Cytotoxic Flashcards
Cytotoxic drugs are used in conditions in which there malignancies.
Which of the following drugs is cytotoxic?
Ciclosporin
Co-careldopa
Cyclophosphamide
Etoricoxib
Methadone
Cyclophosphamide
A 45-year-old woman with oestrogen-receptor positive with breast cancer. She has prescribed tamoxifen 20 mg daily after a total mastectomy. She has a history of depression for which she is taking paroxetine 20 mg every morning.
Which of the following is the most appropriate counselling point for this patient?
Select one:
A. Redness, pain or swelling in the leg can be managed with painkillers and by elevating the leg
B. She should see her GP to review her paroxetine as it may increase the chance of her experiencing side effects from the tamoxifen
C. Take the tamoxifen at night to reduce symptoms of hot flushes
D. Tamoxifen also reduces the risk of endometrial cancer
E. Tamoxifen should be taken daily to reduce the risk of the breast cancer returning Correct
Tamoxifen should be taken daily to reduce the risk of the breast cancer returning, with ongoing review of the benefits versus risks of continuing.
Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.
Tamoxifen may increase the risk of endometrial cancer. Paroxetine reduces the effectiveness of tamoxifen through inhibiting its conversion to its active form. Timing of tamoxifen will not reduce the hot flush which is a common side effect. Tamoxifen increases the risk of venous thromboembolism and a swollen leg could suggest a deep vein thrombosis which requires urgent medical attention in a hospital.
The correct answer is: Tamoxifen should be taken daily to reduce the risk of the breast cancer returning
He calls the pharmacy to state he is stopping his mycophenolate mofetil treatment to try for a baby. He would like to know how long he needs to continue to use contraception for.
1 week
4 weeks
30 days
6 weeks
2 months
90 days
26 weeks
One year
The correct answer was 90 days
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least 90 days after stopping.
She calls the pharmacy to state she is stopping her mycophenolate mofetil treatment to try for a baby. She would like to know how long she needs to continue to use contraception for.
1 week
4 weeks
30 days
6 weeks
2 months
90 days
26 weeks
One year
6 weeks
Female patients of childbearing potential receiving mycophenolate should always use contraception and for up to 6 weeks after stopping treatment.
A 24-year-old with severe eczema who is prescribed azathioprine.
- Take this medication after food
- You may experience sudden onset of sleep. Please exercise caution when performing skilled tasks
- Report any signs of visual impairment immediately to your prescriber
- Your medication may colour your urine blue. This is harmless
- Do not take this medication at the same time as antacids
- Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
- Take this medication at night
Immediately report any signs or symptoms of anaemia, bruising or infection to your doctor
Anaemia, bruising or infection are signs of bone marrow suppression.
A prescription for mycophenolate mofetil for a 25-year-old male patient.
Do not take if you are allergic to sulphur-containing products
May cause drowsiness
Remain upright for 30 minutes after taking
Swallow whole with a glass of water
There are no specific counselling points
This medicine is only taken once per week
You and your partner should use appropriate contraception
You should use two types of contraception during treatment
You and your partner should use appropriate contraception
As a precautionary measure for male patients, it is now recommended that either the patient or their female partner use reliable contraception during treatment with mycophenolate medicines and for at least 90 days after stopping.
What would be appropriate counselling for the patient in the following scenario? Each option may be used once, more than once or not at all.
A prescription for a mycophenolate mofetil for a 25-year-old female patient.
Do not take if you are allergic to sulphur-containing products
May cause drowsiness
Remain upright for 30 minutes after taking
Swallow whole with a glass of water
There are no specific counselling points
This medicine is only taken once per week
You and your partner should use appropriate contraception
You should use two types of contraception during treatment
You should use two types of contraception during treatment
Female patients of childbearing age receiving mycophenolate should always use contraception - 2 methods of effective contraception are preferred.
Cytotoxic drugs are used in conditions in which there malignancies.
Which of the following drugs is cytotoxic?
Ciclosporin
Co-careldopa
Cyclophosphamide
Etoricoxib
Methadone
The correct answer was Cyclophosphamide
Cyclophosphamide is cytotoxic.
You are learning about the use of cytotoxic medicines. According to NPSA guidance, which of the following does a patient NOT need written information on when taking oral cytotoxic medicines?
Intended drug regimen
Monitoring arrangements
Side effects they have experienced
Their specialist’s contact details
Treatment plan
The correct answer was Side effects they have experienced
Patients should be fully informed and receive verbal and up-to-date written information about their oral anticancer therapy from the initiating hospital. This information should include contact details for specialist advice, which can be shared with non-specialist practitioners. Written information including details of the intended oral anti-cancer regimen and treatment plan including arrangements for monitoring, taken from the original protocol, should be given to the patient. When shared with pharmacists and dispensing staff, this would enable the above dispensing requirements to be satisfied.
You have been working on a cytotoxic rotation within your trust and are required to learn the eight side effects of cytotoxic drugs.
Which of the following is NOT a side effect of cytotoxic drugs?
Alopecia
Excessive bone marrow production
Extravasation of intravenous drugs
Hyperuricaemia
Oral mucositis
The correct answer was Excessive bone marrow production
Excessive bone marrow production is incorrect - cytotoxic drugs can cause bone marrow suppression.
Which of the following can be a side-effect of ciclosporin?
The SPC is provided here: http://www.medicines.org.uk/emc/medicine/1307
Hypophosphataemia
Hypomagnesaemia
Hypocalcaemia
Hyponatraemia
Hypokalaemia
The correct answer was Hypomagnesaemia
A 59-year-old woman who has recently had a mastectomy for breast cancer is started on tamoxifen by your consultant. She asks you to discuss tamoxifen therapy with the patient.
Select the two most appropriate pieces of information to convey to the patient from the list below:
- A.Tamoxifen increases the risk of blood clots. She should seek medical attention if calf pain occurs
- B.Tamoxifen therapy is normally used for 2 years following mastectomy
- C.Hot flushes are common in patients who take tamoxifen
- D.There is a small increased risk of uterine fibroids in patients taking tamoxifen
- E.Patients should book an urgent appointment with their doctor if they develop a sore throat
Correct answer: A C
- This question tests a candidates ability to priortise information. Remember during the Prescribing Skills Assessment you have access to a copy of the BNF. The challenge is therefore to process and priortise the information contained within the BNF.
- Hot flushes are important to mention as they are so common. Venous thromoboembolism (VTE) is potentially life-threating but easily treated if caught early. It is therefore important to make patients aware of VTE symptoms.
- Tamoxifen is typically used for 5 years after mastectomy.
- Tamoxifen may cause uterine fibroids but it is certainly not one of the two most important bits of information to convey,
- Tamoxifen does not commonly cause neutropaenia so warnings regarding sore throats are not appropriate.
Tamoxifen
- Tamoxifen is a Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor positive breast cancer
- Adverse effects
- menstrual disturbance: vaginal bleeding, amenorrhoea
- hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
- venous thromboembolism
- endometrial cancer
- Tamoxifen is typically used for 5 years following removal of the tumour.
- Raloxifene is a pure oestrogen receptor antagonist, and carries a lower risk of endometrial cancer
