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GPhC Exam > Immune System and Malignant Disease > Flashcards

Immune System and Malignant Disease Flashcards

1
Q

Azathioprine MoA

A
  • antimetabolite that breaks down into mercaptopurine, which inhibits the repairment and making of DNA
  • broken down by thiopurine methyltransferase (TPMT) - pre-screen as underachieve TPMT = myelosuppression
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2
Q

Azathioprine side effects

A
  • hypersensitivity = malaise, dizziness, DNV, fever, rash, hypotension
  • neutropenia and thrombocytopenia = sore throat, bruising, bleeding
  • nausea = more common at start but resolves over time
  • teratogenic = avoid in pregnancy
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3
Q

Azathioprine monitoring

A
  • TPMT
  • LFT/FBC in severe liver/renal impairment - weekly for first 4 weeks then every 3 months
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4
Q

Azathioprine interactions

A
  • allopurinol = increased risk of haematological toxicity = reduce azathioprine dose
  • ACEi = increased risk of anaemia/leucopenia - avoid concomitant use
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5
Q

Ciclosporin MoA

A
  • calcineurin inhibitor = inhibits lymphokines = suppress cell-mediated response
  • prescribed and dispensed by brand name
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6
Q

Ciclosporin side effects

A
  • HYPER - glycaemia, lipidaemia, tension, uricaemia, kalaemia
  • HYPO - magnesaemia - monitor
  • renal/liver impairment
  • skin reactions
  • gingival hyperplasia
  • hair changes
  • eye inflammation & visual disturbance (in topical use with eyes)
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7
Q

Ciclosporin interactions

A
  • grapefruit and pomelo juice = increases ciclosporin exposure
  • purple grape juice = reduced ciclosporin exposure
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8
Q

Ciclosporin monitoring

A
  • pre-screening: exclude malignancies before systemic use
  • LFTs, Mg, K+, lipids, CrCl, BP, trough levels (range depends on indication)
  • avoid exposure to UV light/sunlight
  • topical (eye) may affect driving/performed skilled tasks
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9
Q

Tacrolimus MoA

A
  • calcineurin inhibitor = inhibits lymphokines = suppress cell-mediated response
  • prescribed and dispensed by brand name
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10
Q

Tacrolimus side effects

A
  • HYPER - glycaemia, uricaemia, kalaemia
  • HYPO/HYPER - tension
  • renal/liver impairment
  • skin reactions, visual disturbances, blood dyscrasia
  • CVD (QT prolongation, cardiomyopathy in children)
  • nervous system disorder, peripheral neuropathy
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11
Q

Tacrolimus interactions

A
  • grapefruit, pomegranate and pomelo juice = increases exposure to tacrolimus
  • DON’T use if sensitive/allergy to macrolides
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12
Q

Tacrolimus monitoring

A
  • BP, ECG, blood glucose, LFT, electrolytes, CrCl
  • avoid exposure to UV light/sunlight
  • may affect driving/performing skilled tasks
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13
Q

Mycophenolate mofetil MoA

A

inhibits purine synthesis

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14
Q

Mycophenolate mofetil side effects

A
  • bone marrow suppression = report infection, bruising, bleeding
  • pure red cell aplasia = reduce dose or discontinue
  • hypogammaglobulinaemia = measure immunoglobulin levels in recurrent infections
  • bronchiostasis = persistent cough and SOB
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15
Q

Mycophenolate mofetil MHRA Alerts

A
  • contraception advice (teratogenic):
  • women = 1 effective contraception during and 6 weeks after (2 methods preferred)
  • men = effective contraception during and 90 days after (for partner aswell)
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16
Q

What is multiple sclerosis

A

autoimmune disease demyelinating the CNS - relapsing, progressive or both

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17
Q

Define active MS

A

2 relapses in the past 2 years despite tx with interferon beta

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18
Q

Managing MS symptoms

A
  • spasticity = baclofen, diazepam, tizanidine, dantrolene
  • relapses = methylprednisolone
  • oscillopsia (objects appear to vibrate) = gabapentin
  • mood alteration = amitriptyline
  • fatigue = amantadine or fampridine
  • titrate baclofen dose slowly to avoid major side effects (sedation and hypotonia)
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19
Q

Drug handling of Cytotoxics

A
  • trained personnel in designates pharmacy areas (aseptics)
  • protective clothing (gloves, gowns, masks, eye protection)
  • avoid by pregnant - childbearing age informed of hazard
  • local procedure for spillage and safe disposal
  • monitor staff exposure to cytotoxics
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20
Q

Name alkylating agents

A

cyclophosphamide, ifofosfamide, melphalan

21
Q

Name anthracyclines

A

daunorubicin, doxorubicin, epirubicin, idarubicin

22
Q

Name antimetabolites

A

cytarabine, florouracil, mercaptopurine

23
Q

Name cytotoxic antibiotics

A

bleomycin, mytomycin

24
Q

Name platinum compounds

A

carboplatin, cisplatin, oxaliplatin

25
Q

Name taxanes

A

cabazitaxel, docetaxel, paclitaxel

26
Q

Name vinca alkaloids

A

vinblastine, vincristine, vindesine

27
Q

Side effects of IV cytotoxics

A

extraversion of IV drugs - local tissue necrosis due to leakage

28
Q

Which cytotoxics cause oral mucositis (sore mouth) & advice

A
  • fluorouracil, methotrexate, anthracyclines
  • good oral hygiene
  • suck ice chips with fluorouracil
  • tx with saline mouthwashes
29
Q

What is tumour lysis syndrome

A
  • from rapid destruction of malignant cells
  • increased risk in NHL, Burkitts lymphoma, ALL, AML, hyperuricaemia, dehydration, renal impairment
  • causes HYPER - K, Phos, Ca, uricaemia = renal damage & arrhythmias
  • tx = allopurinol and rasburicase
30
Q

Hyperuricaemia

A
  • in high grade lymphoma and leukaemia
  • allopurinol started 24 hours before tx - hydrate pt
  • alternative = febuxostat 2 days before treatment
31
Q

Which cytotoxics cause bone-marrow suppression

A
  • all cytotoxics except vincristine and bleomycin
  • happens 7-10 days post tx
  • FBC before tx - reduce dose if bone marrow not recovered
  • avoid tx during acute infection - neutropenic fever = broad spec abx
32
Q

A common side effect of cytotoxics

A

alopecia

33
Q

thromboembolism with cytotoxics

A

chemo increases risk of thromboembolism

34
Q

Which drugs cause urothelial toxicity (haemorrhage in urinary tract)

A
  • cyclophosphamide, ifophosphamide
  • tx = mesna
35
Q

Which drugs cause myelosuppression

A
  • caused by methotrexate
  • use folinic acid to treat toxicity
36
Q

Cytotoxics and reproductive system

A
  • most chemo = teratogenic - avoid in preg, exclude pregnancy before use
  • contraception before tx begins - during and after
  • alkylating drug or procarbazine = increase risk of permanent male sterility, consider sperm storage - affects women less but may cause onset of premature menopause
37
Q

Chemo induce N&V types

A
  • acute, delayed or anticipatory
  • acute is easier to control
  • more common in women, < 50 years, anxiety, repeated exposure
38
Q

Cytotoxics with mild risk of N&V

A

fluorouracil, etoposide, methotrexate, vinka alkaloids

39
Q

Cytotoxics with moderate risk of N&V

A

taxanes, doxorubicin, low dose cyclophosphamide, mitoxantrone, high doses methotrexate

40
Q

Cytotoxics with high risk of N&V

A

cisplatin, dacarbazine, high dose cyclophosphamide

41
Q

Prevention of acute N&V (within 24 hours of tx)

A
  • low risk pts = dexamethasone or lorazepam
  • high risk pts = ondansetron + dexamethasone + aprepitant
42
Q

Prevention of delayed N&V (after 24 hours of tx)

A
  • moderately emetogenic drugs = dexamethasone + ondansetron
  • highly emetogenic drugs = dexamethasone + aprepitant
43
Q

Prevention of anticipatory N&V (before tx)

A

lorazepam

44
Q

Alkylating agents key points

A
  • cyclophosphamide, ifosfamide, melphalan
  • urothelial toxicity - tx = mesna
  • increased risk of permanent male sterility
45
Q

Anthracyclines key points

A
  • daunorubicin, doxorubicin, epirubicin, idarubicin
  • ‘rubi-red’ urine
  • formulations not interchangeable (conventional, liposomal, pegylated liposomal)
  • cardio toxic side effects
  • liposomal = reduced cardio toxicity but causes painful macular skin eruptions - prevent by cooling hands/feet, avoid gloves/socks
46
Q

Antimetabolites key points

A
  • cytarabine, fluorouracil, MTX, mercaptopurine
  • mucositis
  • myelosuppression
47
Q

Cytotoxic Abx key points

A
  • bleomycin, mitomycin
  • progressive pulmonary fibrosis
  • pulmonary toxicity
48
Q

Taxanes key points

A
  • cabazitaxel, docetaxel, paclitaxel
  • hypersensitivity reactions = premedicate with corticosteroids and antihistamines
  • monitor cardiac output
  • monitor for signs and symptoms of pneumonitis and sepsis
49
Q

Vinka alkaloids key points

A
  • vinblastine, vincristine, vindesine
  • IV only, intrathecal = FATAL
  • bronchospasms
  • neurotoxicity - neuropathy, motor weakness, myalgia

GPhC Exam (22 decks)

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