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BNF Chapters > Immunlogy > Flashcards

Immunlogy Flashcards

1
Q

IBD treatments

A

Azathioprine, ciclosporin, mercaptopurine, and methotrexate

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2
Q

Folic and MTX

A

Used to reduce MTX toxicity , given weekly on different day to MTX

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3
Q

Antiproliferative drugs

A

Azathioprine or mycophenolate

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4
Q

Calcineurin inhibitors

A

Ciclosporin or tacrolimus

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5
Q

Other immunosupressantas

A

Sirolimus or corticosteroids

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6
Q

Corticosteroid immunosuppresent side effect

A

Suppress clinical signs of infection and allow diseases such as septicaemia or tuberculosis

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7
Q

What to give after severe chicken pox exposure

A

Varicella–zoster immunoglobulin (VZIG)

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8
Q

What to give after measles exposure

A

Immunoglobulin

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9
Q

What is azathioprine metabolised to

A

Mercaptopurine

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10
Q

When should azathioprine dose be reduced

A

Allopurinol

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11
Q

What antiproliferative drug has a more selective mode of action

A

Azathioprine

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12
Q

What corticosteroid has an antitumour effect

A

Prednisolone

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13
Q

Ciclosporin side effects

A

Nephrotixic

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14
Q

Ciclosporin indication

A

Organ and tissue transplantation, for prevention of graft rejection following bone marrow, kidney, liver, pancreas, heart, lung, and heart-lung transplantation, and for prophylaxis and treatment of graft-versus-host disease

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15
Q

What calcineurin inhibitor is more neurotoxic

A

Tacrolimus

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16
Q

Sirolimus inhibitor

A

Renal transplant

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17
Q

Tacrolimus side effects

A

Neurotoxic, cardiomyopathy, affects glucose metabolism, liver toxicity jaundice

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18
Q

What is MS

A

Chronic, immune-mediated, demyelinating inflammatory condition of the central nervous system, which affects the brain, optic nerves and spinal cord, and leads to progressive severe disability

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19
Q

Relapsing-remitting MS

A

Periods of exacerbation of symptoms and remission/stability

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20
Q

What is secondary progressive MS

A

Progressive disability unrelated to relapses occurs 6-10 years after onset, steadily worsens

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21
Q

Active MS disease definition

A

2 clinically significant releases in last 2 years

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22
Q

Treating active MS disease

A

Interferon beta, teriflunomide, dimethyl fumarate

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23
Q

Drug MS treatment

A

Interferon beta, glatiramer acetate, fingolimod and natalizumab, vit D

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24
Q

Very active disease treatment

A

Natalizumab alemtuzumab

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25
Q

Secondary progressive MS treatment

A

Interferon beta

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26
Q

Chronic MS symptoms

A

Neurological dysfunction, fatigue, spasticity, visual problems, and emotional lability

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27
Q

Treating MS symptoms

A

Stop smoking, methylprednisolone

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28
Q

Treating MS fatigue/ impaired mobility

A

Amantadine, exercise

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29
Q

MS spasticity treatment

A

Baclofen, gabapentin, dantrolene, tizanidine, cannabis

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30
Q

MS emotional lability treatment

A

Amitryptyline

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31
Q

MS oscilopsia is/treatment

A

Feeling like always moving, gabapentin, memantine

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32
Q

Prostate cancer risk factors

A

> 70 afro caribbean, obesity, family

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33
Q

Prostate cancer symptoms

A

Urinary outflow obstruction, or, pelvic or back pain due to bone metastases

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34
Q

How is severity/treatment decided

A

Baseline prostate specific antigen (PSA) levels, tumour grade (Gleason score), the stage of the tumour, the patient’s life expectancy (based on age and comorbid conditions), treatment morbidity, and patient preference.

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35
Q

Prostate cancer treatment

A

Watchful waiting, active surveillance, prostatectomy, radiotherapy (such as external beam), brachytherapy, hormone therapy, and chemotherapy

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36
Q

Prostate hormone therapy

A

Anti-androgen or LHRH or gonadorelin antagonist or bilateral ochidectomy

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37
Q

What should be given in conjunction to radical radiotherapy

A

Androgen deprivation therapy

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38
Q

Treating metastatic prostate cancer

A

Chemo with docetaxel

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39
Q

What to give to those hoping to maintain sexual function

A

Bicalutamide

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40
Q

Preventing skeletal events in metastatic prostate cancer

A

Zoledronic acid

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41
Q

What to give metastatic prostate cancer progresses after chemo

A

Abiraterone with/or prednisolone and enzalutamide

42
Q

When to stop chemo for metastatic prostate cancer

A

10 cycles

43
Q

Alternative to LHRH treatment

A

Bilateral orchidectomy

44
Q

LHRH Treatment

A

Histrelin, triptorelin, goserelin, leuprolide

45
Q

Breast cancer risk factors

A

Age, early onset of menstruation, late menopause, older age at first completed pregnancy, and a family history, HRT oral contraception

46
Q

LHRH stands for

A

Luteinizing hormone-releasing hormone (LHRH) agonists

47
Q

What protects against breast cancer

A

Physical activity, breast feeding

48
Q

Breast cancer types

A 
Non invasive =ductal carcinoma
Invasive = spread beyond ducts
Early stage = stage I/II
Locally advanced = stage III
And advanced = stage IV
49
Q

Aim of breast cancer treatment

A

Reduce mortality, increase progression free and disease free survival and improve QoL

50
Q

Different forms of breast cancer treatment

A

Surgery , radiotherapy ,adjuvant drug therapy, neoadjuvant drug therapy

51
Q

When is tamoxifen recommended

A

Premenopausal women without history of increased thromboembolic disease or endometrial cancer

52
Q

When is anastrazole used

A

Postmenopausal women without severe osteoporosis

53
Q

What breast cancer drug may lead to early meopause

A

Tamoxifen

54
Q

Drugs to stop in breast cancer

A

HRT

55
Q

Relieving menopausal symptoms

A

SSRI for hot flushes in those not taking tamoxifen, or clonidine, venlafaxine and gabapentin

56
Q

When is tamoxifen recommended

A

Tamoxifen is recommended for premenopausal women who do not have a history of, or increased risk of thromboembolic disease or endometrial cancer

57
Q

How long should chemoprevention be given

A

5 years

58
Q

When should chemoprevention be offered

A

Given to all those at high risk

59
Q

Biological treatment in advanced breast cancer

A

Trastuzumab and paclitaxel

60
Q

First line treatment in advanced breast cancer

A

Chemo

61
Q

Adjuvant breast bisphosphonate therapy

A

Zoledronic and sodium clodronate, improve disease-free survival and overall survival in postmenopausal women with node-positive invasive breast cancer

62
Q

Adjuvant biological breast treatment

A

Trastuzumab if HER2 positive invasive

63
Q

Adjuvant endocrine breast therapy

A

Tamoxifen as reducing oestrogen may reduce progression in premenopausal or aromatase inhibitor (zole-anastrazole) in post-menopausal

64
Q

Predictive factors

A

(ER), progesterone receptor (PR), and human epidermal growth receptor 2 (HER2) status of the primary tumour

65
Q

Alternative to radiotherapy

A

Adjuvant endocrine therapy for minimum of 5 years

66
Q

Treatment of early / locally advanced breast cancer

A

Surgery to breast/axillary lymph nodes with/without radiotherapy (if recurrence likely use) possibly followed by adjuvant drug therapy

67
Q

Cytotoxic side effects

A

Extravasation, oral mucositis, tumour lysis syndrome, hyperuricemia, bone marrow suppression, alopecia, thromboembolism,

68
Q

What cancer drugs don’t cause bone marrow suppression

A

Vincristine, bleomycin

69
Q

How should vincristine be used

A

IV

70
Q

When is broad Abx needed for neutropenia

A

Neutrophil count less than 1.06×10^9/litre

71
Q

When to prevent hyperuricaemia

A

When chemo associated with acute renal failure

72
Q

Who is at risk of tumour lysis syndrome

A

Non-Hodgkin’s lymphoma (especially if high grade and bulky disease), Burkitt’s lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia

73
Q

What commonly causes mucositis

A

Fluorouracil, methotrexate, and the anthracyclines

74
Q

Mucositis prevention

A

Oral hygiene (sucking ice when getting flurouracil infusion)

75
Q

Treating sore mouth/mucositis

A

Saline mouthwash, anti-inflammatory/antiseptic mouthwash

76
Q

Cancer drugs causing permanent male sterility

A

Alkylating drug/procarbazine

77
Q

Mildly emetogenic

A

Fluorouracil, etoposide, methotrexate (<100mg/m2), the vinca alkaloids, and abdominal radiotherapy

78
Q

Moderately emetogenic

A

Taxanes, doxorubicin hydrochloride, intermediate and low doses of cyclophosphamide, mitoxantrone, and high doses of methotrexate (0.1– 1.2 g/m2).

79
Q

Highly emetogenic

A

Cisplatin, dacarbazine, and high doses of cyclophosphamide

80
Q

Treating low risk emesis

A

Dexamethasone, lorazepam

81
Q

Treating high risk emesis

A

5ht3 receptor antagonist + dexamethasone, aprepitant

82
Q

5ht3 receptor antagonis

A

ondansetron, granisetron, dolasetron, and palonosetron

83
Q

Treating delayed CINV

A

Metoclopramide, dexamethasone, rolapitant

84
Q

Anthracycline side effects

A

Extravasation cardiotoxic

85
Q

Anthracycline drugs

A

Doxorubicin, daunorubicin, epirubicin and idarubicin

86
Q

Folic acid uses

A

Counteract folate antagonist action of methotrexate, used in methotrexate overdose

87
Q

Methotrexate side effects

A

Liver toxicity (jaundice), GI toxicity (inflamed mouth) nausea, vomiting, blood disorder dyspnoea, cough, mucositis

88
Q

Folinic acid and tripethoprim

A

Does not counteract antibacterial activity

89
Q

Why is folinic used with fluorouracil

A

Better response rate in metastatic colorectal cancer

90
Q

Causes of cystitis

A

oxazaphosphorines, cyclophosphamide and ifosfamide

91
Q

Treating cystitis/urothelial toxicity

A

Mesna

92
Q

What cancer drugs shouldn’t be used with radiotherapy

A

Anthracycline as increases toxicity

93
Q

Doxorubicin indications

A

Acute leukaemia’s, Hodgkin’s and non-Hodgkin’s lymphomas, paediatric malignancies, and some solid tumours including breast cancer.

94
Q

Vinca alkaloid indications

A

Leukaemia’s, lymphomas, and some solid tumours

95
Q

Vinca examples and derivatives

A

Vinca alkaloids, vinblastine sulfate, vincristine sulfate, and vindesine sulfate. Vinorelbine is a semi-synthetic vinca alkaloid. Involved in treatment of breast cancer.

96
Q

Vinca examples and derivative

A

Vinca alkaloids, vinblastine sulfate, vincristine sulfate, and vindesine sulfate. Vinorelbine is a semi-synthetic vinca alkaloid. Involved in treatment of breast cancer.

97
Q

Alkylating mechanism

A

Damage DNA so interfere with cell replication

98
Q

Cyclophosphamide indication

A

Wide range of malignancies, including some leukaemias, lymphomas, and solid tumours, rheumatoid arthritis

99
Q

Cyclophosphamide side effects

A

Agranulocytosis, alopecia, bone marrow CYSTITIS, decreased leucocytes fever haemorrhage, neutropenia, sperm abnormalities, thrombocytopenia

100
Q

Carmustine use

A

Multiple myeloma, non-Hodgkin’s lymphomas, Hodgkin’s disease, and brain tumour

101
Q

Estramustine use

A

Used in prostate cancer

102
Q

Taxane example

A

Paclitaxel, Docetaxel

BNF Chapters (11 decks)

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