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
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
3
Q
Azathioprine monitoring
A
- TPMT
- LFT/FBC in severe liver/renal impairment - weekly for first 4 weeks then every 3 months
4
Q
Azathioprine interactions
A
- allopurinol = increased risk of haematological toxicity = reduce azathioprine dose
- ACEi = increased risk of anaemia/leucopenia - avoid concomitant use
5
Q
Ciclosporin MoA
A
- calcineurin inhibitor = inhibits lymphokines = suppress cell-mediated response
- prescribed and dispensed by brand name
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)
7
Q
Ciclosporin interactions
A
- grapefruit and pomelo juice = increases ciclosporin exposure
- purple grape juice = reduced ciclosporin exposure
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
9
Q
Tacrolimus MoA
A
- calcineurin inhibitor = inhibits lymphokines = suppress cell-mediated response
- prescribed and dispensed by brand name
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
11
Q
Tacrolimus interactions
A
- grapefruit, pomegranate and pomelo juice = increases exposure to tacrolimus
- DON’T use if sensitive/allergy to macrolides
12
Q
Tacrolimus monitoring
A
- BP, ECG, blood glucose, LFT, electrolytes, CrCl
- avoid exposure to UV light/sunlight
- may affect driving/performing skilled tasks
13
Q
Mycophenolate mofetil MoA
A
inhibits purine synthesis
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
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)
16
Q
What is multiple sclerosis
A
autoimmune disease demyelinating the CNS - relapsing, progressive or both
17
Q
Define active MS
A
2 relapses in the past 2 years despite tx with interferon beta
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)
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
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
Name taxanes
cabazitaxel, docetaxel, paclitaxel
26
Name vinca alkaloids
vinblastine, vincristine, vindesine
27
Side effects of IV cytotoxics
extraversion of IV drugs - local tissue necrosis due to leakage
28
Which cytotoxics cause oral mucositis (sore mouth) & advice
- fluorouracil, methotrexate, anthracyclines
- good oral hygiene
- suck ice chips with fluorouracil
- tx with saline mouthwashes
29
What is tumour lysis syndrome
- 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
Hyperuricaemia
- in high grade lymphoma and leukaemia
- allopurinol started 24 hours before tx - hydrate pt
- alternative = febuxostat 2 days before treatment
31
Which cytotoxics cause bone-marrow suppression
- 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
A common side effect of cytotoxics
alopecia
33
thromboembolism with cytotoxics
chemo increases risk of thromboembolism
34
Which drugs cause urothelial toxicity (haemorrhage in urinary tract)
- cyclophosphamide, ifophosphamide
- tx = mesna
35
Which drugs cause myelosuppression
- caused by methotrexate
- use folinic acid to treat toxicity
36
Cytotoxics and reproductive system
- 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
Chemo induce N&V types
- acute, delayed or anticipatory
- acute is easier to control
- more common in women, < 50 years, anxiety, repeated exposure
38
Cytotoxics with mild risk of N&V
fluorouracil, etoposide, methotrexate, vinka alkaloids
39
Cytotoxics with moderate risk of N&V
taxanes, doxorubicin, low dose cyclophosphamide, mitoxantrone, high doses methotrexate
40
Cytotoxics with high risk of N&V
cisplatin, dacarbazine, high dose cyclophosphamide
41
Prevention of acute N&V (within 24 hours of tx)
- low risk pts = dexamethasone or lorazepam
- high risk pts = ondansetron + dexamethasone + aprepitant
42
Prevention of delayed N&V (after 24 hours of tx)
- moderately emetogenic drugs = dexamethasone + ondansetron
- highly emetogenic drugs = dexamethasone + aprepitant
43
Prevention of anticipatory N&V (before tx)
lorazepam
44
Alkylating agents key points
- cyclophosphamide, ifosfamide, melphalan
- urothelial toxicity - tx = mesna
- increased risk of permanent male sterility
45
Anthracyclines key points
- 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
Antimetabolites key points
- cytarabine, fluorouracil, MTX, mercaptopurine
- mucositis
- myelosuppression
47
Cytotoxic Abx key points
- bleomycin, mitomycin
- progressive pulmonary fibrosis
- pulmonary toxicity
48
Taxanes key points
- cabazitaxel, docetaxel, paclitaxel
- hypersensitivity reactions = premedicate with corticosteroids and antihistamines
- monitor cardiac output
- monitor for signs and symptoms of pneumonitis and sepsis
49
Vinka alkaloids key points
- vinblastine, vincristine, vindesine
- IV only, intrathecal = FATAL
- bronchospasms
- neurotoxicity - neuropathy, motor weakness, myalgia
