chapter 8 - maligancy Flashcards
antiproliferative immunosuppressants
azathioprine
mercaptopurine
mycophenolate
other immunosuppressants
ciclosporin
tacrolimus
corticosteroids
what vaccine should you avoid when taking immunosuppressants
LIVE
azathioprine/mercaptopurine MOA
inhibit purine metablosism
stop dna/rna/protein synthesis
aza is metabolised to mercaptopurine
immunosuppressant side effects
hypersensitivity e.g. fever rash myalgia malaise NAV diarrhoea
bone marrow suppression
what to screen for before taking immunosuppressants
thiopurine methyl transferase
low enzyme activity = high risk
immunosuppressant interaction
allopurinol
reduce dose as allopurinol is a xanthine oxidase inhibitor + inhibits purine metabolism
mycophenolate metabolside effects
hypogammaglobinaemia - recurrant infections to mesure serum Ig
bronchiectasis
BMS
mycophenolate + fertility
gentoxic + teratogenic
women + mycophenolate
2 contraceptive methods until 2 weeks after discontinuing
men + mycophenolate
condoms until 90 days after discontinuing OR female contraception
tacrolimus MOA
calcineurin inhibitor
tacrolimus side effects
heart arryth renal tox liver tox blood dys hypertension/glycaemia/kalaemia/uricaemia neurotox blurred vision/photophobia skin rashes / TEN
tacrolimus counselling
photosensitive
avoid high potassium & grapefruit juice
driving may be affected
MHRA tacrolimus
stay on same brand - toxicity & transplant rejected upon switching
ciclosporin MOA
lowers t cell activity
ciclosporin side effects
renal tox liver tox neuro tox blood dys hyperlipid hypertension hyperkalaemia hypomagnesaemia BIH - visual disturbances gingival hyperplasia
ciclosporin counselling
photosensitive
avoid high potassium & grapefruit juice
ciclosporin MHRA
stay on same brand - changes in plasma conc
neoadjuvant therapy
shrinking primary tumour
adjuvant therapy
follows treatment of primary disease when there’s a high risk of sub clinical metastatic disease
requirements for cytotoxics
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
can cytotoxics be repeated
no unless specialist instructs
what cytotoxics carry the risk of infertility after treatment
alkylating drugs + procarbazine
alkylating drugs + procarbazine
men - permenant male sterility
women - early menopause
what is tumour lysis syndrome
rapid destruction of malignant cells
tumour lysis syndrome highest risk in
lymphomas/leukaemias
clinical features of tumour lysis syndrome
hyperkalaemia
hyperurea
hyperphosphataemia
hypocalcaemia
renal failure + arrythmias
patients at risk of TLS
renal impairment
dehydration
hyperuricaemia
cytoxics with highest risk of VTE
tamoxifen
thalidomide/linadamide
counselling to reduce oral mucositis
rinse mouth soft toothbrush suck on ice saline mouthwash folinic acid
cytotoxics with highest risk of oral mucositis
anthracyclines
antimetabolites (MTX/FU/capecitabine)
what is urothelial toxicity
haemorrhagic cystitis
urothelial toxicity treatment
mesna
cytotoxics with highest risk of urothelial toxicity
cyclophosphamide
what cytotoxics dont have a risk of BMS
vincristine + bleomycin
cytotoxics are CI in
infections
fever with neutropoenia
broad spectrum abx + filgrastrim
symptomatic fe-deficient anaemia
erythpoietin/RBC transfusion
hyperuricaemia is present in
high grade lymphoma + leukaemia
hyperuricaemia treatment
allopurinol - 24hrs before chemo
febuxostat if allo CI - 2 days before
treatment for hyperuricaemia if associated w blood cancer
rasburicase
mild emetogenics
MTX
FU
vinca alkaloids
moderate emetogenics
taxanes
doxorubicin
cyclophosphamide
high dose MTX
high emetogenics
cisplatin
high dose cyclophosphamide
treatment for anticipatory emesis
lorazepam
treatment for acute emesis <24 after chemo
low risk - dexamathasone/lorazepam
high risk - 5HT3 antagonist/arprepitant + dex
treatment for acute emesis >24 after chemo
moderate emetogenics - dex + 5HT3 antag
highly emetogenics = dex + arprep
extravasation of iv cytotoxics most common with
vinca alklaoids
anthracyclines
cytotoxic antibiotics
anthracyclines
antineoplastics
anthracyclines
doxo
epi
ida
dauno
anthracycline side effects
cardiotoxicity
red urine
reducing cardiotox + extravasation with anthracyclines
liposomal formulation
liposomal anthracyclines formulations cause
hand and foot syndrome
preventing hand and foot syndrome
keep hands and feet cool
avoid socks and gloves 4-7 days after treatment
treating anthracycline side effects
dexrazoxane
antineoplastic antibiotics
bleomycin
antineoplastic side effects
pulmonary fibrosis
respiratory failure
hypersensitivity (IV hydrocortisone helps prevent)
dermatological toxicity
vinca alkaloid route
IV
IT vinca alkaloid
fatal neurotox
npsa alert for vinca alkaloids
adult + teens receive dose in 50ml mini bag
childrens unit receive dose by syringe
vinca alkaloid side effects
CNS toxicity
peripheral/autonomic neuropathy
antimetabolites
MTX
FU
capecitabine - PD of FU
cyclophosphamide class
alkylating drugs
side effects of alkylators
permanent male sterility
non-lymphocytic leukaemia
aromatase inhibitors
anastrazole letrozole
CI group for aromatase inhibitors
pre-meno women
taxanes
paclitaxel
taxanes side effects
cardiac disease
pneumonitis
sepsis
