Chapter 8: Immune system and malignant disease Flashcards
<p>What is extravasation of IV drugs? What can chemo drugs cause?</p>
<p>Leakage of the drug into surrounding tissue</p>
<p>Extravasation of cytotoxicsCan lead to permanent tissue damage</p>
<p>Chemotherapy can cause Neutropenic sepsis, a MEDICAL EMERGENCY. This is essentially neutropenia. What are the symptoms?</p>
General malaise/ high temp above 37.5 (due to infection)
Shivering/ flu-like
Uncontrolled gum/ nose bleeds (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
<p>What are the Side effects of Chemotherapy?</p>
<p><strong>Oral mucositis- i</strong>nflammation of the mouth-ulcers and pain or difficulty swallowing.</p>
<p>Diarrhoea</p>
<p>Nausea and vomitting</p>
<p>Hyperuricaemia (high uric acid level)</p>
<p>Alopecia</p>
<p>dry mouth</p>
<p>Neutropenia</p>
<p>Which Chemo drugs can only be given by IV administration only?</p>
<p><strong>VINCA ALKALOIDS</strong></p>
<p>e.g. Vinblastine, Vincristine (all the Vin's)</p>
Which 2 immunosuppressant drugs used in chemo have a lot of interactions, plus must always maintain 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
Vinca alkaloids- vinblastine, vincristine
Highly emetogenic: Cisplatin, dacarbazine
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 andon meds for effects of cancer are medically exempt
Tamoxifen usually used for breast cancer at dose of 20mg daily
~ It can increase risk of another cancer ….. ~ It can also result in thromboembolism & patients required to report symptoms like ?
Endometrial cancer
Symptoms such as SOB, pain in one leg
<p>Which class of chemotherapy drug is Cardio toxic and associated with cardiomyopathy?</p>
<p>Anthracyclines eg</p>
<p>Doxorubicin</p>
<p>Epirubicin</p>
<p>Daunorubicin</p>
<p>What class of anti cancer drugs are useful for lung and breast cancers?</p>
<p>Vinca- alkaloids (vincristine, vinblastine)</p>
<p>Also for Leukaemias and Lymphomas</p>
<p>What drug is used as a protectorant from cytotoxic induced urothelial toxcitiy such as heamorrhagic cystitis/ blood in urine?</p>
<p>Mesna</p>
<p>What antiemetic is indicated for chemo-therapy induced nausea and vomiting?</p>
<p>Ondansetron</p>
<p>What would a hightemperature following a dose of Chemo indicate?</p>
<p>Febrile Neutropenia</p>
<p>Remember neutropenia warning signs = fever- this is all it is</p>
<p>Which 2 anticancer drugs DO NOT cause bone marrow suppression?</p>
<p>Bleomycin (an anthracycline cytotoxic antibiotic)</p>
<p>Vincristine</p>
<p>When does bone marrow suppression, caused by most chemo drugs bar vincristine and bleomycin, usually occur?</p>
<p>7 -10 days after administration</p>
What are some main side effects of azathioprine?
NAME?
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?
~ exclude pregnancy in females of child-bearing potential before TX
—2 pregnancy tests 8–10 days apart
~ Women use at least 1 method of effective contraception before & during TX + for 6 weeks after discontinuation- 2 preferred
Mycophenolate medicines remain contraindicated in women of childbearing potential not using reliable contraception & in pregnant women unless no suitable alternatives to prevent transplant rejection
Male patients or their female partner use effective contraception during TX & for 90 days after discontinuation.
Fingolimod, a drug used for MS, carry what MHRA warnings?
NAME?
What is the MHRA advice surrounding the use of bevacizumab?
Risk of osteonecrosis of the jaw
