Chapter 8 BNF (Malignant Diseases)

Question 1

What are the side effects of Azathioprine and mercaptopurin?

Answer 1

Hypersensitivity (stop)

Bone marrow suppression (pre treatment screen for thiopurine methyl transeferases, low = high risk)

Question 2

How does allopurinol interact with azathioprine?

Answer 2

Inhibits it’s metabolism, reduce azathioprine dose

Question 3

What are the side effects of mycophenolate mofetil?

Answer 3

Hypogammaglobinanaemia

Bronchistatis

Bone marrow suppression

Question 4

How should contraception be used with mycophenolate mofetil?

Answer 4

6 weeks after discontinuing - women

Confirms until 90 days after discontinue - men

Question 5

Name a calcineurin inhibitor?

Answer 5

Tacrolimus

Question 6

What are the counselljng points with tacrolimus and ciclosporin?

Answer 6

Avoid sunlight
Avoid high potassium
Grapefruit juice

Question 7

What is the MHRA on tacrolimus and ciclosporin?

Answer 7

Maintain same brand

Question 8

How should Cytotoxics be prescribed, dispensed and administered?

Answer 8

According to written protocol or treatment plan

Question 9

Which Cytotoxics cause permanent male sterility?

Answer 9

Alkylating drugs and procarbazine

Question 10

What is tumour lysis syndrome and what are the clinical features?

Answer 10

Rapid destruction of malignant syndrome

Hyperkalaemia
Hyperuria
Hyperphosphotaemia
Hypocalcaemia

Question 11

What patients are at risk of tumour lysis syndrome?

Answer 11

Renal impairment
Dehydration
Hyperuricaemia

Question 12

Which cancer drugs increase risk of thromboembolism?

Answer 12

Cancer itself is a risk factor

Tamoxifen, thalidomide, linaclamide

Question 13

How is methotrexate induced mucocitis treated?

Answer 13

Folinic acid

Question 14

How is urothelial toxicity treated in cancer?

Answer 14

Mesna

Question 15

Which Cytotoxics do not cause bone marrow suppression?

Answer 15

Vincristine / Bleomycin

FBC before treatment

Question 16

How is bone marrow suppression treated?

Answer 16

Withdraw or reduce dose

Question 17

How is fever with neutropenia treated

Answer 17

Broad spectrum antibiotic / fligrastam

Avoid paracetamol

Question 18

How is hyperuricaemia treated in cancer?

Answer 18

Allopurinol 24 hrs before treatment

Febuxostat: 2 days before If allopurinol is CIed

Rasburicase: hyperuricaemia with blood cancer

Question 19

How is anticipatory acute and delayed nausea and vomiting treated?

Answer 19

Anticipatory: lorazepam

Acute: Dexamethasone, lorazepam, 5HT3 antagonist, aprepitant + Dexamethasone

Delayed: Dexamethasone and 5HT3, Dexamethasone and Aprepitant

Question 20

What are the types of Cytotoxic antibiotics?

Answer 20

Antracylines - doxorubicin

Antineoplastic antibiotics - Bleomycin

Question 21

What are the side effects of doxorubicin?

Answer 21

Cardiotoxicity

Red urine

Question 22

What are the advantages and disadvantages of liposomal doxorubicin?

Answer 22

Advantages - reduction of cardiotoxicity and extravation

Disadvantage: hand and food syndrome

Question 23

How is hand and foot syndrome from liposomal doxorubicin treated?

Answer 23

Cooling hands for 4/7 days

Question 24

How are anthracycline side effects and overdose treated?

Answer 24

Dexrazoxane

Question 25

What are the side effects of Bleomycin?

Answer 25

Pulmonary
Respiratory failure
Hypersensitivity
Dermatological toxicity

Question 26

How are vinca alkaloids administered ?

Answer 26

IV

Question 27

What are the side effects of Vinca alkaloids?

Answer 27

CNS toxicity