Ogled vira Karmustin

{{chembox
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 487305398
| ImageFile = Carmustine.svg
| ImageFile_Ref = {{chemboximage|correct|??}}
| ImageName = Skeletna formula karmustina
| ImageFile1 = Carmustine ball-and-stick.png
| ImageName1 = Model kroglic in paličic molekule karmustina
| IUPACName = 1,3-bis(2-kloroetil)-1-nitrozosečnina<ref>{{PubChem|2578}}</ref>
| OtherNames = ''N'',''N’''-bis(2-kloroetil)-''N''-nitrozosečnina, bis-kloroetilnitrozosečnina
|Section1={{Chembox Identifiers
| CASNo = 154-93-8
| CASNo_Ref = {{cascite|correct|CAS}}
| PubChem = 2578
| ChemSpiderID = 2480
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| UNII = U68WG3173Y
| UNII_Ref = {{fdacite|correct|FDA}}
| EINECS = 205-838-2
| UNNumber = 2811
| DrugBank = DB00262
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| KEGG = D00254
| KEGG_Ref = {{keggcite|correct|kegg}}
| MeSHName = Carmustine
| ChEBI = 3423
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 513
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| RTECS = YS2625000
| SMILES = C(CCl)NC(=O)N(CCCl)N=O
| StdInChI = 1S/C5H9Cl2N3O2/c6-1-3-8-5(11)10(9-12)4-2-7/h1-4H2,(H,8,11)
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = DLGOEMSEDOSKAD-UHFFFAOYSA-N
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
 }}
|Section2={{Chembox Properties
| C=5 | H=9 | Cl=2 | N=3 | O=2
| Appearance = orančni kristali
| Odor = brez vonja
| MeltingPtC = 30
| LogP = 1,375
| pKa = 10,194
| pKb = 3,803
 }}
|Section6={{Chembox Pharmacology
| ATCCode_prefix = L01
| ATCCode_suffix = AD01
| ATC_Supplemental = 
| ATCvet =
| Licence_EU = yes
| INN =
| INN_EMA = 
| Licence_US = 
| Legal_status = 
| Legal_AU = S4
| Legal_AU_comment = 
| Legal_CA = 
| Legal_CA_comment = 
| Legal_NZ = 
| Legal_NZ_comment = 
| Legal_UK = POM
| Legal_UK_comment = <ref>{{navedi splet | title=Carmustine 100mg Powder and solvent for Solution for Infusion - Summary of Product Characteristics (SmPC) | website=(emc) | date=24 March 2020 | url=https://www.medicines.org.uk/emc/product/11176/smpc | access-date=27 February 2021}}</ref><ref>{{navedi splet | title=Gliadel 7.7mg Implant - Summary of Product Characteristics (SmPC) | website=(emc) | date=15 June 2020 | url=https://www.medicines.org.uk/emc/product/36/smpc | access-date=27. 2. 2021}}</ref>
| Legal_US = Rx-only
| Legal_US_comment = <ref>{{navedi splet | title=Bicnu- carmustine kit | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d6cbb63c-e0b1-43ee-ad6f-408da0772079 | access-date=27 February 2021}}</ref><ref>{{navedi splet | title=Gliadel- carmustine wafer | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=38962a55-a514-4c48-bea5-f99a8da4beec | access-date=27 February 2021}}</ref>
| Legal_EU = Rx-only
| Legal_EU_comment = 
| Legal_UN = 
| Legal_UN_comment = 
| Pregnancy_category = 
| Pregnancy_AU = D
| Pregnancy_AU_comment = 
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|Section7={{Chembox Hazards
| GHSPictograms = {{gHS skull and crossbones}} {{gHS health hazard}}
| GHSSignalWord = '''DANGER'''
| HPhrases = {{h-phrases|300|350|360}}
| PPhrases = {{p-phrases|301+310|308+313}}
| LD50 = 20 mg kg<sup>−1</sup> <small>(oral, rat)</small>
 }}
|Section8={{Chembox Related
| OtherFunction_label = (sečnine)
| OtherFunction = [[dimetilsečnina]]
| OtherCompounds = {{unbulleted list|[[noksitiolin]]|[[1,1,3,3-tetrametilgvanidin]]|[[metformin]]|[[alantoinska kislina]]|[[buformin]]}}
 }}
}}
{{Infobox drug
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| INN               = 
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<!-- Clinical data -->
| pronounce         = 
| tradename         = BiCNU, Gliadel
| Drugs.com         = {{drugs.com|monograph|carmustine}}
| MedlinePlus       = a682060
| licence_EU        = <!-- EMA uses INN (or special INN_EMA) -->
| DailyMedID        = Carmustine
| licence_US        = <!-- FDA may use generic or brand name (generic name preferred) -->
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| class             = [[zdravila z delovanjem na novotvorbe]]
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}}
'''Karmustín''' je [[alkilirajoči citostatik]] iz skupine derivatov [[nitrozosečnina|nitrozosečnine]], ki se uporablja za zdravljenje [[rak (bolezen)|raka]].<ref>https://www.termania.net/slovarji/slovenski-medicinski-slovar/8398124/karmustin?query=karmustin&SearchIn=All Slovenski medicinski e-slovar, vpogled: 18. 9. 2021.</ref> Uporablja se v obliki [[infuzija|infuzije]],<ref name=SPC1/> za zdravljenje možganskih tumorjev pa obstajajo tudi vsadki v obliki biorazgradljivih diskov, ki vsebujejo karmustin (odobreni so v ZDA).<ref name="pmid17575228">{{cite journal | vauthors = Ewend MG, Brem S, Gilbert M, Goodkin R, Penar PL, Varia M, Cush S, Carey LA | display-authors = 6 | title = Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control | journal = Clinical Cancer Research | volume = 13 | issue = 12 | pages = 3637–3641 | date = junij 2007 | pmid = 17575228 | doi = 10.1158/1078-0432.CCR-06-2095 | url = http://clincancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=17575228 | doi-access = free }}</ref> 

== Uporaba ==
Karmustin se uporablja samostojno ali v kombinaciji z drugimi zdravili za zdravljenje raka pri naslednjih vrstah raka:<ref name=SPC1>https://www.ema.europa.eu/en/documents/product-information/carmustine-obvius-epar-product-information_sl.pdf {{Webarchive|url=https://web.archive.org/web/20210918113741/https://www.ema.europa.eu/en/documents/product-information/carmustine-obvius-epar-product-information_sl.pdf |date=2021-09-18 }} Povzetek glavnih značilnosti zdravila Karmustin Obvius 1, vpogled: 18. 9. 2021.</ref>
* [[možganski tumor]]ji in [[zasevek|zasevki]] v [[možgani]]h,
* [[ne-Hodgkinov limfom]] in [[Hodgkinova bolezen]].

Uporablja se tudi kot pripravljalno zdravljenje pred avtologno presaditvijo [[krvotvorna matična celica|krvotvornih matičnih celic]] pri [[krvni rak|krvnih rakih]];<ref name=SPC1/> za zmanjšanje števila belih krvničk pri bolniku.<ref>{{cite journal | vauthors = Damaj G, Cornillon J, Bouabdallah K, Gressin R, Vigouroux S, Gastinne T, Ranchon F, Ghésquières H, Salles G, Yakoub-Agha I, Gyan E | display-authors = 6 | title = Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review | journal = Bone Marrow Transplantation | volume = 52 | issue = 7 | pages = 941–949 | date = julij 2017 | pmid = 28112752 | doi = 10.1038/bmt.2016.340 | doi-access = free }}</ref>

== Neželeni učinki ==
Med zelo pogoste [[neželeni učinek|neželene učinke]], ki se pojavljajo pri več kot 10 % bolnikov, spadajo [[mielosupresija]], [[ataksija]], [[omotica]], [[glavobol]], očesna toksičnost, prehodna pordelost
[[veznica|veznic]] in [[zamegljen vid]], [[hipotenzija]] (pri zdravljenju z velikimi odmerki zaradi vsebnosti alkohola v vehiklu), [[flebitis]] (vnetje [[vena|ven]]), pljučna toksičnost, [[slabost]] in [[bruhanje]], [[dermatitis]] (ob topični uporabi na koži).<ref name=SPC1/>

Ker karmustin uničuje [[bela krvnička|bele krvničke]], ki sodelujejo pri obrambi pred mikrobi, je pri bolniku, ki prejema karmustin, povečano tveganje za okužbe, ki se lahko med drugim kažejo kot [[vročina]], bolečine v mišicah, [[glavobol]], [[mrzlica]] in splošno slabo počutje.<ref>{{Navedi splet|url=https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/cancer-drugs/drugs/carmustine|title=Carmustine (BCNU)|accessdate=18. 9. 2021|publisher=Cancer Research UK}}</ref>
 
Uporaba karmustina zelo pogosto povzroči [[mielosupresija|mielosupresijo]] oziroma zavrto delovanje [[kostni mozeg|kostnega mozga]]. Začne se od 7 do 14 dni po dajanju ter izzveni od 42 do 56 dni
po dajanju. Odvisna je od uporabljenega odmerka ter skupnega odmerka, ki ga bolnik prejme med vsem zdravljenjem.<ref name=SPC1/>

Karmustin lahko poškoduje [[pljuča]],<ref>Twohig K. J., Matthay R. A. Pulmonary effects of cytotoxic agents other than bleomycin. Clin Chest Med. 1990 Mar;11(1):31-54.</ref> kar se kaže s pljučnimi infiltrati in/ali fibrozo. Pljučna toksičnost se pojavi pri do 30 % bolnikov, ki prejemajo karmustin in lahko nastopi do tri leta po zdravljenju.<ref name=SPC1/>

Ob infundiranju zdravila lahko pride do preobčutljivostne reakcije, ki je pogostejša pri višjih hitrostih infundiranja.<ref>Janson B. s sod. Carmustine infusion reactions are more common with rapid administration. Support Care Cancer. 2012 Oct;20(10):2531-5. doi: 10.1007/s00520-011-1377-4. Epub 2012 Jan 15.</ref>

== Sklici ==
{{sklici}}

{{Citostatiki}}

[[Kategorija:Citostatiki]]
[[Kategorija:Alkilirajoči citostatiki]]
[[Kategorija:Derivati nitrozosečnine]]