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Pre-reg > Immune system and Malignancy > Flashcards

Immune system and Malignancy Flashcards

1
Q

What type of vaccines should be avoided in immunocompromised patients?

A

live

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2
Q

Examples of live vaccines

A

Measles, mumps, rubella (MMR combined vaccine)
Rotavirus
Smallpox
Chickenpox
Yellow fever
Nasal flu vaccine

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3
Q

What are immunosuppressants used for?

A

Suppress the immune system and chronic inflamation.

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4
Q

Examples of anti proliferative drugs?

A

azathioprine, mercaptopurine, mycophenolate

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5
Q

Examples of calcineurin inhibitors

A

tacrolimus, ciclosporin

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6
Q

What drugs are used in IBD?

A

Azathioprine, mercaptopurine, ciclosporin, methotrexate, corticosteroids

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7
Q

Azathioprine- MoA

A

blocks purine synthesis needed for DNA/RNA/protein synthesis

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8
Q

Azathioprine- side effects

A

blood disorders (leucopenia, thrombocytopenia, anaemia)
Pancreatitis
hypersensitivity
Nausea- take with food

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9
Q

Azathioprine- monitoring (pre-screening and general)

A

pre screening- TMPT testing
general - FBC (weekly for 4/8 weeks, then 3 monthly)

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10
Q

Azathioprine- counselling

A

report signs of blood disorders- unexplained bruising or bleeding and infections
If feeling nauseous then take with food

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11
Q

Azathioprine- interactions

A

ALLOPURINOL (azathioprine is metabolised by xanthines, allopurinol is a xanthine inhibitor)
- ACEi- increases risk of anaemia
- Trimethoprim- haem toxicity
- warfarin- decreases anticoagulant effect

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12
Q

How to deal with con-current use of azathioprine and allopurinol?

A

reduce to 1/4 of normal dose

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13
Q

Mycophenolate- MoA

A

blocks guanosine synthesis (purine) needed for DNA synthesis

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14
Q

Mycophenolate- side effects

A

blood disorders
hypogammaglobinemia
bronchiectasis, pulmonary fibrosis
GI effects (bleeding)
increases risk of skin cancer

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15
Q

Mycophenolate- counselling

A

report signs of infection/bleeding
report any new and persistent cough and SOB
avoid excessive exposure to sunlight

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16
Q

Mycophenolate- Cautions

A

recurrent infection
increased serum iG
persistent respiratory symptoms (cough,SOB)
Serious active GI disease- e.g. Ulcerative Colitis

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16
Q

Mycophenolate- Cautions

A

recurrent infection, increased serum iG

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17
Q

Mycophenolate- contraception requirements (women)

A

Women:
2 pregnancy tests before treatment
(8-10 days apart)
effective contraception until 6 weeks after stopping
must be part of the PPP

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18
Q

Mycophenolate- contraception requirements (men)

A

effective contraception until 90 after stopping

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19
Q

Tacrolimus- MoA

A

Calcineurin inhibitor (calcineurin activates T cells)

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20
Q

Tacrolimus- S/E

A

Blood disorders
Cardiomyopathy
nephrotoxicity
photosensitivity
HYPOKALAEMIA, Increased Glucose and urea

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21
Q

Tacrolimus- monitoring

A

Echo- hypertrophic changes (heart muscle becomes enlarged)

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22
Q

Tacrolimus- counselling

A

avoid excess UV exposure
blood disorders
report any palpitations, SOB, chest pain (hyperK)

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23
Q

Tacrolimus and ciclosporin- interactions

A
  • Enz inhibitors (toxicity)
  • Enz inducers
  • Nephrotoxic drugs- aminoglycosides, glycopeptides, Ciclosporin, methotrexate, NSAIDs
  • Hyperkalaemia- ACE/ARB, K-sparing, MRA, NSAID, Trimethoprim. Heparin
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24
Q

Tacrolimus- MHRA advice

A

brand continuity

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25
Q

Tacrolimus/sirolimus- what ethnicity may require an increased dose?

A

black African or African–Caribbean

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26
Q

Tacrolimus- monitoring

A

Whole-blood tacrolimus trough concentration

ECG
BP
Fasting blood glucose (causes increased glucose)
FBC
U&Es (creatinine)

27
Q

Tacrolimus- contraception

A

exclude before treatment

28
Q

Ciclosporin- MoA

A

calcineurin inhibitor

29
Q

Ciclosporin- S/E

A

Eye inflammation/visual disturbances
gingival hyperplasia
nephrotoxicity
hyperkalaemia

30
Q

Ciclosporin- what food/drinks should be avoided

A

pomelo and grapefruit juice- enz inhibitor
purple grape juice- enz inducer

31
Q

Ciclosporin- monitoring

A

U&Es- potassium and magnesium (exam q- hyperkalaemia and hypomagnesaemia)
LFT- concurrent NSAIDS
FBC
lipids- before and 1 month after
BP- discontinue if uncontrolled

32
Q

Why are cytotoxic treatments used

A

curative, prolong life and palliate symptoms

33
Q

When can cytotoxics be used?

A

Neoadjuvant- before surgery or chemotherapy to shrink tumour
adjuvant- added to radiotherapy/surgery to maximise treatment effects

34
Q

ADV/DISADV of 1 or more cytotoxic

A

ADV- reduces drug resistance, increased survival rate
DISADV- toxicity (increased supression)

35
Q

Handling of cytotoxics (azathioprine, mercaptopurine, IV cytotoxics, finasteride)

A
  • pregnant staff should avoid
  • dedicated area of pharmacy
  • trained staff
  • spills and waste disposal procedure in place
  • protective gear should be worn
    -staff exposure should be monitored
36
Q

What is required for the prescribing, dispensing and administration of cytotoxic drugs?

A

a written protocol or treatment plan

37
Q

What cytotoxics commonly cause: VTE

A

Tamoxifen, thalidomide, linadmonide, pomalidomide

38
Q

What cytotoxics can cause: endometrial cancer

A

tamoxifen

39
Q

What cytotoxics commonly cause: Urethral toxicity

A

Cyclophosphamide, infosfamide (exam q)

TREAT WITH MESNA

40
Q

What cytotoxics commonly cause: extravasation

A

vinca alkaloids, anthracyclines

41
Q

What cytotoxics commonly cause: infertility in men

A

alkalating drugs and procarbozine

42
Q

What are the 2 cytotoxics that do not cause bone marrow supression?

A

vincristine and bleomycin

43
Q

What cytotoxics commonly cause: oral mucocytis

A

fluorouracil, methotrexate, anthracyclines

44
Q

Bone marrow suppression:
treatment of fever and neutropenia

A

figrastim

45
Q

Bone marrow suppression:
treatment of symptomatic iron deficiency anaemia

A

RBC transfusion
erythropoetin

46
Q

Hyperuricaemia (common in lymphoma and leukaemia):
Treatment

A

allopurinol (24hours before chemo)
febuxostat (2 days before chemo)
rasburicase (haem cancers)

47
Q

N&V
Mildly emetogenic

A

Methotrexate
vinca alkaloids
flurouracil
etoposide

48
Q

N&V
moderate emetogenic

A

high dose MTX
Taxanes
Doxorubicin
Cyclophosphamide
mitoxantrone

49
Q

N&V
Highly emetogenic

A

Cisplatin
Dacarbazine
High dose cyclophosphamide

50
Q

N&V treatment:
Anticipatory

A

lorazepam

51
Q

N&V treatment:
Acute <24 hours

A

Low risk: Dexamethasone or Lorazepam
High risk: Dex+ ondansetron + Aprepitant

52
Q

N&V treatment:
Delayed

A

mod emetogenic= Dex + 5 HT3
High = Dex and Aprepitatn
or Rolapitant and metoclopramide

53
Q

Vinca Alkaloids- what route should be avoided

A

intrathecal (neurotoxicity)

54
Q

Vinca Alkaloids (vincristine side effects)

A

bronchospasm and neurotoxicity

55
Q

What is given for the treatment of methotrexate induced oral mucositis

A

folinic acid (calium folate)

56
Q

What form of treatment must be avoided with anthracyclines

A

radiotherapy

57
Q

Examples of anthracyclines

A

Xrubicin
doxorubicin, daunorubicin, epirubicin, Idarubicin

58
Q

Side effects of anthracyclines

A

red urine and caridotoxicity

59
Q

Example of an anthracycline derivative

A

mitoxantrone

60
Q

examples of alkylating drugs?

A

Cyclophosphamide, Ifosfamide, melphalan,

61
Q

Methotrexate- Side effects

A

Blood disorders
liver toxicity
Respiratory effects- pneumonitis (cough (lasting weeks), SOB, weight loss)
nephrotoxicity

62
Q

Methotrexate- monitoring

A

FBC and renal and LFTs repeated every 1–2 weeks until therapy stabilised, thereafter patients should be monitored every 2–3 months.

63
Q

What OTC products should be avoided with methotrexate

A

NSAIDs, aspirin
penicillins, PPIs
statins
most antibiotics
TRIMETHOPRIM

64
Q

what drugs are used in MS?

A

interferon beta
Glatiramer acetate
fingolimod (PO, highly active disease)
Natalizumab (rapidly evolving severe MS)

65
Q

what drugs are used in breast cancer?

A

Early and locally advanced= tamoxifen

If patient declines chemotherapy= goserelin

Anastrozole and letrozole (Aromatase inhibitors)

66
Q

What is used in advanced breast cancers

A
  1. endocrine therapy- tamoxifen
  2. Aromatase inhibitors (Anastrozole and letrozole & exemestane)

Pre-reg (13 decks)

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