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Question 1

State the cytotoxic drug handling guidelines:

Answer 1

Trained personnel should reconstitute cytotoxics

Reconstitution should be carried out in designated pharmacy areas

Protective clothing (gloves, gowns, masks) should be worn

Eyes should be protected and means of first aid should be specified

Pregnant staff should avoid exposure to cytotoxic drugs (all females of child-bearing age should be informed of the reproductive hazard)

Question 2

State antiproliferative immunosuppressants:

Answer 2

Azathioprine widely used for transplant recipients and is also used to treat autoimmune conditions. It is metabolised to mercaptopurine and doses should be reduced when allopurinol is given concurrently

Mycophenolate mofetil is metabolised to mycophenolic acid which has more selective mode than azathioprine

Mycophenolate mofetil reduces the risk of acute rejection episodes; the risk of opportunistic infections (particularly due to tissue-invasive cytomegalovirus) and the occurrence of blood disorders such as leucopenia may be higher

“Antiproliferative immunosuppressants” are medications that help prevent the immune system from attacking the body’s own cells and tissues by slowing down or stopping the growth of certain cells, such as those involved in inflammation or immune responses.

Question 3

State the important safety information for ciclosporin:

Answer 3

Ciclosporin must be prescribed and dispensed by brand name

because switching between formulations without close monitoring may lead to clinically important changes in blood-ciclosporin concentration

Question 4

State the important safety information for tacrolimus:

Answer 4

Tacrolimus must be prescribed and dispensed by brand name only, to minimise the risk of inadvertent switching between products, which has been associated with reports of toxicity and graft rejection

“Inadvertent switching between products” means mistakenly changing or using different products unintentionally.

Question 5

State the cytotoxic drug side effects of vinca-alkaloids:

Answer 5

Neurotoxicity

Vinblastine (VBL), vinorelbine (VRL), vincristine (VCR) and vindesine (VDS)

Question 6

Which cytotoxic drugs cause a sore mouth:

Answer 6

Most often associated with fluorouracil, methotrexate, anthracyclines

Good oral hygiene (rinsing the mouth frequently and effective brushing of the teeth with a soft brush 2-3 times daily is helpful

For fluorouracil, sucking ice chips during short infusions is helpful too

Fluorouracil is part of a group of chemotherapy drugs known as anti metabolites.

Methotrexate belongs to a class of drugs known as antimetabolites. It works by slowing or stopping the growth of cancer cells and suppressing the immune system.

Daunorubicin, doxorubicin, and epirubicin are anthracyclines.

Question 7

All cytotoxic drugs cause bone-marrow suppression besides these 2 drugs:

Answer 7

Vincristine sulfate and bleomycin

Question 8

State how soon bone-marrow suppression occurs:

Answer 8

Commonly occurs 7-10 days after administration but it is delayed for certain drugs, such as carmustine, lomustine and melphalan

Question 9

State the cytotoxic drugs effect on pregnancy and reproductive function:

Answer 9

Most cytotoxic drugs are teratogenic and should not be administered during pregnancy especially in the 1st trimester

Exclude pregnancy before any treatment with cytotoxic drugs

Contraceptive advice should be given before cytotoxic therapy begins - women of child-bearing age should use effective contraception during and after treatment

Question 10

State the cytotoxic drugs effect on reproductive function:

Answer 10

Regimens that do not contain an alkylating drug or procarbazine may have less effect on fertility

but those with an alkylating drug or procarbazine carry the risk of causing permanent male sterility (there is no effect on potency)

counsel patient on sperm storage

Question 11

State the cytotoxic drugs effect on nausea and vomiting:

Answer 11

Mildly emetogenic treatment = fluorouracil, etoposide, methotrexate (less than
100mg/m2), vinca-alkaloids, abdominal radiotherapy

Moderately emetogenic treatment = the taxanes, doxorubicin hcl, intermediate and low doses of cyclophosphamide, mitoxantrone, and high doses of methotrexate (0.1-1.2g/m2)

Highly emetogenic treatment = cisplatin, dacarbazine, and high doses of cyclophosphamide

Question 12

State the prevention of acute symptoms for patients at low risk of emesis:

Answer 12

Pre-treatment with dexamethasone or lorazepam may be used

Question 13

State the prevention of acute symptoms for patients at high risk of emesis:

Answer 13

A 5-HT3-receptor antagonist, usually given by mouth in combination with dexamethasone

e.g.ondanestron

Question 14

State a neurokinin receptor antagonist that may be used also for patients at high risk of emesis:

Answer 14

Arepitant

Question 15

State the drug that it used for prevention of anticipatory symptoms and why:

Answer 15

Lorazepam can be helpful for its amnesic, sedative and anxiolytic effects

Question 16

State the anthracycline side-effects:

Answer 16

Anthracycline-induced cardiotoxicity

Question 17

State the treatment for methotrexate overdose:

Answer 17

Folinic acid

Question 18

State the treatment of methotrexate-induced mucositis or myelosuppression:

Answer 18

Folinic acid (given as calcium folinate)

Question 19

State which drugs can cause haemorrhagic cystitis (urothelial toxicity):

Answer 19

Oxazaposphorines

cyclophosphamide

ifosfamide

“Hemorrhagic cystitis (urothelial toxicity)” is a condition where there is bleeding and irritation in the bladder’s lining, often caused by certain medications or infections.

Question 20

State what causes urothelial toxicity:

Answer 20

Metabolite acrolein

“Metabolite acrolein” is a substance produced in the body during the breakdown of certain chemicals. It can be harmful and is associated with inflammation and damage to tissues when present in high levels.

Question 21

State what drug can be given to prevent urothelial toxicity:

Answer 21

Mesna

Mesna, sold under the brand name Mesnex among others, is a medication used in those taking cyclophosphamide or ifosfamide to decrease the risk of bleeding from the bladder. It is used either by mouth or injection into a vein.

Question 22

State the vinca-alkaloid drugs:

Answer 22

Vinblastine sulfate, vincristine sulfate and vindesine sulfate

Question 23

State which route vinca-alkaloids are administered:

Answer 23

Intravenous administration only! KEY

Inadvertent intrathecal administration can cause severe neurotoxicity which is usually fatal

Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid and is useful in spinal anesthesia, chemotherapy, or pain management applications.

Question 24

State a semi-synthetic vinca-alkaloid and its use:

Answer 24

Vinorelbine

role in treatment of breast cancer

Question 25

State what is tumour lysis syndrome:

Answer 25

Rapid destruction of malignant cells

Patients at risk include those with non-hodgkin’s lymphoma, burkitt’s lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia

Tumor lysis syndrome happens when cancer cells break down too quickly, releasing harmful substances into the body. This can cause serious problems like imbalances in electrolytes (important minerals in the body), kidney damage, heart issues, and neurological problems. So, even though getting rid of tumors is good, doing it too fast can be dangerous.

Non-Hodgkin’s Lymphoma: This is a type of cancer that affects the lymphatic system, which is a part of the body’s immune system. It involves abnormal growth of white blood cells called lymphocytes.

Burkitt’s Lymphoma: This is a fast-growing type of non-Hodgkin’s lymphoma. It’s characterized by abnormal growth of B-cells, a type of white blood cell, and often affects the jaw, face, or abdomen.

Acute Lymphoblastic Leukemia (ALL): This is a type of cancer that starts in the bone marrow and affects the white blood cells called lymphoblasts. It progresses quickly and primarily affects children, but can also occur in adults.

Acute Myeloid Leukemia (AML): This is a type of cancer that starts in the bone marrow and affects the white blood cells called myeloid cells. It progresses rapidly and can occur in both adults and children.

Question 26

State in which conditions hyperuricaemia may be present in:

Answer 26

High-grade lymphoma, leukaemia, markedly worsened by chemotherapy and is associated with acute renal failure

Question 27

State the treatment of hyperuricaemia:

Answer 27

Allopurinol should be started 24 hours before treating such tumours and patients should be adequately hydrated

Dose of mercaptopurine or azathioprine should be reduced if allopurinol needs to be given concomitantly

Febuxostat may also be used and should be started 2 days before cytotoxic therapy is initiated

Rasburicase licensed for hyperuricaemia in patients with haematological malignancy

“Hyperuricemia and chemotherapy” refers to high levels of uric acid in the blood, which can occur as a side effect of certain chemotherapy treatments. This condition can lead to problems such as gout or kidney stones and may require management with medications to lower uric acid levels.

“Haematological malignancy” is a broad term that refers to cancers that affect the blood, bone marrow, and lymphatic system. These cancers involve abnormal growth of cells in these areas, which can impact the body’s ability to produce healthy blood cells and fight off infections

Febuxostat is used to lower hyperuricemia (high uric acid in the blood) in patients with gout who have been treated with allopurinol that did not work well or cannot be treated with allopurinol. This medicine is a xanthine oxidase inhibitor.

hyperuricemia serves as one of the factors contributing to the development of tumor lysis syndrome.

Rasburicase is a medication used to treat hyperuricemia, particularly in the context of tumor lysis syndrome (TLS). It works by rapidly converting uric acid into a substance that is more easily excreted by the kidneys. By lowering uric acid levels in the blood, rasburicase helps prevent or manage complications associated with hyperuricemia, such as kidney damage and electrolyte imbalances.

Question 28

State a common complication of chemotherapy:

Answer 28

Reversible hair loss

There are no pharmacological methods of preventing this are available

Question 29

State the anthracycline antibiotics:

Answer 29

Daunorubicin, doxorubicin hcl, epirubicin hcl and idarubicin hcl

Question 30

State an anthracycline derivative:

Answer 30

Mitoxantrone

Question 31

State the common use of doxorubicin hcl:

Answer 31

Treat leukaemia’s, hodgkin’s and non-hodgkin’s lymphomas, pediatric malignancies and some solid tumours including breast cancer

Question 32

State the common use of epurubicin hcl:

Answer 32

Most commonly used in treatment of haematological malignancies

Blood cancer, also called hematological cancer, occurs when abnormal cells in the blood grow out of control.

Question 33

State the use of pixantrone:

Answer 33

Monotherapy for treatment of refractory or multiply relapsed aggressive non-hodgkin B-cell lymphomas

Question 34

State the common use of bleomycin:

Answer 34

Is given IV or IM to treat metastatic germ cell cancer

and in some regimens, non-hodgkin’s lymphoma

Germ cell tumors can spread (metastasize) to other parts of the body. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system

Non-Hodgkin lymphoma is diverse, spreads unpredictably, and lacks Reed-Sternberg cells. Hodgkin lymphoma is more predictable, has Reed-Sternberg cells, and often has a better prognosis. Both are treated with chemotherapy and sometimes radiation, but outcomes vary.

Reed-Sternberg cells: are large abnormal cells,

Question 35

State the common use of dactinomycin:

Answer 35

Paediatric cancers

Question 36

State the common use of mitomycin:

Answer 36

Can be given IV to treat gastro-intestinal, breast, non-small cell lung, and metastatic pancreatic cancers, and by bladder instillation for superficial bladder tumours

Question 37

State the alkylating drugs and its common uses:

Answer 37

Cyclophosphamide - mainly used in combination with other agents for treating wide range of malignancies, some leukaemias, lymphomas and solid tumours. It is given by mouth or IV; it is inactive until it is metabolised by liver

Ifosfamide - given IV

Melphalan - treatment of multiple myeloma, polycythemia vera, childhood neuroblastoma, advanced ovarian adenocarcinoma and advanced breast cancer

Lomustine - lipid soluble nitrosourea and drug is given at intervals of 4 to 6 weeks Carmustine - given to patients with multiple myeloma, non-hodgkin’s lymphoma, Hodgkin’s disease and brain tumours

Estramustine phosphate - combination of an estrogen and chlormethine used predominantly in prostrate cancer

Mitobronitol - treatment of chronic myeloid leukaemia

Question 38

Define multiple sclerosis:

Answer 38

Is a chronic, immune-mediated demyelinating inflammatory condition of the central nervous system, which affects the brain, optic nerves and spinal cord, leading to progressive severe disability

There is no medicinal treatment for multiple sclerosis

Question 39

State some information about breast cancer:

Answer 39

Most common form of malignancy in women, especially those aged 50+

Question 40

State the risk factors of breast cancer:

Answer 40

Age, early onset of menstruation, late menopause, older age at first completed pregnancy, family history of breast cancer, the use of oral contraceptives and HRT is also associated with increased risk of breast cancer

Breast cancer is men is rare, although risk factors are not full understood in men it may be associated with abnormalities of the sex hormone metabolism, including those caused by liver disease or testicular trauma, genetic predisposition or industrial exposure to chronic heat

Note: The treatments for breast cancer, prostrate cancer, multiple sclerosis may not be asked in exam as they are considered very specialist conditions