immune system and malignant disease (medium) Flashcards

1
Q

what the MOA of azathioprine and how is it broken down

A

antimetabolite which breakdown into mercaptopurine
this then inhibits repairmen’s and making of DNA

azathioprine is broken down by TPMT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is myelosuppression observed with azathioprine

A

need to prescreen TPMT levels

underactiveTPMPT means azathioprine toxicity/ myelosuppresion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the side effects of azathioprine

A

hypersensitivity: fever, rash, hypotension, malaise, dizziness, myalgia = STOP
neutropenia and thrombocytopenia: sore throat, bruising, bleeding
nausea - common at start of treatment
teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

monitoring of azathioprine

A

TPMT
regular LFT and FBC in severe renal and liver impairment
FBC weekly for the first 4 weeks then at least every 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

interactions of azathioprine and management

A

with allopurinol - increased risk of haematological toxicity - reduce dose of azathioprine

with ACE inhibitor - increased risk of anaemia and leukopenia - avoid use together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MOA of cyclosporin and tacrolimus

A

calcineurin inhibitor which inhibits lymphokines and suppresses cell mediated response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

similarities and differences of cautions, side effects and monitoring or cyclosporin and tacrolimus

A

similarities:
- both must be brand specific
- both can cause hyperglycaemia, hyperuricaemia, hyperkalameia
- both cause renal/ liver impairment
- both cause skin reactions - rashes, toxic epidermal necrolysis
- both can cause visual disturbances and eye inflammation with topical use
- both should be avoided in pregnancy and breastfeeding
- both should avoid grapefruit juice and pomelo juice
- both avoid UV/ Sunlight
- avoid high potassium diet

differences:
- cyclosporin can cause hypomagesemia, hyperlipidaemia and hypertension unlike tacrolimus
- tacrolimus may cause hypo or hypertension
- tacrolimus can cause blood dyscrasia
- tacrolimus can cause CVD - arrhythmia, cardiomyopathy in children…
- tacrolimus can cause peripheral neuropathy/ nervous system disorders (headaches/ tremors…)
- ciclosporin can cause hair changes and hirsutism
- cyclosporin can cause gingival hyperplasia
- tacrolimus must also avoid pomegranate juice
- cyclosporin should avoid purple grape juice - decreases cyclosporin conc
- magnesium needs to be monitored with cyclosporin
- tacrolimus should not be used if hypersensitivity to macrolide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

monitoring parameters for tacrolimus and ciclosporin

A

LFT, blood pressure, CrCl, blood glucose, electrolytes

ECG also required for tacrolimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MOA for mycophenolate

A

inhibits purine synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

side effects of mycophenolate

A

bone marrow suppression: infection, bleeding, bruising
pure red cell aplasia: reduce dose or discontinue
hypogammaglobulinaemia: measure immunoglobulin in recurrent infections
bronchiectasis: SOB/ cough could indicate this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MHRA warning for mycophenolate

A

teratogenic

male: contraception needed during and 90 days after (for partner as well)
women: contraception needed during and 6 weeks after (2 methods preferred)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the 3 types of MS

A

relapsing, progressive and both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is considered as active MS

A

2 relapses in the past 2 years despite treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

management of symptoms of MS

A

spasticity: baclofen, diazepam, tizanidine, dantrolene
relapse: methykprednisolone
oscillopsia (objects vibrate): gabapentin
mood alteration: amitriptyline
fatigue: amatadine or fampridine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

side effects and cautions of baclofen

A

can cause sedation and hypotonia (low muscle strength)

increase dose slowly to avoid major side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are alkylating agents and their main side effects

A

cyclophosphamide
ifosfamide
melphalan

SE: bone marrow suppression, male sterility, N/V with cyclophosphamide and urothelial toxicity with cyclophosphamide and ifosfamide

17
Q

what are the anthracyclines and their main SE

A

doxorubicin, daunorubicin, epirubicin, idarubicin

SE: sore mouth, bone marrow suppression, red urine, formulation NOT interchangeable, cardiotoxic SE, liposomal = less cardiotoxic

18
Q

antimetabolites and their SE

A

Flourouracil, methotrexate, cytarabine, mercaptopurine

SE: bone marrow suppression, myelosuppresion with methotrexate, mucositis (sore mouth) with fluorouracil and MTX

19
Q

cytotoxic antibiotics and their SE

A

bleomycin, mitomycin

SE:
bone marrow suppression (not bleomycin)
pulmonary toxicity/ fibrosis: SOB, coughing, wheezing

20
Q

taxanes and their main SE and monitoring

A

docetaxel, paclitaxel, carbazitaxel

SE: bone marrow suppression, hyperactivity - premeditate with corticosteroids and antihistamines

monitoring: cardiac output, symptoms pneumonitis and sepsis

21
Q

vinca alkaloids and their main SE and cautions

A

vinblastine, vincristine, vindesine

SE: bone marrow suppression (but not vincristine), mild N/V, bronchospasm, neurotoxicity, motor weakness, myalgia, neuropathy…

caution: GIVE BY IV NEVER GIVE BY INTRATHECAL

22
Q

platinum compounds and their main SE

A

carboplatin, cisplatin, oxaliplatin

SE: bone marrow suppression, high N/V with cisplatin

23
Q

which cytotoxic drug does NOT cause bone marrow suppression

A

vincristine and bleomycin

24
Q

which drugs cause mucositis and how to prevent this and the treatment

A

fluorouracil and MTX
anthracyclines (rubicins)

prevention: good oral hygiene and sucking on ice chips
treatment: saline mouthwash or use colonic acid if caused my MTX

25
Q

what causes tumour lysis syndrome:

A

more common in non-hodgkins, burkitts, lymphoblastic, acute myeloid leukaemia

hyperkalamia, hyperphosphotaemia, hypercalcemia, hyperuricaemia can cause it and result in renal damage and arrhythmia

26
Q

how to treat hyperuricaemia

A

allopurinol 24 hours before
OR
febuxostat - given 2 days before treatment

27
Q

how to manage bone marrow suppression

A

occurs 7-10 days after treatment
check blood count before treatment and reduce dose if haven’t recovered
avoid treatment during acute infection
if become ill after treatment - seek medical attention
neutropenic fever: give immediate broad spectrum antibiotics

28
Q

what is urothelial toxicity and what drugs can cause this and how to treat this

A

haemorrhage in urinary tract
common with cyclophosphamide and ifosfamide
treat with mesa

29
Q

cause and treatment of myelosuppression

A

cause: MTX
treatment: folonic acid

30
Q

what are highly ematogenic drugs

A

cisplatin, dacarbazine, high cyclophosphamide dose

31
Q

treatment of acute symptoms of N/V in low and high risk patients

A

low risk: dexamethasone + lorazepam

high risk: dexamethasone + ondansetron + aprepitant

32
Q

treatment of prevention of delayed symptoms (after 24 hours of treatment) if on moderate and high emetogenic drugs

A

moderately emetogenic drugs: dexamethasone + ondansetron

highly emetogenic drugs: dexamethasone + aprepitant

33
Q

prevention of anticipatory N/V

A

lorazepam