immune and malignancy extra Flashcards
Hannah, a 45-year-old woman undergoing chemotherapy for breast cancer, has been feeling increasingly unwell with nausea, diarrheal, and changes in urination. Blood tests confirm she is experiencing tumour lysis syndrome. Which of the following features is NOT commonly associated with tumour lysis syndrome?
hyperuricaemia, hyperkalaemia,hyperphosphataemia, hypocalaemia, hyperglycaemia
hyperglycaemia is not typically associated with tumour lysis syndrome. The common features of tumour lysis syndrome include hyperuricemia, hyperkalaemia, hyperphosphatemia, and hypocalcaemia.
MOA anthracyclines
disrupt DNA by poisoning topoisomerase, a critical enzyme for unwinding of the DNA for replication and synthesis, thereby causing growth arrest and programmed cell death
Which cytotoxic drugs works by inhibiting topoisomerase
anthracyclines
disrupt DNA by poisoning topoisomerase, a critical enzyme for unwinding of the DNA for replication and synthesis, thereby causing growth arrest and programmed cell death
which ones need pretreatment to reduce risk hypersensitivty reactions
taxanes
P + C: CC, H2RA, antihistamine
D: dexamethasone to reduce fluid retention and hypersensitivity
they can still rarely occur even with pre treatment
Mr. Neo Sporin, a 22-year-old man, has been admitted to the hospital with a flare-up of his ulcerative colitis. As he hasn’t responded to standard therapy, intravenous ciclosporin has been started. You visit him at bedside to discuss the potential side effects of this medication. Which of the following side effects would NOT be expected with ciclosporin?
- RI
- visual disturbances
- gingival hyperplasia
- hair changes
- cardiomyopathy
cardiomyopathy
Ciclosporin can cause renal impairment, visual disturbances, gingival hyperplasia, and hair changes. However, cardiomyopathy is not a commonly reported side effect of ciclosporin, however it is reported with tacrolimus.
bone marrow suppression usually occurs 7-10 days after chemo admin. these three drugs however have delayed onset, causing bone marrow suppression several days to weeks after admin
carmustine, lomustine, and melphalan
which of the following is not a likely SE of mycophenolate?
bone marrow suppression, pure red cell aplasia, hypogammaglobulinemianeurotoxicity, bronchiestasis, neurotoxicity
neurotoxicity
mycophenolate - contraception for males
The MHRA advises that male patients or their female partners should use effective contraception during treatment and for 90 days after discontinuation.
Mr Loren Zi Pam has been started on a moderately emetogenic chemotherapy drug and usually feels nauseous 3-4 days after treatment. Which of the following anti-emetic plans would be most appropriate to give this patient?
Aprepitant
B. Aprepitant + dexamethasone
C. Aprepitant + dexamethasone + ondansetron
D. Aprepitant + lorazepam
E. Aprepitant + ondansetron
F. Dexamethasone + ondansetron
G. Lorazepam
H. Ondansetron
F. Dexamethasone + ondansetron
A patient has been admitted to the oncology ward for chemotherapy treatment. They have started to feel nauseous before starting medication. Which of the following anti-emetic plans would be most appropriate to give this patient?
A. Aprepitant
B. Aprepitant + dexamethasone
C. Aprepitant + dexamethasone + ondansetron
D. Aprepitant + lorazepam
E. Aprepitant + ondansetron
F. Dexamethasone + ondansetron
G. Lorazepam
H. Ondansetron
G Lorazepam
Lorazepam should be used in anticipatory nausea and vomiting. This is as the nausea and vomiting is most likely due to nerves, and requires a short acting benzodiazepine to help the patient.
A patient has come into the out-patient clinic to receive their weekly dose of cancer treatment. Every now and then, they tend to vomit a couple of hours after the treatment and are classed as low risk of vomiting. Which of the following anti-emetic plans would be most appropriate to give this patient?
A. Aprepitant
B. Aprepitant + dexamethasone
C. Aprepitant + dexamethasone + ondansetron
D. Aprepitant + lorazepam
E. Aprepitant + ondansetron
F. Dexamethasone + ondansetron
G. Lorazepam
H. Ondansetron
G lorazepam
Patients who have a low risk of nausea and vomiting within 24 hours of taking the treatment should be treated using either lorazepam or dexamethasone.
Mr Dale Teparin has been started on a highly emetogenic chemotherapy drug and usually feels nauseous 2 days after treatment. Which of the following anti-emetic plans would be most appropriate to give this patient?
A. Aprepitant
B. Aprepitant + dexamethasone
C. Aprepitant + dexamethasone + ondansetron
D. Aprepitant + lorazepam
E. Aprepitant + ondansetron
F. Dexamethasone + ondansetron
G. Lorazepam
H. Ondansetron
B – Patients with delayed symptoms (more than 24 hours after treatment), taking highly emetogenic medications should be started off on dexamethasone and aprepitant.
Mrs Val Sartan is a high-risk patient for vomiting after taking chemotherapy medication. They usually vomit instantly after the treatment. Which of the following anti-emetic plans would be most appropriate to give this patient?
A. Aprepitant
B. Aprepitant + dexamethasone
C. Aprepitant + dexamethasone + ondansetron
D. Aprepitant + lorazepam
E. Aprepitant + ondansetron
F. Dexamethasone + ondansetron
G. Lorazepam
H. Ondansetron
C
A patient taking cyclophosphamide has come into the walk-in clinic worried that the medication is causing them harm as they have started to produce red urine. This is a new side-effect for the patient which started this morning. Which of the following counselling points would be most appropriate?
A. This is a harmless side-effect which will continue throughout treatment
B. This is a harmless side-effect which requires treatment discontinuation
C. This side-effect requires an increase in medication dose
D. This side-effect requires a reduction in medication dose
E. This side-effect requires immediate discontinuation of the medication
F. This side-effect usually resolves on its own
G. This side-effect usually resolves on its own, but if it doesn’t, medication is needed
H. This side-effect usually resolves on its own, but medication should be stopped
E – When red urine is produced in patients taking cyclophosphamide, this is usually haematuria. Urotoxicity may mandate interruption of treatment. Cases of urotoxicity with fatal outcomes have been reported. Haematuria usually resolves in a few days after cyclophosphamide treatment is stopped, but it may persist.
Which of the following medications is used to manage the symptoms of spasticity in patients with multiple sclerosis?
A. Amantadine
B. Amitriptyline
C. Baclofen
D. Citalopram
E. Gabapentin
F. Hydrocortisone
G. Methylprednisolone
H. Sertraline
C – Baclofen, as well as diazepam, tizanidine and dantrolene can be used to treat spasticity in patients with multiple sclerosis.
