immune system and malignant disease (medium) Flashcards
what the MOA of azathioprine and how is it broken down
antimetabolite which breakdown into mercaptopurine
this then inhibits repairmen’s and making of DNA
azathioprine is broken down by TPMT
How is myelosuppression observed with azathioprine
need to prescreen TPMT levels
underactiveTPMPT means azathioprine toxicity/ myelosuppresion
what are the side effects of azathioprine
hypersensitivity: fever, rash, hypotension, malaise, dizziness, myalgia = STOP
neutropenia and thrombocytopenia: sore throat, bruising, bleeding
nausea - common at start of treatment
teratogenic
monitoring of azathioprine
TPMT
regular LFT and FBC in severe renal and liver impairment
FBC weekly for the first 4 weeks then at least every 3 months
interactions of azathioprine and management
with allopurinol - increased risk of haematological toxicity - reduce dose of azathioprine
with ACE inhibitor - increased risk of anaemia and leukopenia - avoid use together
MOA of cyclosporin and tacrolimus
calcineurin inhibitor which inhibits lymphokines and suppresses cell mediated response
similarities and differences of cautions, side effects and monitoring or cyclosporin and tacrolimus
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
monitoring parameters for tacrolimus and ciclosporin
LFT, blood pressure, CrCl, blood glucose, electrolytes
ECG also required for tacrolimus
MOA for mycophenolate
inhibits purine synthesis
side effects of mycophenolate
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
MHRA warning for mycophenolate
teratogenic
male: contraception needed during and 90 days after (for partner as well)
women: contraception needed during and 6 weeks after (2 methods preferred)
what are the 3 types of MS
relapsing, progressive and both
what is considered as active MS
2 relapses in the past 2 years despite treatment
management of symptoms of MS
spasticity: baclofen, diazepam, tizanidine, dantrolene
relapse: methykprednisolone
oscillopsia (objects vibrate): gabapentin
mood alteration: amitriptyline
fatigue: amatadine or fampridine
side effects and cautions of baclofen
can cause sedation and hypotonia (low muscle strength)
increase dose slowly to avoid major side effects
what are alkylating agents and their main side effects
cyclophosphamide
ifosfamide
melphalan
SE: bone marrow suppression, male sterility, N/V with cyclophosphamide and urothelial toxicity with cyclophosphamide and ifosfamide
what are the anthracyclines and their main SE
doxorubicin, daunorubicin, epirubicin, idarubicin
SE: sore mouth, bone marrow suppression, red urine, formulation NOT interchangeable, cardiotoxic SE, liposomal = less cardiotoxic
antimetabolites and their SE
Flourouracil, methotrexate, cytarabine, mercaptopurine
SE: bone marrow suppression, myelosuppresion with methotrexate, mucositis (sore mouth) with fluorouracil and MTX
cytotoxic antibiotics and their SE
bleomycin, mitomycin
SE:
bone marrow suppression (not bleomycin)
pulmonary toxicity/ fibrosis: SOB, coughing, wheezing
taxanes and their main SE and monitoring
docetaxel, paclitaxel, carbazitaxel
SE: bone marrow suppression, hyperactivity - premeditate with corticosteroids and antihistamines
monitoring: cardiac output, symptoms pneumonitis and sepsis
vinca alkaloids and their main SE and cautions
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
platinum compounds and their main SE
carboplatin, cisplatin, oxaliplatin
SE: bone marrow suppression, high N/V with cisplatin
which cytotoxic drug does NOT cause bone marrow suppression
vincristine and bleomycin
which drugs cause mucositis and how to prevent this and the treatment
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
