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immune system and malignant disease > chapter 8 > Flashcards

chapter 8 Flashcards

1
Q

what are immunosuppressants used for?

A

to suppress transplant injections

to treat chronic or inflammatory or autoimmune diseases

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2
Q

what are the 6 types of immunosuppressant drugs and give examples of each?

A
  1. monoclonal antibodies: infiliximab, belimumab
  2. corticosteroids: prednisolone
  3. antiproliferative immunosuppressants eg mycophenolate mofetil
  4. calcineurin inhibitor: ciclosporin
  5. non calcineurin inhibitor: sirolimus
  6. t cell activtating inhibitors: belatacept
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3
Q

what is a disadvantage of corticosteroids?

A

can increase spread of infection and mask signs of infection

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4
Q

what are the 2 key side effects of immunosuppressants?

what is the specialist advice regarding pt on immunosuppressants?

A

bone marrow suppression and mask signs of infection/increase risk of infection

live vaccines for patients

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5
Q

why is folic acid given to those who take methotrexate?

are they given on the same day?

A

given to reduce toxicity of methotrexate

given on diff day of the week

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6
Q

what is azathioprine metabolised to?

when are they used?

A

mercaptopurine

used when corticosteroids are not enough alone to provide adequate control

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7
Q

what is the interaction between allopurinol and azathioprine and what is the action?

A

allopurinol increases risk of haematological toxicity

must reduce the azathioprine dose to 1/4 of the usual dose when given with allopurinol

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8
Q

what are the side effects of azathioprine?

A 
bone marrow suppression
leukopenia
increased risk of infection
hypersensitivity 
nausea 
thrombocytopenia
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9
Q

how is nausea managed in a patient taking azathioprine?

A

divided doses
taken with or after food
take antiemetics
temporarily reduce dose

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10
Q

is azathioprine safe in pregnancy?

A

no teratogenic. but if pt already on it do not discontinue, just monitor

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11
Q

what should be measured before treatment with azathioprine?

what do you do if a patient has low levels of this?

A

TMPT enzyme metabolises thiopurine drugs so must measure

pt with low levels, monitor. pt with absent levels must not receive this drug

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12
Q

what are the monitoring requirements of azathioprine?

A

toxicity
myelosuppression
full blood count weekly

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13
Q

what is the pt and carer advice of azathioprine?

A

report signs of bone marrow suppression

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14
Q

what s mycophenolate metabolised to?

A

mycophenolic acid

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15
Q

what are the cautions of mycophenolate?

A

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]

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16
Q

is mycophenolate it safe in pregnancy?

A

no causes congenital malformations and spontaneous abortions

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17
Q

what is the contraception and conception advice regarding mycophenolate>

A

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

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18
Q

what is the patient and carer advice of mycophenolate?

A

females should be on pregnancy prevention programme

report signs of bone marrow suppression

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19
Q

what class of immunosuppressants is ciclosporin?

what is the risk associated with its use?

A

calcineurin inhibitor

nephrotoxic

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20
Q

what are the prescribing requirement of ciclopsorin?

A

must prescribe by brand or changes in blood ciclosporin changes

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21
Q

what are the contraindications of ciclopsorin? [3]

A
  • uncontrolled infection
  • uncontrolled hypertension
  • malignancy
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22
Q

what are the monitoring requirements of ciclosporin? [5]

A
  • ciclosporin blood concentrations
  • blood pressure and renal function checked at least twice before treatment
  • liver function
  • serum potassium and magnesium
  • blood lipids
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23
Q

what is the patient and carer advice associated with ciclosporin? [4]

A
  • 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
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24
Q

how many times should a full blood count be conducted in patients on ciclopsorin?

A

weekly for the first month, then monthly for the next 3 months, then every 3 months for the next year

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25
Q

which 2 immunosuppressants do not cause bone marrow suppression?

A

vincristine and bleomycin

26
Q

what is a common side effect of ciclosporin?

A

eye inflammation

27
Q

what are 2 juices that interact with ciclosporin?

A

purple grape fruit juice decreases exposure

pomelo juice increases exposure

28
Q

what class of immunosuppressants is tacrolimus in?

what is the prescribing requirement for it?

A

calcineurin inhibitor?

brand specific

29
Q

what risks are associated with tacrolimus? [4]

A
  • neurotoxicity
  • hyperglycaemia
  • cardiomyopathy
  • bone marrow suppression
30
Q

can tacrolimus be used in pregnancy?

A

avoid unless benefits outweigh risks

31
Q

what must you monitor with tacrolimus?

A

liver and kidney

32
Q

what is the patient and carer advice of tacrolimus?

A

avoid excess exposure to UV light

may affect performance of skilled tasks

33
Q

what drug class is sirolimus in?

what is it licensed for?

is it safe in pregnancy?

A

non-calcineurin inhibitor

renal transplantation

avoid unless essential

34
Q

what is the contraception and conception advice of sirolimus?

A

wear contraception during and 12 weeks after treatment

35
Q

what kinds of patients require higher doses of sirolimus?

A

african caribbean patients

36
Q

what is the pt and carer advice of sirolimus?

A

avoid exposure to uv light

37
Q

what are the 2 phases of chemotherapy treatment?

A

neoadjuvant: initial treatment to shrink tumour
adjuvant: to prevent cancer after neoadjuvant tumour

38
Q

what is the guideline for handling cytotoxic drugs?

A
  1. trained personnel should reconstitute them
  2. protective clothing should be worn
  3. protect eyes
  4. pregnant staff should stay away from them
  5. local procedures for dealing with spillages/safe disposal
  6. staff exposure to cytotoxic drugs should be monitored
39
Q

what are the 8 side effects of cytotoxic drugs?

A 
bone marrow suppression
teratogenic in pregnancy
nausea and vomiting
alopecia
hyperuricaemia
tumour lysis syndrome
oral mucositis
extravasation of iv drugs [local tissue death]
40
Q

which cytotoxic drugs cause oral mucositis? [3]

A

flame

fluorouracil
anthracylines
methotrexate

41
Q

which drug can be used to treat hyperuricaemia with cytotoxic drugs?

A

allopurinol

42
Q

which patients are at higher risk of N&V side effects of cytotoxic drugs?

A

women
pt under 50
pt with motion sickness
pt with repeat exposure to cytotoxic drugs

43
Q

what are acute, delayed and anticipatory symptoms of nausea and vomiting side effect of cytotoxic drugs?

A

acute: occur within 24 hours
delayed: more than 24 hours
anticipatory: occur prior to subsequent doses

44
Q

what is the treatment of anticipatory nausea and vomiting symptoms?

A

lorazepam

45
Q

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?

A

dexamethasone or lorazepam

5ht3 receptor antagonist with dexamethasone and aprepitant

46
Q

what is the treatment of delayed n&v symptom for patients who are at moderate risk of emesis?

those who are at high risk?

A

dexamethasone and 5ht3 receptor antagonist

dexamethasone and aprepitant

47
Q

what is the treatment for haemorrhagic cystitis side effect caused by the cytotoxic drug cyclophosphamide?

A

mesna

48
Q

what is an important side effect of anthracycline antibiotics eg doxorubicin? [2]

A

red urine and cardiotoxicity

49
Q

what are the important side effects of doxorubicin? [3]

A
  • extravasation [tissue death]
  • cardiomyopathy
  • hand foot syndrome
50
Q

how do alkylating drugs work in cancer chemotherapy?

give an example

A

damage DNA and prevents cell replication

cyclophosphamide

51
Q

what is the drug action of methotrexate?

A

inhibit dihydrofolate reductase enzyme which is needed for synthesis of purines

52
Q

what is the only strength of methotrexate and how often should methotrexate be taken?

A

2.5mg

once a week on same day every week

53
Q

what things must the patient report when on methotrexate? [3]

A
  • blood disorder symptoms
  • liver toxicity symptoms
  • respiratory symptoms
54
Q

what are the cautions of methotrexate? [4]

A

low blood count
gi toxicity
liver toxicity
pulmonary toxicity

55
Q

what are the monitoring requirements of methotrexate?

A

full blood count, liver and renal tests every 1-2 weeks then every 2-3 months

56
Q

what is the pt and carer advice of methotrexate?

A 
report signs of blood disorders
report signs of liver toxicity
report abnormal respiratory effects
give methotrexate treatment booklet
avoid self medication eg nsaids
57
Q

what are the important interactions of methotrexate?

A 
trimethoprim
penicillins
most antibiotics
NSAIDs
aspirins
statins
58
Q

give examples of drugs in vinca alkaloids drug class

which route of admin is contraindicated in vinca alkaloids and why?

A

vincristine, vinblastine

intrathecal bc causes neurotoxicity

59
Q

what are the 2 side effects of vincristine?

A

neurotoxicity and bronchospasm

60
Q

what drug is used in breast cancer?

A

tamoxifen

immune system and malignant disease (1 decks)

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