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cardiovascular system 1 > Immune system and malignant disease > Flashcards

Immune system and malignant disease Flashcards

1
Q

Why do we give folic acid and how often to patients on methotrexate?

A

To reduce the possibility of methotrexate toxicity (unlicensed)
Give weekly on different days

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2
Q

Example of Antiproliferate Immunosuppresant

A

Azathioprine
Mycophenolate

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3
Q

Indication of Azathioprine

A

IBD. RA, autoimmune condition, suppression of transplant rejection, severe refractory eczema

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4
Q

Important interaction of Azathioprine

A

Increases the risk of haematological toxicity when given with allopurinol
Reduce the dose of Azathioprine to 1/4 when given with allopurinol

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5
Q

Azathioprine is broken down into

A

MERCAPTOPURINE

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6
Q

Side effect of Azathioprine

A

Bone marrow depression, increased risk of infection, leucopenia, thrombocytopenia, pancreatitis.
Nausea
Neutropenia and thrombocytopenia

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7
Q

Side effect of Azathioprine may require drug withdrawal. True/false

A

True

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8
Q

Side effect of Azathioprine that requires immediately withdrawal

A

Hypersensitivity rxn such as Dizziness, malaise, rash, N andV, fever

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9
Q

All immuosupressant are teratogenic. True/false

A

True

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10
Q

Azathioprine pre treatment screening

A

TPMT enzyme metabolises thiopurine drugs
AbsentTPMT activity- Don’t give thiopurine drugs
Reduced TPMT activity- treat under specialist care

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11
Q

Risk of myelosuppression increases in patients with reduced TPMT activity on Azathioprine. True/false

A

True

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12
Q

List examples of thiopurine

A

Tioguanine
Mercaptopurine
Azathioprine

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13
Q

Patient and carer advice for Azathioprine

A

Report any signs of bone Marrow suppression such as inexplicable bruising or bleeding, infection

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14
Q

Facts about Mycophenolate

A

Metabolised to mycophenolic acid
More selective MOA than Azathioprine
Incorporating Azathioprine and mycophenolate reduces risk of rejection but higher risk of blood disorder and infection

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15
Q

Caution with mycophenolate

A

Increased risk of skin cancer ( avoid exposure to strong sunlight)
Risk
Risk of hypogammaglobulinaemia ) ( low antibodies production) or bronchiectasis ( abnormal widening of the bronchi leading to infection when used in combination with other immunosuppresant

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16
Q

State what to do if recurrent infections develop when taking mycophenolate

A

Measure serum immunoglobulin levels
Consider bronchiectasis or pulmonary fibrosis if persistent respiratory symptoms eh cough and dyspnoea

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17
Q

Conception and contraception with mycophenolate

A

MHRA advises to exclude pregnancy in women of child bearing potential before treatment
2 pregnancy test 8-10days apart are recommended
Women should use atleast 1 method of contraception before and during tx and for 6weeks after discontinuation
Two method of contraception preferred

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18
Q

How.long should male patients and their partners use contraception while on mycophenolate

A

During tx and for 90days after discontinuation

19
Q

Patients and carer advice while on mycophenolate

A

Warn patients to report any signs of bone marrow suppression eg infections, bruising or bleeding
Female patients should be part of PPP

20
Q

Facts about corticosteroids in immunosuppression

A

Marked anti tumour effect in leukamia, hodgkin disease and non hodgkin lymphomas
Enhance appetite and sense of well being in end stags malignant disease
They are powerful immunosuppresant
Used to prevent organ transport rejection and in high doses to treat rejection episode

21
Q

Facts about Ciclosporin

A

Potent immunosuppressant
Marked nephritoxic
Used in organ and tissue transplant
Prevention of graft rejection following bone marrow, kidney, liver , pancreas, heart, lung and heart -lung transplant

22
Q

What drug is used in the prophylaxis and treatment of graft-versus-hot disease

A

Ciclosporin

23
Q

Ciclosporin should be prescribed by brand. True or false

A

True

23
Q

Monitoring requirements for ciclosporin

A

Blood concentration
With systemic use- dermatological and physical examination ( for atopic dermatitis and psoriasis)
Liver function ( if given with NSAID)
Serum potassium
Blood lipids before and after 1month of treatment
Kidney function and blood pressure ( discontinue if htn that cannot be co trolled develop)

23
Q

Contraindications of ciclosporin

A

Uncontrolled infection, Uncontrolled blood pressure and malignancy

24
Q

List the two major electrolytes to monitor with ciclosporin

A

Serum k and Mg

24
Q

Why monitor serum K while on ciclosporin

A

Risk of hyperkalaemia esp in renal dysfunction

25
Q

Why monitor Magnesium in patients on ciclosporin

A

Causes hypomagnesaemia

26
Q

Ciclosporin patients and carer advice

A

With systemic use, counsel pt on administration of different formulations
Avoid excessive exposure to UV light including sun light
Avoid use of UVB or PUVA in psoriasis and atopic dermatitis
Ocular use: may affect driving and skilled task ( increased risk of blurred vision)
RBC aphasia, bone marrow suppression ( neutro, thrombocytopenia)

27
Q

Other Monitoring requirements (ciclosporin)

A

Monitor FBC weekly for first month , then monthly for first 3 months, then every 3 months for next year, use oral if IV is irritant

28
Q

Drugs that causes bone marrow suppression

A

Azathioprine, ciclosporin methotrexate

29
Q

Vincristine and bleomycin causes Bone marrow suppression true or false

A

False

30
Q

Side effect of ciclosporin

A

Eye inflammation

31
Q

Food interaction with ciclosporin

A

Pomelo juice is predicted to increase ciclosporin exposure and purple grape fruit is predicted to decrease exposure

32
Q

Tacrolimus must be prescribed by brand . T/F

A

T

33
Q

Tacrolimus causes greater neurotoxicity. True/false

A

True

34
Q

Facts about Tacrolimus

A

Similar mode of action and ADR to ciclosporin
Cardiomyopathy reported
Bone marrow suppression
Disturbance of glucose metabolism (signs of hyperglycemia)
Causes hyperkalaemia

35
Q

Monitoring requirements with Tacrolimus

A

Monitor liver and kidney function

36
Q

Patient and carer advice for Tacrolimus

A

Avoid excess exposure to UV light including sunlight ( use wide spectrum SPF)
May affect performance of skilled task( eg driving)

37
Q

Indication of Sirolimus

A

Licensed for renal transplantation
Prophylaxis of organ transplant rejection in kidney recipients

38
Q

Which ethnicity may require higher doses of Sirolimus

A

Afro carribean

39
Q

Monitoring with Sirolimus

A

Blood- sirolimus trough concentration

40
Q

Patient and carer advice on sirolimus

A

Avoid excessive exposure to UV light

41
Q
A

cardiovascular system 1 (41 decks)

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