Immune System and Malignant Disease Flashcards
What are the specific side effects for azathioprine?
Hypersensitivty reactions, neutropenia and thrombocytopenia, nausea
What is the important safety information for ciclosporin?
Patients should be stabilised on a particular brand before switching between as changing without close monitoring can lead to large differences in blood levels
What are the monitoring requirements for ciclosporin?
Liver function, serum potassium, blood lipids, magnesium, kidney function, blood pressure and stop if uncontrolled hypertension, lymphadenopathy,
What is the important safety information for tacrolimus?
Stick to the same brand due to reports of toxicity and graft rejection
What is the contraception advice for mycophenolate?
Pregnancy should be excluded - 2 tests 8-10 days apart. Women should use at least one method of effective contraception before and during treatment, and for 6 weeks after discontinuation. 2 methods preferrred. Males should use effective contraception during tx and for 90 days after finishing.
What are the cytotoxic drug handling guidelines?
- trained personnel only should reconstitute cytotoxic
- reconstitution should only be carried out in a designated pharmacy area
- protective clothing should be worn
- eye protection
- pregnant staff should avoid exposure to cytotoxic drugs
- monitor staff exposure
What is advised to avoid extravasation of cytotoxic drugs?
- only administered by specially trained staff
Which cytotoxics are associated with oral mucositis?
- fluorouracil, methotrexate, anthracyclines
What is advised to prevent oral mucositis?
good oral hygiene. Once sore mouth develops, saline moutwashes can be used but mostly self limiting
What is tumour lysis syndrome
Occurs due to tx related destruction of malignant cells. Common in lymphoma and leukaemia. Features are hyperkalaemia, hyperuricaemia and hyperphosphotaemia/hypocalcaemia, prophylaxis is essential
When is hyperuricaemia associated with cytotoxics and how is it managed?
Lymphoma and leukaemia, allopurinol started 24 hours before and oatuents adequately hydrated. Mercaptopurine and azathioprine need dose reduction if allopurinol started. Rasburicase used in haematological malignancy
Discuss bone marrow suppression in relation to cytotoxics
Check blood counts before each tx, fever in a neutropenic patient must be treated with empirical broad spec abx.
Discuss cytotoxics and pregnancy
Teratogenic drugs, not in pregnancy and especially not in the first trimester. exclude pregnancy before and effectice contraception should be given. Pretreatment advice and consideration of sperm storge considered
When does acute n&v occur
Within 24 hours
When ford delayed n&v occur
more than 24 hrs
