Cytotoxics and immunosuppressant therapies Flashcards
Points for cytotoxic drug handling?
- Trained personnel should reconstitute cytotoxics
- Carried out in designated areas
- Pregnant staff should avoid exposure
- Follow SOPs for disposal
- Wear protective clothing
What may alter cytotoxic doses
> BSA
Body weight
Neutrophil count
Renal function
Hepatic impairment
What side effect is commonly associated with Fluorouracil and Methotrexate
Oral mucositis : painful inflammation and ulceration
How to help this= good oral hygiene, sucking ice chips during infusions
For chemotherapy mucositis = folinic acid is given as counteracts folate antagonist action
What are the features of tumour lysis syndrome
Occurs secondary to rapid destruction of malignant cells
Feature=
-Hyperkalemia
-Hyperuricemia
-Hyperphosphatemia with hypocalcemia
What should be initiated 24 hours before treating high grade lymphoma and leukaemia ?
ALLOPURINOL
As hyperuricemia is present here and it is worsened by chemotherapy
Which 2 cytotoxic drugs do not cause bone marrow suppression ?
Vincristine and Bleomycin
Nausea and Vomiting are common side effects of cytotoxics and chemotherapy, when does it occur?
ACUTE= Within 24 hours
DELAYED= More than 24 hours after
ANTICIPATORY= Prior to treatment
What can be used for treatment of low risk emesis ?
Pre-treatment with Dexamethasone / Lorazepam
What can be used for treatment of high risk emesis
5HT3 receptor antagonist with dexamethasone
Metoclopramide is licensed for delayed nausea
What is Doxorubicin
Cytotoxic antibiotic
Used to treat various cancers
Inhibits growth by interfering with DNA replication
What is wrong with given corticosteroids in infections
Can modify tissue reactions = rapid spread of infection
Can also suppress signs of infection
What are antiproliferative immunosuppressants
Stop / slow down cell proliferation (growth)
Example of antiproliferative immunosuppressants
Azathioprine
Mycophenilate mofetil= more selective
When should the dose of azathioprine be altered
Dose should be reduced if given with allopurinol: bone marrow suppression
What is CICLOSPORIN
Calcineurin inhibitor
(nephrotoxic)
Must be prescribed by BRAND
Eye related side effected
Avoid excessive UV exposure
Oral solution = mixed with orange / apple juice
What is TACROLIMUS
Calcineurin inhibitor, greater nephrotoxicity than ciclosporin
Must be prescribed by brand
Avoid UV exposure
Contraindicated if hypersensitive to macrolides
Tacrolimus side effects?
TACROLIMUS
Tremor
Alopecia
Cardiovascular (HTN)
Renal insufficiency
Oncology (skin)
Lipids
Insulin dependent diabetes
Magnesium wastage
Uric acid elevation
Seizures
