Chapter 8: Immune system and malignant disease Flashcards
What is extravasation of IV drugs? What can chemo drugs cause?
Leakage of the drug into surrounding tissue
Extravasation of cytotoxics Can lead to permanent tissue damage
Chemotherapy can cause Neutropenic sepsis, a MEDICAL EMERGENCY. This is essentially neutropenia. What are the symptoms?
General Malaise/ high temp above 38 (due to infection)
Shivering/ flu-like symptoms
Uncontrolled gum/ nose bleeds (due to low platelets)
Bruising
Mouth ulcers (worse than usual)
Diarrhoea/ uncontrolled vomiting (dont forget- chemo can cause some vomiting itself)
Advise patient to go to A&E asap and not to take paracetamol
What are the Side effects of Chemotherapy?
Oral mucositis- inflammation of the mouth- ulcers and pain or difficulty swallowing.
Diarrhoea
Nausea and vomitting
Hyperuricaemia (high uric acid level)
Alopecia
dry mouth
Neutropenia
Which Chemo drugs can only be given by IV administration only?
VINCA ALKALOIDS
e.g. Vinblastine, Vincristine (all the Vin’s)
Which two immunosuppressant drugs used in chemo have a lot of interactions, plus must always maintain the same brand?
Ciclosporin
Tacrolimus
What is important to let patients know on therapy with Azathioprine?
Reporting- Blood disorders- sore throat, mouth ulcers, bleeding, fever- seek medical attention
Which chemo drugs have a lower emetogenic (vomitting) potential?
Methotrexate 5-FU Etoposide Vinka Alkolids
How much will a patient recieving treatment for unpleasant side effects they experienced from their last dose of chemotherapy, have to pay for their prescription of Folinic acid (used for methotrexate side effects)?
Nothing- free
Those on cancer meds and on meds for effects of cancer are medically exempt
Tamoxifen is usually used for breast cancer at a dose of 20mg daily. It can increase the risk of another cancer: ______ cancer. It can also result in thromboembolism and patients are required to report symptoms like?
Endometrial cancer
Symptoms such as SOB, pain in one leg
Which class of chemotherapy drug is Cardio toxic and associated with cardiomyopathy?
Anthracyclines eg
Doxorubicin
Epirubicin
Daunorubicin
What class of anti cancer drugs are useful for lung and breast cancers?
Vinca- alkaloids (vincristine, vinblastine)
Also for Leukaemias and Lymphomas
What drug is used as a protectorant from cytotoxic induced urothelial toxcitiy such as heamorrhagic cystitis/ blood in urine?
Mesna
What antiemetic is indicated for chemo-therapy induced nausea and vomiting?
Ondansetron
What would a high temperature following a dose of Chemo indicate?
Febrile Neutropenia
Remember neutropenia warning signs = fever- this is all it is
Which 2 anticancer drugs DO NOT cause bone marrow suppression?
Bleomycin (an anthracycline cytotoxic antibiotic)
Vincristine
When does bone marrow suppression, caused by most chemo drugs bar vincristine and bleomycin, usually occur?
7 -10 days after administration
What are some main side effects of azathioprine?
Hypersensitivity reactions Hypersensitivity reactions (including malaise, dizziness, vomiting, diarrhoea, fever, rigors, myalgia, arthralgia, rash, hypotension and renal dysfunction) call for immediate withdrawal. Neutropenia and thrombocytopenia Neutropenia is dose-dependent. Management of neutropenia and thrombocytopenia requires careful monitoring and dose adjustment. Bruising, bleeding, infection (Bone marrow suppression) Nausea Nausea is common early in the course of treatment and usually resolves after a few weeks without an alteration in dose. Moderate nausea can be managed by using divided daily doses, taking doses after food, prescribing concurrent antiemetics or temporarily reducing the dose.
What pre-treatment screening is needed with azathioprine?
TPMT levelsTPMT metabolises the drug, so if reduced levels, there is an increased risk of myelosuppression
What is the MHRA advice regarding ciclosporin prescribing?
Must be prescribed and dispensed by brand name
What is the MHRA advice surrounding tacrolimus prescribing?
Prescribe and dispense by brand name only, to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection
When monitoring tacrolimus, should peak or trough levels be taken?
Trough Especially when there is diarrhoea, levels need to be closely monitored
What is the MHRA advice surrounding the use of mycophenolic acid/MMF?
The MHRA advises to exclude pregnancy in females of child-bearing potential before treatment—2 pregnancy tests 8–10 days apart are recommended. Women should use at least 1 method of effective contraception before and during treatment, and for 6 weeks after discontinuation - 2 are preferredMycophenolate medicines remain contraindicated in women of childbearing potential who are not using reliable contraception and in pregnant women unless there are no suitable alternatives to prevent transplant rejectionMale patients or their female partner should use effective contraception during treatment and for 90 days after discontinuation.
Fingolimod, a drug used for MS, carry what MHRA warnings?
1) Not recommended for patients at known risk of cardiovascular events - known to cause bradycardia and heart block after first dose - can cause arrhythmias 2) Rebound MS after stopping or switching Tx 3) Skin cancer and lymphoma 4) Risk of congenital malformations (contraception during and 2 months after stopping) 5) Serious liver injury and herpes meningocephalitis
What is the MHRA advice surrounding the use of bevacizumab?
Risk of osteonecrosis of the jaw Aneurysm and aortic dissection
What is the MHRA advice surrounding the use of EGFR inhibitors e.g. cetuximab?
Keratitis and ulcerative keratitisIn rare cases, this has resulted in corneal perforation and blindness
What is the MHRA advice surrounding the use of nivolumab?
Risk of organ transplant rejection Reports of cytomegalovirus (CMV) gastrointestinal infection or reactivation (October 2019)
Which two cytotoxic drugs do not cause bone marrow suppression?
Vincristine Bleomycin
Ciclosporin can cause what kinds of toxicity?
Neurotoxicity Nephrotoxicity Hepatoxicity
What is the patient advice surrounding ciclosporin?
Manufacturer advises avoid excessive exposure to UV light, including sunlight. In psoriasis and atopic dermatitis, avoid use of UVB or PUVA. Avoid grapefruit juice
Tacrolimus can cause what kinds of organ damage?
Nephrotoxicity Cardiomyopathy Neurotoxicity - headaches, tremors Hepatotoxicity Eye disorders- burred vision Can also disturb glucose metabolism
What is the patient advice surrounding tacrolimus?
Avoid excessive exposure to UV light including sunlight. May affect performance of skilled tasks (e.g. driving). Pomelo and pomegranate juices might greatly increase the concentration of tacrolimus.