Immune system and malignancy

Question 1

Which immunosuppressants are “anti-proliferative” ?

3 points

Answer 1

Azathioprine

Cyclophosphamide

Mycophenolate mofetil

Question 2

True or false:

Prednisolone can stimulate appetite

Answer 2

TRUE

In end stage cancers they can be used to stimulate appetite

Question 3

What class of drug is ciclosprin

Answer 3

A calcineurin inhibitor

As is tacrolimus

Question 4

Which calcineurin inhibitor is more nephrotoxic ?

Answer 4

Tacrolimus

Question 5

How long must contraception be continued after discontinuing:

a) Mycophenolate (hint: different in men and women)
b) Methotrexate
c) Statins
d) Isotretinoin

Answer 5

a) 6 weeks for women. 90 days for men
b) 6 months
c) 1 month
d) 1 month

Question 6

Which drugs can be used as disease modifying drugs in multiple sclerosis

Answer 6

Interferon Beta

Peginterferon Beta

Question 7

Which drugs can be used to treat spasticity associated with multiple sclerosis?
(2 points)

Answer 7

Baclofen

Gabapentin [unlicensed]

Question 8

What class of drug is baclofen?

Answer 8

It is a centrally acting muscle relaxant

Centrally acting so can cause side effects e.g. hypotension, nausea and some antimuscarinic effects!

Question 9

What are the cytotoxic handling guidelines?

6 points

Answer 9

1. Only reconstituted by TRAINED personnel
2. Reconstituted in DESIGNATED AREAS
3. PROTECTIVE CLOTHING must be worn
4. EYE PROTECTION must be worn
5. PREGNANT staff should avoid exposure
6. MONITOR staff exposure to cytotoxics

Question 10

Oral mucositis is associated with which 3 cytotoxic drugs?

Answer 10

1. Methotrexate
2. Fluorouracil
3. Anthracyclines (e.g. doxorubicin)

Question 11

Which class of cytotoxics are known as cytotoxic antbiotics ?

Answer 11

Anthracyclines

Question 12

What are the features of tumour lysis syndrome

Answer 12

Hyperkalaemia
Hyperuriceamia

Hypocalcaemia
Hypophosphatemia

May lead to renal damage

Question 13

Management of hyperuricaemia associated with chemotherapy:

a) Prophylaxis
b) Treatment

Answer 13

a) Allopurinol - start 24 hours before treatment

b) Rasburicase - licensed for hyperuricaemia is haematological malignancy

Question 14

All cytotoxics cause bone marrow suppression except _____ and ______

Answer 14

Vincristine and Bleomycin

Question 15

True or false:

Alopecia caused by cytotoxics is irreversible

Answer 15

FALSE

Hair will grow back once treatment is stopped

Question 16

True or false:

Cancer chemotherapy increases the VTE risk

Answer 16

TRUE

Though the risk may also be increased by the cancer itself

Question 17

Cyclophosphamide, Carmustine and Melphalan are examples of what class of cytotoxic ?

Answer 17

Alkylating agents

Question 18

What class of cytotoxic has a risk of permanent male sterility and premature menopause associated with it?

Answer 18

Alkylating agents e.g cyclophosphamide

Question 19

Mild, moderate or highly emetogenic:

(intermediate dose) Cyclophosphamide

Answer 19

Moderate

Question 20

Mild, moderate or highly emetogenic:

Dacarbazine

Answer 20

High

Question 21

Mild, moderate or highly emetogenic:

Fluorouracil

Answer 21

Mild

Question 22

Mild, moderate or highly emetogenic:

Taxanes e.g. Paclitaxel

Answer 22

Moderate

Question 23

Mild, moderate or highly emetogenic:

Vinca alkaloids e.g. vincristine

Answer 23

Mild

Question 24

Mild, moderate or highly emetogenic:

Doxorubicin

Answer 24

Moderate

Question 25

Mild, moderate or highly emetogenic: | High doses of methotrexate

Answer 25

Moderate

Question 26

Mild, moderate or highly emetogenic: | Platinum based chemotherapy e.g. Cisplatin

Answer 26

High

Question 27

Drugs used to prevent acute symptoms in low risk of emesis associated with chemo? (2 options)

Answer 27

Lorazepam OR Dexamethasone

Question 28

Drugs used to prevent acute symptoms in high risk of emesis associated with chemo: ______ and _______ and _______

Answer 28

5HT3 receptor atagonist (e.g. ondansetron) Dexamethasone Aprepitant (a NK1 receptor antagonist)

Question 29

To prevent delayed symptoms of emesis with moderately emetogenic chemo: _____ and ______

Answer 29

Ondansetron + Dexamethasone

Question 30

To prevent delayed symptoms of emesis with highly emetogenic chemo: _____ and ______

Answer 30

Dexamethasone + Aprepitant

Question 31

``` Which class of cytotoxics are known to be cardiotoxic ? Give an example ```

Answer 31

Anthracyclines | e.g. Doxorubicin and Bleomycin

Question 32

What is used to counteract folate antagonism caused by methotrexate ?

Answer 32

Folinic acid (as Ca folinate) note: It is also used in the management of methotrexate overdose

Question 33

What is used to prevent urothelial toxicity caused by cyclophosphamide and ifosfamide ?

Answer 33

Mesna

Question 34

Which drugs are aromatase inhibitors? | 2 points

Answer 34

Letrozole | Anastrozole

Question 35

What is used as adjuvant therapy in men and PRE-menopausal women with ER+ breast cancer?

Answer 35

Tamoxifen

Question 36

What is 1st line for ER+ breast cancer in post-menopausal women

Answer 36

Aromatase inhibitors e.g. letrozole | Tamoxifen if CI or low risk of recurrence

Question 37

How long is chemo-prevention with tamoxifen given in familial breast cancer?

Answer 37

5 years

Question 38

Which bisphosphonates are used in malignant diseases? | 2 points

Answer 38

Pamidronate | Zoledronic acid