Immune system & malignancy Flashcards
Which cytotoxic drug should never be given intrathecally?
Vinca alkaloids
Patient has experienced nausea and vomiting >24hours after initiating chemo regimen which contains cisplatin, what antiemetics do you suggest?
Cisplatin is highly emetogenic
Dexamethasone and aprepitant
Cyclophosphamide is known for causing urothelial toxicity (haemarrhagic cystitis), what is given to prevent this?
MESNA
If a patient is on chemotherapy and has neutropenia, what medication can be given?
filgrastrim
Which cytotoxic drug causes permenant male sterility and requires sperm storage counselling?
cyclophsophamide
which cytotoxic drug causes urine red
doxorubicin (think cadiotoxic=red)
which immunosuppressant do we need to counsel pts to avoid grapefruit juice, high K diet and sun exposure
tacrolimus
which drug causes hand foot syndrome and how is it managed
doxorubicin -macular skin eruptions
cool hadns and feet, avoid gloves and socks for 7-14 days, treat with dexrazosone
what medication is used to treat hyperuricamia associated with haematological cancers
rasburicase
or allopurinol
What is the interaction between allopurinol and azathiprine
reduce aza dose to 1/4
what is the reversal agent for overdose of mtx?
calcium folinate
what are the main side effects of tacrolimus?
SHBBNELK Skin-rash, TEN Heart-cardiomyopathy and aryththmias Bone marrow suppression Blood - hypertension, hyperglycaemia, hyperkalaemia, hyperuricaemia Neurotoxicity - headache, tremor Eyes - blurred vision, photophobia Liver toxicity Kidney toxicity
What is the contraceptive advice for males in mycophenolate
use condoms until 90 days aftr discontinuation
or female partners of the male should us contraception for 90 days
What is the contraceptive advice for females in mycophenolate
using 2 methods of effective contraception until 6 weeks after discontinuation
3 counselling points for tacrolimus
- avoiding sun exposure and using SPF - skin s/e
- avoiding grapefuit juice, high potasssium foods = increass toxicity
- care when driving
Is tacrolimus brand specific?
Yes -includes generic or branded fomrulations -maintain patients
reports of toxicity and transplant rejection when switched
is ciclosporin brand specific
Yes-maintaining on same brand
What are side effcts of ciclosporin
Similar to tacrolimus e.g. nephrotoxicity, hepatotoxicity, BM suppression, bloods, visual, neurotoxicity, gingival hyperplasia
If you have 2 chemo drugs to be injected but one has high vesicant risk, how are they administered
Inject vesicant agent first, then separate by 3-5ml saline flush
If a patient on tamoxifen describes abnormal bleeding between periods, what are we worried about
endometrial cancer-tamoxifen causes this
what are risk factos for nausea and vomiting associated with chemo
female
>50
anxiety
motion sickness
if there is anticipatory N&V, what is used
lorazepam
If acute symptoms <24hrs after chemo, what medication is given
Low risk: dex or loraz
High risk: ondansetron, aprepitant, dex
If delayed symptoms >24hrs after chemo what is given
Moderate risk: dex and 5-ht3
high risk: dex and aprepitant
