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    《ISPN学习》总第506期
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    《ISPN学习》总第598期
    日期:2020-03-09 21:48:58    
     
    《ISPN学习》2020年02月26日总第598期
     
     
    想提高专业英语听力吗?想边练听力边增加护理专业知识吗?Listening -- Elementary》(专业英语听力 – 初级)可助你一臂之力。
     
     
    ISPN  Review  
     
    Monoclonal Antibodies 单克隆抗体
    Monoclonal antibodies include adalimumab (Humira), alemtuzumab (Campath), basiliximab (Simulect), bevacizumab (Avastin), cetuximab (Erbitux), certolizumab (Cimzia), daclizumab (Zenapax), eculizumab (Soliris), erlotinib (Tarceva), gemtuzumab (Mylotarg), ibritumomab (Zevalin), infliximab (Remicade), natalizumab (Tysabri), omalizumab (Xolair), palivizumab (Synagis), pegaptanib (Macugen), rituximab (Rituxan), tocilizumab (Actemra), tositumomab combined with iodine-131 tositumomab (Bexxar), trastuzumab (Herceptin), and ustekinumab (Stelara).
    单克隆抗体包括阿达木单抗(修美乐)、阿仑珠单抗(坎帕斯)、巴利昔单抗(舒莱)、贝伐单抗(阿瓦斯丁)、西妥昔单抗(艾比特思)、赛妥珠单抗(希敏佳)、达珠单抗(赛尼哌)、依库珠单抗(索里瑞思)、埃罗替尼(塔西法)、吉姆单抗(麦罗塔)、替伊莫单抗(泽娃灵)、英夫利昔单抗(类克)、那他珠单抗(塔沙布里)、奥马佐单抗(索雷尔)、帕利珠单抗(西那吉斯)、培加尼布(马库根)、利妥昔单抗(瑞图宣)、托珠单抗(雅美罗)、131碘托西莫单抗(百克沙)、曲妥珠单抗(赫赛汀)和乌司妈单抗(喜达诺)。
     
    Therapeutic Actions and Indications 治疗作用和适应症

    Muromonab-CD3, the first monoclonal antibody approved for use, is a T-cell–specific antibody that is available as an IV agent. It reacts as an antibody to human T cells, disabling the T cells and acting as an immune suppressor.
    莫罗单抗-CD3是首款获准使用的单克隆抗体,为T细胞特异性抗体,IV注射。作为人T细胞抗体,莫罗单抗-CD3失T细胞失能,作用就象是免疫抑制剂。
    Muromonab is indicated for the treatment of acute allograft rejection in patients undergoing renal transplantation. It also is indicated for the treatment of steroid-resistant acute allograft rejection in those receiving heart or liver transplants.
    莫罗单抗适用于治疗肾移植病人的急性同种异体排斥,也适用于治疗以及或肝移植患者激素抵抗型急性同种异体移植排斥。
    Adalimumab, certolizumab, and infliximab are antibodies specific for human tumor necrosis factor. It keeps the inflammatory reaction in check by reacting with and deactivating the free-floating tumor necrosis factor released by active leukocytes.
    阿达木单抗、赛妥珠单抗和英夫利昔单抗是人肿瘤坏死因子特异性抗体,通过活性白细胞释放的游离-漂浮肿瘤坏死因子反应和去活化,抑制炎症反应。
    Alemtuzumab is an antibody specific for lymphocyte receptor sites.
    阿仑珠单抗是淋巴细胞受体部位特异性抗体。
    Basiliximab and daclizumab are specific to interleukin-2 receptor sites on activated T lymphocytes; they react with those sites and block cellular response to allograft transplants.
    巴利昔单抗和达珠单抗为激活的T淋巴细胞白细胞介素2受体部位特异性抗体。药物在这些受体部位起作用,阻断异体移植物的细胞响应。
    Cetuximab is an antibody specific to epidermal growth factor receptor sites. Trastuzumab also reacts with human epidermal growth factor receptor 2 (HER2), a genetic defect that is seen in certain metastatic breast cancers. It is used in the treatment of metastatic breast cancer in tumors that overexpress HER2.
    西妥昔单抗是表皮生长因子受体部位特异性抗体,曲妥珠单抗同样对人表皮生长因子受体2(HER2)起作用,HER2属于遗传缺陷,见于某些转移性乳腺癌中。药物用于治疗HER2过度表达肿瘤的转移性乳腺癌。
    Eculizumab binds to complement proteins and prevents the formation of the complement complex.
    依库珠单抗与补体蛋白质结合,阻止补体复合物的形成。
    Erlotinib, bevacizumab, pegaptanib, and tositumomab combined with iodine-131 tositumomab are effective against specific malignant receptor sites.
    埃罗替尼、贝伐珠单抗、培加尼布和131碘托西莫单抗对特异性恶性受体位点有效。
    Gemtuzumab is an antibody to CD33 sites found in acute myelocytic leukemia. It is given IV to treat the first relapse in patients 60 years of age or older who are not candidates for cytotoxic chemotherapy.
    吉妥珠单抗为急性髓细胞性白血病CD33位点抗体。IV输入,治疗60岁以上不适合行细胞毒性化疗患者的首次复发。
    Ibritumomab and rituximab are antibodies specific to sites on activated B lymphocytes.
    替伊莫单抗和利妥昔单抗为活化B淋巴细胞位点特异性抗体。
    Natalizumab is an antibody specific to surface receptors on all leukocytes except neutrophils.
    那他珠单抗为所有白细胞(中性白细胞除外)表面受体特异性抗体。
    Omalizumab is an antibody to immunoglobulin E, an important factor in allergic reactions. It has not had a great deal of success because of related respiratory adverse effects.
    奥马珠单抗为IgE抗体,IgE是所有过敏反应的一个重要因素。由于相关的呼吸系统不良效应,该药并没有大量的成功例子。
    Palivizumab is specific to the antigenic site on respiratory syncytial virus (RSV); it inactivates that virus. It is used to prevent RSV disease in high-risk children.
    帕利珠单抗为呼吸道合胞病毒(RSV)抗原位点特异性抗体,灭活该病毒。用于预防高危儿童的RSV疾病。
    Tocilizumab and ustekinumab are antibodies specific to interleukins.
    托珠单抗和乌司奴单抗为白细胞介素类特异性抗体。

    Pharmacokinetics  药代动力学

    With the exception of erlotinib (an oral agent), all of the monoclonal antibodies have to be injected. They can be given IV, IM, or SQ. Because antibodies are proteins, they are rapidly broken down in the GI tract. They are processed by the body like naturally occurring antibodies.
    除埃罗替尼(口服)外,所有单克隆抗体均须注射,可以IV、IM、或SQ。因为抗体是蛋白质,在GI道迅速分解,就象天然抗体那样被身体处理。

    Contraindications and Cautions  禁忌与注意事项

    Monoclonal antibodies are contraindicated in the presence of any known allergy to the drug or to murine products and in the presence of fluid overload. They should be used cautiously with fever (treat the fever before beginning therapy) and in patients who have had previous administration of the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration). Because of the potential for adverse effects, they should not be used during pregnancy or lactation unless the benefit clearly outweighs the potential risk to the fetus or neonate.
    下列情况禁忌单克隆抗体:已经对药物或鼠类产品过敏,存在液体过载。发烧(开始单克隆抗体治疗前先治疗发烧)和以前用过单克隆抗体(反复使用易引起严重的过敏反应)的患者慎用。鉴于不良效应可能,妊娠或哺乳期间不应使用单克隆抗体,除非使用好处明显超过对胎儿或新生儿带来的潜在风险。

    Adverse Effects  不良效应

    The most serious adverse effects associated with the use of monoclonal antibodies are acute pulmonary edema (dyspnea, chest pain, wheezing), which is associated with severe fluid retention, and cytokine release syndrome (flu-like symptoms that can progress to third-spacing of fluids and shock).
    与单克隆使用相关的最严重不良效应是急性肺水肿(呼吸困难、胸痛、哮鸣),--这与严重的液体潴留相关,和细胞因子释放综合征(流感样症状,可进而影响第三间隙液,出现休克)
    Other adverse effects that can be anticipated include fever, chills, malaise, myalgia, nausea, diarrhea, vomiting, and increased susceptibility to infection.
    可以预期的其他不良效应包括发烧、恶寒、全身乏力、肌痛、恶心、腹泻、呕吐、感染易感性增加。
    Eculizumab can lead to intravascular hemolysis with resultant fatigue, pain, dark urine, shortness of breath, and blood clots.
    依库珠单抗可以导致血管内溶血伴因之引起的疲劳、疼痛、黑尿、呼吸急促、血凝块。
    Erlotinib is reserved for patients whose disease has progressed after other therapies.
    埃罗替尼是其他疗法治疗后疾病依然进行的患者的保留药物。
    Gemtuzumab is commonly associated with fever after infusion of the drug, and it is important to make sure that the patient is well hydrated.
    吉妥珠单抗常常与药物注射后发烧存在相关性,因此,要确保患者水合充分。
    The manufacturer of natalizumab stopped marketing the drug weeks after its release because of reports of CNS complications. It was returned to the market in June 2006 with warnings about the potential for CNS complications.
    那他珠单抗制造商在该药披露几周后就停止销售,原因是有人报告CNS并发症。2006年,该药重新上市,并附CNS并发症可能警示。
     
    Vocabulary for Today   
     
    常用单克隆抗体2-1
    monoclonal – a. 单克隆的
    adalimumab – n. 阿达木单抗
    Humira – n. 修美乐
    alemtuzumab – n. 阿仑珠单抗
    Campath – n. 坎帕斯阿仑珠单抗
    basiliximab – n. 巴利昔单抗
    Simulect – n. 舒莱
    bevacizumab – n. 贝伐单抗
    Avastin – n. 阿瓦斯丁
    cetuximab – n. 西妥昔单抗
    Erbitux – n. 艾比特思
    certolizumab – n. 赛妥珠单抗
    Cimzia – n. 希敏佳
    daclizumab – n. 达珠单抗
    Zenapax – n. 赛尼哌
    eculizumab – n. 依库珠单抗
    Soliris – n. 索里瑞思
    erlotinib – n. 埃罗替尼
    Tarceva – n. 塔西法
    gemtuzumab – n. 吉姆单抗
     
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    Video  
     
    Monoclonal Antibodies
      
     
    Test  
     
    1. A 48-year-old woman with 2-year history of rheumatoid arthritis has not had sufficient relief with methotrexate alone. Her physician prescribes a biologic TNF-a inhibitor that consists of a recombinant human IgG fused to TNF-a receptor. Which of the following drugs is this?
    A. Adalimumab
    B. Certolizumab
    C. Etanercept
    D. Golimumab
    2. A 31-year-old woman presents to the clinic for follow-up of her abdominal pain. The pain has been occurring for a couple of years but has worsened recently. She is often constipated and then will have periods of diarrhea. Her pain does usually improve after a bowel movement. After multiple negative tests, the diagnosis of constipation-predominant irritable bowel syndrome is made. Which of the following is an appropriate treatment for this patient?
    A. Tegaserod
    B. Metoclopramide
    C. Ondansetron
    D. Sulfasalazine
     
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    答案
    Key to Question
     
     
    1. C: Etanercept.
    Rationale: All of the options listed are biologic TNF-a inhibitors. TNF-a is a signaling molecule that stimulates leukocyte activation, bone reabsorption, and cartilage degradation. Blocking TNF-a significantly improves symptoms of rheumatoid arthritis. Etanercept is a recombinant human IgG molecule fused to a recombinant TNF-a receptor molecule. The TNF-a receptor moiety binds up endogenous TNF-a to prevent it from stimulating its normal downstream effects.
    2. A: Tegaserod.
    Rationale: Tegaserod is a 5-HT4 serotonin receptor agonist used in the treatment of constipation-predominant irritable bowel syndrome. The 5-HT4 receptor is thought to help control GI motility; therefore, being an agonist will increase GI motility and prevent constipation.





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