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32p-sodium orto-phosphate for injection.

Instructions for use

NAME OF THE MEDICINAL PRODUCT: 32P-Sodium orto-phosphate for injection.
32P Acidum phosphoricum 74 -370 MBq (2 - 10 mCi) or Phosphorus in the form of sodium phosphate The product does not contain any antimicrobial additives.
3. PHARMACEUTICAL FORM: Radiopharamceuticals - solution for injection.
4.1. Indication
Therapy of polycythemia vera and polythrombocytemia and related disorders, leukemia and
other neoplastic haematological disorders. Palliative treatment of painful bone metastasis
from prostate, breast, lung and other carcinomas is reported but its myelotoxicity should be
4.2.Posology and method of administration
The preparation is destined for direct oral or intravenous administration to the patient in
aliquots varying in activity depending on therapeutic application.
4.2.1. In the treatment of polycythemia vera recommended dose is 74 - 111 MBq (2 - 3 mCi)
on 1 m2 of body surface but not more than 185 MBq (5 mCi), another method recommends
first application of 111 MBq (3 mCi) and if after 3 months the symptoms of polycythemia are
still present the second, higher of 25% dose is administered. Single dose should not be higher
than 250 MBq (7 mCi). In leukemia approximately 37 -74 MBq (1 to 2 mCi) is given weekly
until the white blood cell count is sufficiently decreased.
4.2.2. In the treatment of of bone metastases the doses of 370 do 555 MBq (10 - 15 mCi) can
be administered for pain palliation in terminally ill patients who have not responded to
conventional therapies (hormones, wide or narrow beam radiotherpay, cytotoxicosis etc.)
who present with widespread painful bone matestases from assorted primaries and who may
be requiring or are likely to require increasing quantities of strong analgesics. Reduction of
bone pain may take several weeks to occur and may be associated with improved morale as
well as decreased analgesic requirements.
4.3. Contra indications
This agent is contraindicated in children, during pregnancy or females wishing to continue
breast feeding. If the patients platelet count is less than 15,000 it is suggested not to
administer the preparation.

4.4. Special precautions

The administration of 32P is usually not recommended in patients under 50 years of age. It
should be noted that polycythemia rubra vera may also be palliated by repeated venesections,
thioureas or regular courses of oral chlorambucil. More appropriate radiopharmaceuticals
may be available for the treatment of painful bone metastases secondary to prostatic cancer.
Because of the relatively long effective half life 32P-Sodium orto-phosphate it should not be
administered to patients with a very short life expectancy.
Radiopharmaceutical agents should be used only by qualified personnel with the appropriate
government authorisation for the use and manipulation of radionuclides.
This radiopharmaceutical may be received, used and administered only by authorised
personnel in designated clinical settings. Its receipt, storage, use, transfer and disposal are
subject to the regulations and/or appropriate licenses of the local competent official
Because of the risk of serious, delayed bone marrow depression, cytotoxic agents should not
be prescribed until aperiod of four months has elapsed from treatment with 32P.
4.5. Interactions
The use of oestrogen and androgen preparations may affect the metabolism and retention of
labelled phosphorus 32P.
Interactions with other drugs are not known; with respect to the adverse effect on bone
marrow, the product should not be administered simultaneously with chemotherapy and
radiation therapy (or within a short interval after them), if the therapeutic effect does not
outbalance the risk.
4.6. Pregnancy and lactation
When it is necessary to administer radioactive medicinal products to women of childbearing
potential, information should always be sought about pregnancy. Any woman who has
missed a period should be assumed to be pregnant until proven otherwise.
Breast feeding should be discontinued after administration because of the potential hazard to
the suckling; breast -feeding can only be restarted when the radiation dose obtained by the
child due to the consuming of this milk and contact with the mother is lower than limits given
by regulations on ionising radiation protection.
Pregnancy: There are no available data in animals or man but, at the activities proposed, this
radiopharmaceutical is likely to both mutagenic and teratogenic. The administration of 32P is
therefore contraindicated in pregnancy.
Where uncertainty exists it is important that radiation exposure should be the minimum
consistent with achieving the desired clinical information. Alternative techniques which do
not involve ionising radiation should always be considered.
4.7. Effects on ability to drive and use machines
The product is safe.
4.8. Undesirable effects
Therapy with 32P-Sodium orto-phosphate inj. gives the risk of leukemia in 2 - 15% of patients
during 10 years (similar to chemotherapy).
4.9. Overdose
32P-Sodium orto-phosphate should be administered by qualified personnel in designated
clinical settings. The preparation is delivered in portions prepared on request with a patient
activity dose. The possibility of overdosing is therefore markedly reduced. In the event of this
occuring, however, overdose would be limited to excessive body irradiation rather than the
remote possibility of chemical overdose. Excessive radiation effects all rapidly developing
dividing tissues but those on haemopoietic tissues could be delayed for several months. In the
event of overdosage an appropriate increase in fluid intake is advised to promote diuresis and
excretion of the label (forced diuresis). Frequent bladder emptying is also advised. In
addition, the administration of unlabelled phosphate salts can reduce the incorporation of the
radionuclide in body tissues thereby reducing exposure.
5.1., 5.2. Pharmacodynamic and pharmacokinetic properties
Polycythemia vera is a disease characterized by an increased red blood cell mass, frequently
associated with bone marrow hyperactivity. Therapy results from radiation injury to the cell
precursors and the bone marrow due to bone accumulation of 32P. A fraction of 0.30 of
intravenously administered activity is assumed to go to mineral bone and to be permanently
retained, and 0.70 is assumed to be distributed in soft tissues.
After injection the soluble radiophosphate is concentrated by rapidly proliferating tissue. The blood cells precursors in the bone marrow divide and proliferate rapidly in health and even more so in these diseases. The radionuclide 32P present in sodium ortophosphate-32P selectively concentrates in the mitotically active cells of the bone marrow and in trabecular and cortical bone. Selective uptake of 32P by haemopoietic tissue provides a continuous irradiation of dividing cells which significantly interferes with their viability. Its uptake by the different tissues depends on several factors including exchangeable tissue phosphate in the tissue, the rate of new tissue formation and tissue vascularity.
5.3. Preclinical safety data
32P-Sodium orto-phosphate has not been subjected to acute toxicity studies in any animal
species. Likewise, its carcinogenicity or reproductive toxicity have not been evaluated.
5.4. Radiation dosimetry
Phosphorus [32P] is a beta emitter (Emax 1.71 MeV) with a physical half-life of 14.29 days.
It gives off Bremsstrahlung. According to ICRP model, a fraction of 0.30 of intravenously
administered activity is assumed to go to mineral bone and to be permanently retained, and
0.70 is assumed to be distributed in soft tissues. Phosphorus metabolism is complex. Activity
deposited in soft tissues is assumed to be rapidly eliminated from the body (30%) and about
40% of activity possesses a 19-day biological half-life, the remaining 30% is reduced by
radioactive decay. The high-energy beta emissions can present a substantial skin dose hazard.
The effective dose equivalent at adult patient (70 kg) after administration of 32P-Sodium
orto-phosphate is 2.20 mSv/MBq.The radiation dose absorbed in breast is about 0.92
mGy/MBq, in the bone marrow 11.0 mGy/MBq and in bone surfaces about 11.0 mGy/MBq.
In the other organs, the absorbed radiation doses are lower (0.74 mGy/MBq).
The radiation dose to patients from the administered with 32P-Sodium orto-phosphate inj. located in different
organs and tissues. This distribution is presented in the ICRP 53: Annals of the ICRP, Radiation dose to Patients
from Radiopharmaceuticals. Vol.18 No. 1-4 1987 p.83-84.
Absorber dose per unit activity administrered (mGy/MBq)


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