chapter 8 Flashcards
what are immunosuppressants used for?
to suppress transplant injections
to treat chronic or inflammatory or autoimmune diseases
what are the 6 types of immunosuppressant drugs and give examples of each?
- monoclonal antibodies: infiliximab, belimumab
- corticosteroids: prednisolone
- antiproliferative immunosuppressants eg mycophenolate mofetil
- calcineurin inhibitor: ciclosporin
- non calcineurin inhibitor: sirolimus
- t cell activtating inhibitors: belatacept
what is a disadvantage of corticosteroids?
can increase spread of infection and mask signs of infection
what are the 2 key side effects of immunosuppressants?
what is the specialist advice regarding pt on immunosuppressants?
bone marrow suppression and mask signs of infection/increase risk of infection
live vaccines for patients
why is folic acid given to those who take methotrexate?
are they given on the same day?
given to reduce toxicity of methotrexate
given on diff day of the week
what is azathioprine metabolised to?
when are they used?
mercaptopurine
used when corticosteroids are not enough alone to provide adequate control
what is the interaction between allopurinol and azathioprine and what is the action?
allopurinol increases risk of haematological toxicity
must reduce the azathioprine dose to 1/4 of the usual dose when given with allopurinol
what are the side effects of azathioprine?
bone marrow suppression leukopenia increased risk of infection hypersensitivity nausea thrombocytopenia
how is nausea managed in a patient taking azathioprine?
divided doses
taken with or after food
take antiemetics
temporarily reduce dose
is azathioprine safe in pregnancy?
no teratogenic. but if pt already on it do not discontinue, just monitor
what should be measured before treatment with azathioprine?
what do you do if a patient has low levels of this?
TMPT enzyme metabolises thiopurine drugs so must measure
pt with low levels, monitor. pt with absent levels must not receive this drug
what are the monitoring requirements of azathioprine?
toxicity
myelosuppression
full blood count weekly
what is the pt and carer advice of azathioprine?
report signs of bone marrow suppression
what s mycophenolate metabolised to?
mycophenolic acid
what are the cautions of mycophenolate?
increased risk of skin cancer [avoid sun]
when used together with other immunosuppressants can increase risk of hypogammaglobinemia
bronchiectasis [wide bronchi increase risk of infection]
is mycophenolate it safe in pregnancy?
no causes congenital malformations and spontaneous abortions
what is the contraception and conception advice regarding mycophenolate>
must wear effective contraception throughout treatment and for 6 weeks after.
partner should also wear contraception
2 pregnancy tests must be done at least 8-10 days apart before treatment
what is the patient and carer advice of mycophenolate?
females should be on pregnancy prevention programme
report signs of bone marrow suppression
what class of immunosuppressants is ciclosporin?
what is the risk associated with its use?
calcineurin inhibitor
nephrotoxic
what are the prescribing requirement of ciclopsorin?
must prescribe by brand or changes in blood ciclosporin changes
what are the contraindications of ciclopsorin? [3]
- uncontrolled infection
- uncontrolled hypertension
- malignancy
what are the monitoring requirements of ciclosporin? [5]
- ciclosporin blood concentrations
- blood pressure and renal function checked at least twice before treatment
- liver function
- serum potassium and magnesium
- blood lipids
what is the patient and carer advice associated with ciclosporin? [4]
- avoid excessive exposure to UV light
- avoid UVB and PUVA light
- signs of bone marrow suppression must be reported
- when used by eye: affects driving and skilled tasks
how many times should a full blood count be conducted in patients on ciclopsorin?
weekly for the first month, then monthly for the next 3 months, then every 3 months for the next year
which 2 immunosuppressants do not cause bone marrow suppression?
vincristine and bleomycin
what is a common side effect of ciclosporin?
eye inflammation
what are 2 juices that interact with ciclosporin?
purple grape fruit juice decreases exposure
pomelo juice increases exposure
what class of immunosuppressants is tacrolimus in?
what is the prescribing requirement for it?
calcineurin inhibitor?
brand specific
what risks are associated with tacrolimus? [4]
- neurotoxicity
- hyperglycaemia
- cardiomyopathy
- bone marrow suppression
can tacrolimus be used in pregnancy?
avoid unless benefits outweigh risks
what must you monitor with tacrolimus?
liver and kidney
what is the patient and carer advice of tacrolimus?
avoid excess exposure to UV light
may affect performance of skilled tasks
what drug class is sirolimus in?
what is it licensed for?
is it safe in pregnancy?
non-calcineurin inhibitor
renal transplantation
avoid unless essential
what is the contraception and conception advice of sirolimus?
wear contraception during and 12 weeks after treatment
what kinds of patients require higher doses of sirolimus?
african caribbean patients
what is the pt and carer advice of sirolimus?
avoid exposure to uv light
what are the 2 phases of chemotherapy treatment?
neoadjuvant: initial treatment to shrink tumour
adjuvant: to prevent cancer after neoadjuvant tumour
what is the guideline for handling cytotoxic drugs?
- trained personnel should reconstitute them
- protective clothing should be worn
- protect eyes
- pregnant staff should stay away from them
- local procedures for dealing with spillages/safe disposal
- staff exposure to cytotoxic drugs should be monitored
what are the 8 side effects of cytotoxic drugs?
bone marrow suppression teratogenic in pregnancy nausea and vomiting alopecia hyperuricaemia tumour lysis syndrome oral mucositis extravasation of iv drugs [local tissue death]
which cytotoxic drugs cause oral mucositis? [3]
flame
fluorouracil
anthracylines
methotrexate
which drug can be used to treat hyperuricaemia with cytotoxic drugs?
allopurinol
which patients are at higher risk of N&V side effects of cytotoxic drugs?
women
pt under 50
pt with motion sickness
pt with repeat exposure to cytotoxic drugs
what are acute, delayed and anticipatory symptoms of nausea and vomiting side effect of cytotoxic drugs?
acute: occur within 24 hours
delayed: more than 24 hours
anticipatory: occur prior to subsequent doses
what is the treatment of anticipatory nausea and vomiting symptoms?
lorazepam
what is the treatment of acute n&v symptoms in pt who are MILD risk of emesis?
in patients who are at high risk of emesis?
dexamethasone or lorazepam
5ht3 receptor antagonist with dexamethasone and aprepitant
what is the treatment of delayed n&v symptom for patients who are at moderate risk of emesis?
those who are at high risk?
dexamethasone and 5ht3 receptor antagonist
dexamethasone and aprepitant
what is the treatment for haemorrhagic cystitis side effect caused by the cytotoxic drug cyclophosphamide?
mesna
what is an important side effect of anthracycline antibiotics eg doxorubicin? [2]
red urine and cardiotoxicity
what are the important side effects of doxorubicin? [3]
- extravasation [tissue death]
- cardiomyopathy
- hand foot syndrome
how do alkylating drugs work in cancer chemotherapy?
give an example
damage DNA and prevents cell replication
cyclophosphamide
what is the drug action of methotrexate?
inhibit dihydrofolate reductase enzyme which is needed for synthesis of purines
what is the only strength of methotrexate and how often should methotrexate be taken?
2.5mg
once a week on same day every week
what things must the patient report when on methotrexate? [3]
- blood disorder symptoms
- liver toxicity symptoms
- respiratory symptoms
what are the cautions of methotrexate? [4]
low blood count
gi toxicity
liver toxicity
pulmonary toxicity
what are the monitoring requirements of methotrexate?
full blood count, liver and renal tests every 1-2 weeks then every 2-3 months
what is the pt and carer advice of methotrexate?
report signs of blood disorders report signs of liver toxicity report abnormal respiratory effects give methotrexate treatment booklet avoid self medication eg nsaids
what are the important interactions of methotrexate?
trimethoprim penicillins most antibiotics NSAIDs aspirins statins
give examples of drugs in vinca alkaloids drug class
which route of admin is contraindicated in vinca alkaloids and why?
vincristine, vinblastine
intrathecal bc causes neurotoxicity
what are the 2 side effects of vincristine?
neurotoxicity and bronchospasm
what drug is used in breast cancer?
tamoxifen
