Immune system & malignancy

Question 1

Which cytotoxic drug should never be given intrathecally?

Answer 1

Vinca alkaloids

Question 2

Patient has experienced nausea and vomiting >24hours after initiating chemo regimen which contains cisplatin, what antiemetics do you suggest?

Answer 2

Cisplatin is highly emetogenic

Dexamethasone and aprepitant

Question 3

Cyclophosphamide is known for causing urothelial toxicity (haemarrhagic cystitis), what is given to prevent this?

Answer 3

MESNA

Question 4

If a patient is on chemotherapy and has neutropenia, what medication can be given?

Answer 4

filgrastrim

Question 5

Which cytotoxic drug causes permenant male sterility and requires sperm storage counselling?

Answer 5

cyclophsophamide

Question 6

which cytotoxic drug causes urine red

Answer 6

doxorubicin (think cadiotoxic=red)

Question 7

which immunosuppressant do we need to counsel pts to avoid grapefruit juice, high K diet and sun exposure

Answer 7

tacrolimus

Question 8

which drug causes hand foot syndrome and how is it managed

Answer 8

doxorubicin -macular skin eruptions

cool hadns and feet, avoid gloves and socks for 7-14 days, treat with dexrazosone

Question 9

what medication is used to treat hyperuricamia associated with haematological cancers

Answer 9

rasburicase

or allopurinol

Question 10

What is the interaction between allopurinol and azathiprine

Answer 10

reduce aza dose to 1/4

Question 11

what is the reversal agent for overdose of mtx?

Answer 11

calcium folinate

Question 12

what are the main side effects of tacrolimus?

Answer 12

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

Question 13

What is the contraceptive advice for males in mycophenolate

Answer 13

use condoms until 90 days aftr discontinuation

or female partners of the male should us contraception for 90 days

Question 14

What is the contraceptive advice for females in mycophenolate

Answer 14

using 2 methods of effective contraception until 6 weeks after discontinuation

Question 15

3 counselling points for tacrolimus

Answer 15

1. avoiding sun exposure and using SPF - skin s/e
2. avoiding grapefuit juice, high potasssium foods = increass toxicity
3. care when driving

Question 16

Is tacrolimus brand specific?

Answer 16

Yes -includes generic or branded fomrulations -maintain patients
reports of toxicity and transplant rejection when switched

Question 17

is ciclosporin brand specific

Answer 17

Yes-maintaining on same brand

Question 18

What are side effcts of ciclosporin

Answer 18

Similar to tacrolimus e.g. nephrotoxicity, hepatotoxicity, BM suppression, bloods, visual, neurotoxicity, gingival hyperplasia

Question 19

If you have 2 chemo drugs to be injected but one has high vesicant risk, how are they administered

Answer 19

Inject vesicant agent first, then separate by 3-5ml saline flush

Question 20

If a patient on tamoxifen describes abnormal bleeding between periods, what are we worried about

Answer 20

endometrial cancer-tamoxifen causes this

Question 21

what are risk factos for nausea and vomiting associated with chemo

Answer 21

female
>50
anxiety
motion sickness

Question 22

if there is anticipatory N&V, what is used

Answer 22

lorazepam

Question 23

If acute symptoms <24hrs after chemo, what medication is given

Answer 23

Low risk: dex or loraz

High risk: ondansetron, aprepitant, dex

Question 24

If delayed symptoms >24hrs after chemo what is given

Answer 24

Moderate risk: dex and 5-ht3

high risk: dex and aprepitant

Question 25

what are the high risk emetogenic chemo?

Answer 25

cisplatin

cyclophosphamide high dose

Question 26

Name 3 side effects of doxoubicin / epirubicin (anthracyclines)

Answer 26

cardiotoxicity

red urin

hand foot syndrome

Question 27

In response to NPSA alert regarding vinca alkaloids route- what is done?

Answer 27

warning labels on bags - Give via IV ONLY -positive wording
separate fridge
50ml mini bags
childrens doses via a syringe