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Immune System And Malignant Disease Flashcards

1
Q

Immune response drugs used in IBD

A

Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate - HIGH RISK DRUG

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2
Q

Folic acid

A

Given to reduce the possibility of methotrexate toxicity
Given weekly on different day to methotrexate

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3
Q

Immunosuppressant therapy

A

Used to suppress rejection in organ transplant recipients (choice depends on; organ type, time after transplantation and clinical condition of the patient)
Treat a variety of chronic inflammatory and autoimmune diseases
Drugs used for immune suppression;
Anti-proliferative drugs (azathioprine, mycophenolate mofetil)
Calcineurin inhibitors (ciclosporin, tacrolimus)
Corticosteroids
Sirolimus

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4
Q

Azathioprine

A

Used widely for transplant recipients
Used to treat a number of auto immune conditions when corticosteroids alone are inadequate
Metabolised to mercaptopurine
Measure TPMT; thiopurine methyltransferase breaks it down; lower enzyme concentration will build up causing toxicity, CI if levels are low as risk mylosuppression
CI; in hypersensitivity to mercaptopurine

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5
Q

Side effects of azathioprine

A

Bone marrow depression ; hence screen TPMT
Increase risk of infections
Thrombocytopenia
Neutropenia (blood disorders)
Side effects may require withdrawal
Hypersensitivity reactions; dizziness, malaise, N/V, fever, rash; immediate withdrawal

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6
Q

Azathioprine and allopurinol

A

Reduce allopurinol dose by 1/4 - to prevent haematological toxicity

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7
Q

Azathioprine monitoring requirements

A

TPMT measurement before treatment
Monitor for toxicity throughout treatment
Monitor FBC weekly for the first 4-8 weeks then every 3 months
Blood tests and monitoring for signs of myelosuppression essential in long term treatment

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8
Q

Azathioprine and patient and carer advice

A

Report signs of bone marrow suppression - careful in elderly
E.g inexplicable bruising or bleeding, infections

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9
Q

Mercaptopurine

A

Active ingredient / drug
Azathioprine is metabolise to mercaptopurine

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10
Q

Mycophenolate mofetil

A

Anti-proliferative Immunosuppressant
Metabolised into mycophenolic acid
More selective action than azathioprine
Addition with azathioprine reduced risk of rejection BUT increases risk infection and blood disorders
Teratogenic - women need 2 effective methods of contraception and until 6 weeks after discontinuing, men need condoms (or their partner) for further 90 days after stopping

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11
Q

Mycophenolate mofetil side effects

A

Bone marrow suppression
Bronchietasis (respiratory symptoms; cough or dyspnoea)
Hypogaimmaglobinaemia; recurrent infections; measure serum immunoglobulin

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12
Q

Predinisolone

A

Used in oncology, anti tumour effect in leukaemia, Hodgkin disease and non Hodgkin lymphomas
Enhances appetite and sense of wellbeing in end stage malignant disease
Corticosteroids are powerful immunosuppressant
Used to prevent organ rejection

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13
Q

Ciclosporin

A

Potent immunosuppressant
Calcineurin inhibitor
Used in organ and tissue transplant, prevention graft rejection following transplant, acute ulcerative colitis, active RA, atopic dermatitis, psoriasis, in eye drops for severe keratitis
Prescribe by brand name

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14
Q

Ciclosporin monitoring requirements

A

FBC ; causes blood dyscrasia
Liver function; causes hepatoxicity
blood lipids
Blood pressure
Dermatological and physical examinations
Renal function; nephrotoxic
U&Es enhances risk hyperkalemia and causes HYPOmagnesium

Monitor FBC weekly for 1st months then monthly for 1st 3 months then every 3 months for the next year
If stable for 12 months frequency of monitoring can be reduced to every 3 months (individual basis)

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15
Q

Ciclosporin side effects

A

Hypertension
Gingival hyperplasia
Blood disorders
Liver toxicity
Nephrotoxicity
Hyperlipidaemia
Hyperglycaemia
Intracranial hypertension (rare)

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16
Q

Caution and CI of Ciclosporin

A

CI - malignancy, uncontrolled hypertension, systemic infection, concomitant use of Rosuvastatin, Dabigatran or oral tacrolimus
Caution - hyperuricaemia, elderly (monitor renal function closely)

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17
Q

Ciclosporin patient and carer advice

A

Avoid excess exposure to UV light including sunlight - use wisespectrum SPF
Counsel on administration of different formulations solution, capsules, infusions
Avoid use of UVB and PUVA photo chemotherapy in psoriasis and atopic dermatitis as risk of malignancy
Report signs of infection
Avoid live vaccines

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18
Q

Ciclosporin interactions

A

Decreased concentration with; carbamezapine, phenytoin, phenobarbital, St John’s, Rifampicin
Increased concentration with; statins, be a fibrate, macrolides, colchicine, DOACs, NSAIDs, diltiazem, digoxin tacrolimus, verapamil, grapefruit juice

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19
Q

Tacrolimus

A

Calcineurin inhibitor
Similar mode of action to Ciclosporin but has greater neurotoxicity
Cardiomyopathy reported
Prescribe and maintained on same brand
Can cause glucose metabolism disturbances (signs hyperglycaemia)
Avoid high potassium, excess UV exposure
Monitor kidney and liver function
S/e; neurotoxic, nephrotoxicity, eye disorder, skin reactions, hyperglycaemia, hyperuricaemia

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20
Q

Sirolimus

A

Liecensed for renal transplantation and prophylaxis of organ transplant rejection in kidney recipients
Monitor blood-Sirolimus trough concentration
Afro Caribbean patients may require higher doses
Avoid excess exposure to UV light

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21
Q

Cytotoxic drugs

A

Have both anti cancer activity and potential to damage normal tissue
Given to prolong life, cure or help symptoms
Balance risk Vs benefits
Side effects can occur days or weeks after administration
Teratogenic; exclude pregnancy before treatment

22
Q

Neo-adjuvant therapy

A

Treatment before the primary cancer treatment
Initial therapy aimed at shrinking primary tumour before primary treatment
E.g chemotherapy, radiotherapy, hormone therapy

23
Q

Adjuvant therapy

A

Therapies administered after primary cancer treatment
E.g after surgery, to prevent cancer after neo-adjuvant treatment
E.g chemotherapy + radiotherapy + surgery

24
Q

Guidelines for handling cytotoxic drugs

A

Trained personnel should reconstitute cytotoxics
Reconstitution should be carried out in designated pharmacy areas
Protective; gloves, gowns and masks should be worn
Pregnant staff should avoid handling
Dispense; confirm dose, don’t repeat rx unless stated, patients must have written information, pharmacist to have access of info and to experienced cancer pharmacist

25
Cytotoxic side effects
Extravasion of IV drugs - severe local tissue necrosis of leakage into extra vascular compartment occur. Reduce risks by using trained staff Oral mucositis - sore mouth (common; have good oral hygiene, brush teeth, saline mouthwash) Tumour lysis syndrome - rapid destruction of malignant cells causing hyperkalaemia, hyperuricaemia, hyperphosphocaemia, renal damage and arrhythmias Hyperuricaemia - worsen by chemo, associated with acute renal failure, treat allopurinol, fexubostat Bone marrow depression - FBC before, treat fever with abx, blood transfusion anaemia, dr infection signs Thromboembolism - increased cytotoxic drugs, malignant disease risk factor Alopecia - reversible hair loss common Teratogenic - avoid 1st trimester, exclude pregnancy before treatment, advice contraception
26
Nausea and vomiting in cytotoxics
Anticipatory - lorazepam Acute <24 h chemo; low risk (dexamethasone / lorazepam), high risk (5HT3 antagonists) Delayed >24 h chemo; moderate (5HT3 antagonists, dexamaethsone) high (aprepitant, dexamethasone) Highest risk cisplatin
27
Vincristine and bleomycin
Don’t cause bone marrow suppression Antineoplastic S/e; pulmonary fibrosis, hypersensitivity,
28
Vinca alkaloids
IV only NEVER for intrathecal use Vincristine, vinblastine, vindesine Severe neurotoxicity intratheacally Adults and teens receive in 50 mL mini bag and children receive in a syringe S/e vincristine; bronchospasm, neurotoxicity
29
Cytotoxic
Drugs that kill cell and can cause tumour shrinkage
30
Cytostatic
Drugs which inhibit growth without toxic effects on other cells
31
Immunomodulator
Drugs which help normal is the immune system
32
Antiproliferative
Drugs which slow down the rapid growth of cells
33
Antineoplastic
Drugs used to treat cancer
34
Immunosuppressant
Drugs which lower the body’s ability to reject a transplanted organ
35
What is used in methotrexate overdose?
Calcium folinate
36
Methotrexate
Weekly dose Only 2.5 mg is dispensed and available on prescription Prescription and dispensing label should show dose and frequency Report; blood disorder (sore throat, bruising, mouth ulcers), liver toxicity (n/v, abdominal pain, dark urine), respiratory effects (SOB- pulmonary toxicity), GI Avoid OTC aspirin and ibuprofen Issue methotrexate booklets Contraception during and 6 months after
37
Methotrexate monitoring requirements
FBC, renal and liver function tests every 1-2 weeks until stabilised (then every 2-3 months) Advice patients to report all signs of infections especially sore throats Folinic acid treatment in acute toxicity; prevent mucositis and myelosuppression
38
Cisplatin
Testicular cancer Highly emetogenic - sick Platinum compound
39
Alkylating drugs
Damage DNA and interfere with cell replication Widely used on cancer therapy E.g cyclophosphamide, carmustine S/e; permanent male sterility (counsel sperm storage), non-lymphocytic leukaemia
40
Bicalutamide
Prostate cancer Photosensitivity consider sunscreen
41
Multiple sclerosis
Chronic, immune mediated inflammatory conditions of the CNS Affects brain, optic nerve and spinal cord Leads to severe disability No cure Treatment aimed at reducing frequency and duration of relapses and preventing or slowing disabiltiy
42
Multiple sclerosis drug management
Interferon beta Glatiramer acetate Fingolimod (orally taken for highly active disease) Natralizumab (only recommended for treating rapidly evolving severe replasing-remitting MS)
43
Cytotoxic abx
Radiomimetics avoid concomitant radiotherapy = toxicity Anthracycline ‘rubicin’; doxorubicin, epiribucin, idarubicin, daunomubicin S/e; cardiotoxicity, red urine Liposomal formulations of doxorubicin reduce incidence of cardiotoxicity and extravation but cause hand and foot syndrome (macular red skin eruptio; cool hand and feet and gloves 4-7 days after treatment) Dexrazoxane given in overdose or for induced s/e of extravation
44
Bleomycin
S/e; pulmonary fibrosis, respiratory failure, hypersensitivity, dermatological toxicity
45
Breast cancer
Risk factors; elderly, age, early onset menstruation, late menopause, family history, oral contraception Management; surgery, radiotherapy or drug treatment or combination of all
46
Early and locally advanced breast cancer
Surgery, radiotherapy or drug treatment Tamoxifen; given after surgery alone or with other chemo meds pre menopausal women Women who decline chemo may have gosenelin Anastrasole and letrazole (aromatise inhibitors); post menopausal women - treatment continued for 5 years
47
Advanced breast cancer treatment
1st line endocrine therapy Aromatise inhibitors (anastrazole, letrazole and extemestane) offered to patients with no history of endocrine therapy or in previously treated with tamoxifen
48
Red flags for breast cancer
Inverted nipple Discharge Change in size and shape Skin changes Unexplained breast lumps or lump in axila (armpit)
49
Breast cancer checking
Biopsy, mammograms and ultrasound From ages 50 to 70 Every 3 years
50
Tamoxifen
Anti-oestrogen; treat breast cancer for the first time treatment duration for 5 years Can cause Cerebral isachaemia Endometrial cancer risk; report vaginal bleeds, menstrual irregularities, pelvic pain, discharge Thromboembolism Retinopathy Thrombocytopenia
51
Cancer referral
Immediate - within a few hours or even more quickly Very urgent - within 48 hours Urgent - within 2 weeks Non-urgent - all other refferals

Medium Weighted Topics (5 decks)

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