Chapter 8 BNF (Malignant Diseases) Flashcards
What are the side effects of Azathioprine and mercaptopurin?
Hypersensitivity (stop)
Bone marrow suppression (pre treatment screen for thiopurine methyl transeferases, low = high risk)
How does allopurinol interact with azathioprine?
Inhibits it’s metabolism, reduce azathioprine dose
What are the side effects of mycophenolate mofetil?
Hypogammaglobinanaemia
Bronchistatis
Bone marrow suppression
How should contraception be used with mycophenolate mofetil?
6 weeks after discontinuing - women
Confirms until 90 days after discontinue - men
Name a calcineurin inhibitor?
Tacrolimus
What are the counselljng points with tacrolimus and ciclosporin?
Avoid sunlight
Avoid high potassium
Grapefruit juice
What is the MHRA on tacrolimus and ciclosporin?
Maintain same brand
How should Cytotoxics be prescribed, dispensed and administered?
According to written protocol or treatment plan
Which Cytotoxics cause permanent male sterility?
Alkylating drugs and procarbazine
What is tumour lysis syndrome and what are the clinical features?
Rapid destruction of malignant syndrome
Hyperkalaemia
Hyperuria
Hyperphosphotaemia
Hypocalcaemia
What patients are at risk of tumour lysis syndrome?
Renal impairment
Dehydration
Hyperuricaemia
Which cancer drugs increase risk of thromboembolism?
Cancer itself is a risk factor
Tamoxifen, thalidomide, linaclamide
How is methotrexate induced mucocitis treated?
Folinic acid
How is urothelial toxicity treated in cancer?
Mesna
Which Cytotoxics do not cause bone marrow suppression?
Vincristine / Bleomycin
FBC before treatment
How is bone marrow suppression treated?
Withdraw or reduce dose
How is fever with neutropenia treated
Broad spectrum antibiotic / fligrastam
Avoid paracetamol
How is hyperuricaemia treated in cancer?
Allopurinol 24 hrs before treatment
Febuxostat: 2 days before If allopurinol is CIed
Rasburicase: hyperuricaemia with blood cancer
How is anticipatory acute and delayed nausea and vomiting treated?
Anticipatory: lorazepam
Acute: Dexamethasone, lorazepam, 5HT3 antagonist, aprepitant + Dexamethasone
Delayed: Dexamethasone and 5HT3, Dexamethasone and Aprepitant
What are the types of Cytotoxic antibiotics?
Antracylines - doxorubicin
Antineoplastic antibiotics - Bleomycin
What are the side effects of doxorubicin?
Cardiotoxicity
Red urine
What are the advantages and disadvantages of liposomal doxorubicin?
Advantages - reduction of cardiotoxicity and extravation
Disadvantage: hand and food syndrome
How is hand and foot syndrome from liposomal doxorubicin treated?
Cooling hands for 4/7 days
How are anthracycline side effects and overdose treated?
Dexrazoxane
