLSR UD]OLþQLKVKHPDKRGYLVQRRGEROH]QL
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9 VYHWX åH YHþ OHW L]YDMDMR LQWUDYHQVNR ]GUDYOMH- QMH]DQWLELRWLNLQDGRPX7RSRPHQLGDVRYHOLN del odgovornosti prevzeli tako zdravstveni delavci NRWWXGLVDPLEROQLNLR]QMLKRYLVYRMFL3UYLRSLVL LQWUDYHQVNHJD ]GUDYOMHQMD L]YLUDMR åH L] OHWD
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3ULRGORþDQMXRYNOMXþLWYLEROQLNDV&)YSURJUDP zdravljenja z intravenskimi antibiotiki na domu upoštevamo naslednja merila:
$OLMHEROQLNYGRYROMGREUHPVWDQMX]DRGSXVW iz bolnišnice?
$OL LPD EROQLN Y GRPDþHP RNROMX XVWUH]QR SRGSRUR NL ER ]DJRWRYLOD XVWUH]QR GDMDQMH LQWUDYHQVNLK ]GUDYLO WM SUDYRþDVQR SUDYLOQR in v celoti?
$OLLPDEROQLNSRGSRURYGRPDþHPRNROMXY VPLVOX]DJRWDYOMDQMDUHGQH¿]LRWHUDSLMHSUDYLO- QHJDSUHKUDQMHYDQMD]DGRVWQHJDYQRVDWHNRþLQ LQGRYROMSRþLWND"
$OLEROQLNLQDOLGUXåLQDODKNR]DJRWDYOMDGR- EURVNUE]DLQWUDYHQVNLNDQDODOLFHQWUDOQLåLOQL NDWHWHU SUHSR]QDYD QHåHOHQH XþLQNH ]GUDYLOD LQYHNDNRXNUHSDWLþHVHSRMDYLMR"
$OL EROQLN LQDOL GUXåLQD VLFHU GREUR VRGHOXMH v procesu zdravljenja in upošteva ostalo pred- pisano zdravljenje?
$OLEROQLNGUXåLQDGREURUD]XPHRGJRYRUQRVWL in tveganja ob izvajanju intravenskega zdra- YOMHQMDQDGRPX"
3UYHL]NXãQMHVRSRND]DOHGDVREROQLNLLQQMLKRYL VWDUãLVWDNãQLPQDþLQRP]GUDYOMHQMD]HOR]DGRYROM- QL YHQGDU MH ]DQMH WXGL GRGDWQR EUHPH =HOR SR- PHPEQRMHGDJODYQLUD]ORJ]GUDYOMHQMDQDGRPX ni pomanjkanje bolniških postelj ali zmanjšanje EROQLãQLþQLKVWURãNRYDPSDNUHVQLþQDåHOMDEROQLND LQ GUXåLQH SR VDPRVWRMQHP ]GUDYOMHQMX RE KNUDWQL RFHQL]GUDYVWYHQLKGHODYFHYGDVRWDNãQHJDQDþLQD ]GUDYOMHQMD]PRåQLLQVSRVREQL
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%ROQLNX R] VWDUãHP SUHGVWDYLPR QDþUW ]GUD- YOMHQMD
2FHQLPRQMLKRYR]PRåQRVW]DL]YDMDQMHLQWUD- YHQVNHJDDQWLELRWLþQHJD]GUDYOMHQMDQDGRPX
3ULSUDYLPR SULSRPRþNH R] PDWHULDO ]D LQWUD- YHQVNRGDMDQMHDQWLELRWLNRY
3UDNWLþQR SULNDåHPR SULSUDYR LQ GDMDQMH DQ- WLELRWLND
6WDUãL R] EROQLN VNXSDM ] PHGLFLQVNR VHVWUR pripravijo intravenski antibiotik in ga vbri- ]JDMR
2FHQLPR]PRåQRVWL]DL]YDMDQMHLQWUDYHQVNHJD DQWLELRWLþQHJD]GUDYOMHQMDQDGRPX
8þQL SURJUDP L]GHODPR Y REOLNL WDEHOH KLJL- HQD ELYDOQHJD RNROMD SULSUDYD SULSRPRþNRY
]D SUHEUL]JDYDQMH SULSUDYD SULSRPRþNRY ]D GDMDQMHDQWLELRWLNDSULSUDYD]GUDYLOD±EROXV SULSUDYD]GUDYLOD±LQIX]LMDQHåHOHQLXþLQNL±
RSD]RYDQMH SUHSR]QDYDQMH LQ XNUHSDQMH GR- VHåHQD VWRSQMD ]QDQMD ± EROQLN MH WHRUHWLþQR VH]QDQMHQ]YVHELQREROQLNMHSUDNWLþQRVH]QD- QMHQ]YVHELQREROQLNSRVWRSHNL]YHGHVDP
Ponovno se pogovorimo o dajanju antibiotikov LQQHåHOHQLKXþLQNLK]GUDYLOD
7HPHOMLWR VH SRJRYRULPR R Y]GUåHYDQMX LQ- WUDYHQVNH NDQLOH LQ XNUHSDQMX þH PRUGD QH GHOXMHSUDYLOQR
3UDNWLþQR SUHGVWDYLPR XSRUDER (SL3HQD® v SULPHUXDQD¿ODNWLþQHUHDNFLMH
%ROQLNX R] VWDUãHP L]URþLPR SLVQD QDYRGLOD RSULSUDYLLQWUDYHQVNHJDDQWLELRWLND
3UHYHULPRUD]XPHYDQMHQDYRGLO
=QDQMH UHGQR SUHYHUMDPR RE NRQWUROQLK SUH- JOHGLK
8þHQMHSULSUDYHLQGDMDQMDDQWLELRWLNDSUHNRLQWUD- YHQVNHJD NDQDOD SRWHND LQGLYLGXDOQR LQ SRVWRSQR WMSRNRUDNLK7RYSUDNVLSRPHQLGDEROQLNQH- NDM þDVD SUHMHPD DQWLELRWLþQR ]GUDYOMHQMH Y EROQL- ãQLFLSRGQDG]RURPýHQLPDWHåDYSULSUHMHPDQMX DQWLELRWLNDODKNRSULþQH]XþHQMHP]DVDPRVWRMQR GDMDQMH
%ROQLNSUHMPHWXGLQDWDQþQDQDYRGLODNDNRXNUHSD- ti ob morebitnem pojavu naslednjih znakov:
L]SXãþDM
VODERVW
SRYLãDQDWHOHVQDWHPSHUDWXUD
EUXKDQMH
QDQDYDGQLREþXWNL
WHåNRGLKDQMH
RWHNOLQDRNURJYUDWX
Ob pojavu katerega koli od naštetih znakov dajanje zdravila takoj prekinemo in stopimo v stik z zdrav- QLNRPR]SRNOLþHPRQXMQRPHGLFLQVNRSRPRþQD WHOHIRQVNRãWHYLONR
7UDMDQMHDQWLELRWLþQHJD]GUDYOMHQMDYHGQRSUHGSLãH ]GUDYQLN PHGWHP NR PHGLFLQVND VHVWUD SULSUDYL PDWHULDOLQ]GUDYLOD
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Prednosti:
QDG]RUQDGSUHMHPDQMHP]GUDYOMHQMD
VSUHPOMDQMH]GUDYVWYHQHJDVWDQMD
GDMDQMH]GUDYLOQDGDOMãHREGREMH
QDG]RURYDQDSULSUDYD]GUDYLOD Slabosti:
SRJRVWHRGVRWQRVWLL]ãROHLQVOXåEH
QXMQRVWNRULãþHQMDGRSXVWDVWDUãL
HNRQRPVNLUD]ORJLL]RVWDQNLL]VOXåEHVWURãNL SUHYR]D
L]SRVWDYOMHQRVWEROQLãQLþQLPRNXåEDP
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Prednosti:
enakomerna koncentracija imunoglobulinov v NUYL
UHGQRRELVNRYDQMHãROHLQVOXåEHEUH]L]RVWD- MDQMD
QLåMLVWURãNL
PDQMãDL]SRVWDYOMHQRVWEROQLãQLþQLPRNXåEDP Slabosti:
QHQDG]RURYDQRGDMDQMH]GUDYLOD
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