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extra bnf flashcards > chapter 8 - maligancy > Flashcards

chapter 8 - maligancy Flashcards

1
Q

antiproliferative immunosuppressants

A

azathioprine
mercaptopurine
mycophenolate

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2
Q

other immunosuppressants

A

ciclosporin
tacrolimus
corticosteroids

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3
Q

what vaccine should you avoid when taking immunosuppressants

A

LIVE

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4
Q

azathioprine/mercaptopurine MOA

A

inhibit purine metablosism

stop dna/rna/protein synthesis

aza is metabolised to mercaptopurine

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5
Q

immunosuppressant side effects

A

hypersensitivity e.g. fever rash myalgia malaise NAV diarrhoea

bone marrow suppression

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6
Q

what to screen for before taking immunosuppressants

A

thiopurine methyl transferase

low enzyme activity = high risk

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7
Q

immunosuppressant interaction

A

allopurinol

reduce dose as allopurinol is a xanthine oxidase inhibitor + inhibits purine metabolism

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8
Q

mycophenolate metabolside effects

A

hypogammaglobinaemia - recurrant infections to mesure serum Ig

bronchiectasis

BMS

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9
Q

mycophenolate + fertility

A

gentoxic + teratogenic

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10
Q

women + mycophenolate

A

2 contraceptive methods until 2 weeks after discontinuing

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11
Q

men + mycophenolate

A

condoms until 90 days after discontinuing OR female contraception

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12
Q

tacrolimus MOA

A

calcineurin inhibitor

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13
Q

tacrolimus side effects

A 
heart arryth
renal tox
liver tox
blood dys
hypertension/glycaemia/kalaemia/uricaemia
neurotox
blurred vision/photophobia
skin rashes / TEN
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14
Q

tacrolimus counselling

A

photosensitive

avoid high potassium & grapefruit juice

driving may be affected

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15
Q

MHRA tacrolimus

A

stay on same brand - toxicity & transplant rejected upon switching

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16
Q

ciclosporin MOA

A

lowers t cell activity

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17
Q

ciclosporin side effects

A 
renal tox
liver tox
neuro tox
blood dys
hyperlipid
hypertension
hyperkalaemia
hypomagnesaemia
BIH - visual disturbances
gingival hyperplasia
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18
Q

ciclosporin counselling

A

photosensitive

avoid high potassium & grapefruit juice

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19
Q

ciclosporin MHRA

A

stay on same brand - changes in plasma conc

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20
Q

neoadjuvant therapy

A

shrinking primary tumour

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21
Q

adjuvant therapy

A

follows treatment of primary disease when there’s a high risk of sub clinical metastatic disease

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22
Q

requirements for cytotoxics

A

prescribed dispensed & administered according to a treatment plan

injectables can only be dispensed if they are already prepared for admin

oral should be dispensed with clear directions

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23
Q

can cytotoxics be repeated

A

no unless specialist instructs

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24
Q

what cytotoxics carry the risk of infertility after treatment

A

alkylating drugs + procarbazine

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25
Q

alkylating drugs + procarbazine

A

men - permenant male sterility

women - early menopause

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26
Q

what is tumour lysis syndrome

A

rapid destruction of malignant cells

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27
Q

tumour lysis syndrome highest risk in

A

lymphomas/leukaemias

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28
Q

clinical features of tumour lysis syndrome

A

hyperkalaemia
hyperurea
hyperphosphataemia
hypocalcaemia

renal failure + arrythmias

29
Q

patients at risk of TLS

A

renal impairment
dehydration
hyperuricaemia

30
Q

cytoxics with highest risk of VTE

A

tamoxifen

thalidomide/linadamide

31
Q

counselling to reduce oral mucositis

A 
rinse mouth
soft toothbrush
suck on ice
saline mouthwash
folinic acid
32
Q

cytotoxics with highest risk of oral mucositis

A

anthracyclines

antimetabolites (MTX/FU/capecitabine)

33
Q

what is urothelial toxicity

A

haemorrhagic cystitis

34
Q

urothelial toxicity treatment

A

mesna

35
Q

cytotoxics with highest risk of urothelial toxicity

A

cyclophosphamide

36
Q

what cytotoxics dont have a risk of BMS

A

vincristine + bleomycin

37
Q

cytotoxics are CI in

A

infections

38
Q

fever with neutropoenia

A

broad spectrum abx + filgrastrim

39
Q

symptomatic fe-deficient anaemia

A

erythpoietin/RBC transfusion

40
Q

hyperuricaemia is present in

A

high grade lymphoma + leukaemia

41
Q

hyperuricaemia treatment

A

allopurinol - 24hrs before chemo

febuxostat if allo CI - 2 days before

42
Q

treatment for hyperuricaemia if associated w blood cancer

A

rasburicase

43
Q

mild emetogenics

A

MTX
FU
vinca alkaloids

44
Q

moderate emetogenics

A

taxanes
doxorubicin
cyclophosphamide
high dose MTX

45
Q

high emetogenics

A

cisplatin

high dose cyclophosphamide

46
Q

treatment for anticipatory emesis

A

lorazepam

47
Q

treatment for acute emesis <24 after chemo

A

low risk - dexamathasone/lorazepam

high risk - 5HT3 antagonist/arprepitant + dex

48
Q

treatment for acute emesis >24 after chemo

A

moderate emetogenics - dex + 5HT3 antag

highly emetogenics = dex + arprep

49
Q

extravasation of iv cytotoxics most common with

A

vinca alklaoids

anthracyclines

50
Q

cytotoxic antibiotics

A

anthracyclines

antineoplastics

51
Q

anthracyclines

A

doxo
epi
ida
dauno

52
Q

anthracycline side effects

A

cardiotoxicity

red urine

53
Q

reducing cardiotox + extravasation with anthracyclines

A

liposomal formulation

54
Q

liposomal anthracyclines formulations cause

A

hand and foot syndrome

55
Q

preventing hand and foot syndrome

A

keep hands and feet cool

avoid socks and gloves 4-7 days after treatment

56
Q

treating anthracycline side effects

A

dexrazoxane

57
Q

antineoplastic antibiotics

A

bleomycin

58
Q

antineoplastic side effects

A

pulmonary fibrosis
respiratory failure
hypersensitivity (IV hydrocortisone helps prevent)
dermatological toxicity

59
Q

vinca alkaloid route

A

IV

60
Q

IT vinca alkaloid

A

fatal neurotox

61
Q

npsa alert for vinca alkaloids

A

adult + teens receive dose in 50ml mini bag

childrens unit receive dose by syringe

62
Q

vinca alkaloid side effects

A

CNS toxicity

peripheral/autonomic neuropathy

63
Q

antimetabolites

A

MTX
FU
capecitabine - PD of FU

64
Q

cyclophosphamide class

A

alkylating drugs

65
Q

side effects of alkylators

A

permanent male sterility

non-lymphocytic leukaemia

66
Q

aromatase inhibitors

A

anastrazole letrozole

67
Q

CI group for aromatase inhibitors

A

pre-meno women

68
Q

taxanes

A

paclitaxel

69
Q

taxanes side effects

A

cardiac disease
pneumonitis
sepsis

extra bnf flashcards (6 decks)

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