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Pradeepa's notes > Immune System and Malignant Disease > Flashcards

Immune System and Malignant Disease Flashcards

1
Q

Azathioprine

A

-antimetabolite - breaks down into mercaptopurine which inhibits the repairment + making of DNA
-It is broken down by thiopurine methyltransferase (TMPT)
-> pre-screening TPMT lvls is advised underactive TMPT -> myelosupression

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2
Q

Azathioprine s/e

A

-hypersensitivity - malaise, dizziness, D+V, fever, rash, hypotension, myalgia
-neutropenia + thrombocytopenia = report sore throat, bruising, bleeding
-nausea - more common at start but resolves
-teratogenic = avoid in pregn

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3
Q

Azathioprine monitoring

A
  • TPMT
    -regular LFT + FBC in severe liver/renal impairment
    -FBC weekly 1st 4WK*3MT
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4
Q

Azathioprine interactions

A
  • Azathioprine + allopurinol -> high risk of haematological toxicity - dec dose of azathioprine
    -Azathioprine + ACEi - high risk of anaemia/lucopenia - avoid concommitant use
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5
Q

ciclosporin

A

calcineurin inhibitor - inhibits lymphokines suppresses cell-mediated response
-prescribe by brand

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6
Q

ciclosporin s/e

A

-avoid in pregn + BF
-HYPER - gylcaemia, lipidaemia, tension, uricemia, kalaemia
-HYPO-mg
-renal/liver impairment
-givgival hyperplasia
-skin reactions
-hair changes
-eye inflammation + visual disturbances ( topical - eyes)

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7
Q

aciclosporin interactions

A

-grapefruit + pomelo juice - inc ciclosporin exposure
-purple grape juice - lowers exposure
-pre-screening exclude malignancies before systemic use

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8
Q

ciclosporin monitor

A

LFT
Mg+
K+
lipidis
CrCl
BP (trough)
avoid exposure to UV/sunlight
vision with topical use

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9
Q

tacrolimus

A

calcineurin inhibitor inhibiting lymphokines - supresses cell-mediated response
-prescribe by brand

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10
Q

tacrolimus S/E

A

-avoid in pregnancy + BF
-HYPO/HYPER - tension
-HYPER-glycaemia, uricemia, kalaemia
-renal/liver impairment
-skin reactions
-visual disturbances
-blood dyscaria
-cardiovascular disease (QT prolongation, cardiomyopathy in children)
-nervous system disorder - peripheral neuropathy

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11
Q

tacrolimus interactions

A

-grapefruit + pomegranate + pomelo juice - inc exposure
-x use in hypersensitivity to macrolides

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12
Q

tacrolimus monitoring

A

-BP
-ECG
-blood glucose
-LFT
-electrolytes
-CrCl
-skilled tasks
-avoid exposure to sunlight/UV

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13
Q

mycophenolate mofetil

A

inhibits purine synthesis
-bone marrow supression = report infections/bruising/bleeding
-pure red cell aplasia = reduce dose or discontinue
-hypogammaglobulinaemia = measure immunoglobulin lvls in recurrent infection
-bronchiestasis = consider if persistent cough/SoB develops

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14
Q

mycophenolate mofetil MHRA

A

-contraception advise
-tetrogenic
-women = 1 effective contraception during + 6wk after (2MT ideal)
-men = effective contraception during + 90DY after (+partners)

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15
Q

multiple sclerosis

A

-chronic autoimmune disease demyelinating CNS
-can be relapsing, progressive or both
-active: 2 relapses in past 2yr despite tx with interferon beta

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16
Q

multiple sclerosis managing symptoms

A

-spasticity; baclofen (dose slowly avoid major S/E - sedation + hypotonia), diazepam, tizanidine, dantrolene
-relapses; methylprednisolone
-oscillopsia (objects appear to vibrate); gabapentin
-mood alteration; amitriptylline
-fatigue; amantadine or fampride

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17
Q

handling cytotoxic drugs

A

-chemotherapy of cancer - specialists in oncology
-reconstitued by trained professionals
-wear protective clothing
-use eye protection
-avoid by pregn staff/child bearing age
-use local procedure - spillage, safe disposal, syringes, containers, abosbent materials
-monitor staff exposure

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18
Q

cytotoxic drug classes

A

-alkylating agents
-anthracyclines
-antimetabolites
-cytotoxic antibodies
-platinum compounds
-taxanes
-vinca alkaloids

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19
Q

alkylating agents

A

cyclophosphamide
fosfamide
mephalan

20
Q

anthracyclines

A

daunorubicin
doxonrubicin
epirubicin
idarubicin

21
Q

antimetabolites

A

cytarabine
fluorouracil
methotrexate
mercaptopurine

22
Q

cytotoxic antibodies

A

belomycin
mitromycin

23
Q

platinum compounds

A

carboplatin
cisplatin
oxaliplatin

24
Q

taxanes

A

cabazitaxel
docetaoxel
paditaxel

25
vinca alkaloids
vinblatine vincistine vinderine
26
cytotoxin s/e
-extravasation of IV drugs - severe local tissue necrosis due to leakage of cyotoxin -oral mucositis -tumor lysis syndrome -hyperuricaemia -bone marrow suppression -alopecia (most common) -thromboembolism (chemo inc risk) -urothelial toxicity -myelosuppression
27
oral mucositis
-sore mouth assoc with fluorouracil, methotrexate, anthracyclines -good oral hygiene + sucking ice chips = fluorouracil -tx is less effective than preventing - tx with saline mouthwashes -if caused by methotrexate use folinic acid (levofloinic)
28
tumor lysis syndrome
-occurs due to rapid destruction of malignant cells -high risk in non-hodgkins lymphoma, burkitts lymphoma, acute lymphblastic leukaemia + acute myeloid leukaemia -high risk in pre-exisiting hyperuricaemia, dehydration + renal impairment -causes HYPER- kalaemia, phosphataemia, calcaemia - renal damange + arrythmia
29
hyperuricaemia
-more present in high grade lymphoma + leukaemia -allopurinol start 24HR before tx tumors - hydrate pt -alternative - feboxostat given 2DY before tx
30
bone marrow suppression
-caused by all drugs other than vincristine + bleomycin -occurs 7-10DY after admin -check blood count before tx - reduce dose if bone marrow x recovered -avoid tx during acute infections/seek medical -neutropenic fever immediate broad spectrum antibodies
31
urothelial toxicity
-causes haemorrhage in urinary tract -common in cyclophosphamide + ifosfamide -tx with mesna
32
myelosuppression
-can be caused by methotrexate -use folinic acid to tx toxicity
33
Cytotoxin drugs + reproductive systems
--mostly teratotogenic - x pregn -exclude pregn before tx -contraception advise before tx -women of child-bearing age = contraception before + after tx -alkylating drug or procarbazines ->high risk of permanent male stetility ->consider sperm storage ->affects women less onset of premature menopause
34
N+V
-symptoms can be acute, delayed or anticipatory ->delayed or anticipatory more difficult to control than acute -more common in women, pt <50, anxiety, repeated exposure
35
mild N+V
-fluorocuracil, exopuride, methotrexate, vinca alkaloids
36
moderate N+V
-taxanes, doxorubicin, less cyclophsophamide doses, mitoxantrane + high methotrexate doses
37
severe N+V
-cisplatin, dacarbazine, high cyclophosphamide doses
38
prevention of N+V acute symptoms
-within 24hr of tx -low risk pt = dexamethasone, lorazepam -high risk pt = ondansetron, dexamethasone + aprepitant
39
prevention of N+V delayed symptoms
-after 24hr tx - moderate emtogenic drugs = dexa + ondan -highly emetogenic drugs = dexa + aprepitant
40
prevention of N+V anticipatory symptoms
-before tx -lorazepam
41
alkylating agents
-cyclophosphamide, ifofsamide ,melphalan -urthoelial toxicity -high risk of permanent male sterility
42
anthracyclines
-daunorubicin, doxorubicin, epirubicin, idarubicin, -rubi - red urine -formulation x interchangable (conventional, liposomal, peggylated liposomal) -cardiotoxic s/e -liposomal - less cardiotoxicity but causes painful mascular skin eruptions - prevent by cooling hands/feet/ avoiding gloves + sicks
43
antimetabolites
-cytarabine, fluorouracil, methotrexate, mercaptopurine ->mucositis + myelosupression
44
cytotoxic antibodies
-blemoycin, mitomycin -progressive pulmonary fibrosis -pulmonary toxicity
45
taxanes
-carbazitaxenes, docetaxes, paciltaxes -hypersensitivity reactions - premediate with corticosteroids + antihistamines -monitor cardiac output -monitor for signs + symp of penumonitis + spesis
46
vinca alkaloids
-vinblastine, vincristine, videsine -IV admin only - intratheal = fatal -bronchospasms -neurotoxicity - neuropathy, motor weakness, myalgia

Pradeepa's notes (12 decks)

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