Immunomodulators And Antineoplastics

Question 1

Methotrexate

Answer 1

DC: Antimetabolite (Folic acid antagonist)

I:

• According to treatment protocol: eg Breast cancer, bladder cancer
• RA
• Psoriasis
• Ectopic pregnancy
• Crohn’s disease

D:

• If neoplasticism indication, according to treatment protocol
• Crohn’s disease: initially 25mg once weekly, then reduce to 15-25mg once weekly for maintenance.

M:

• Improvement of symptoms
• Complete blood count (FBE)
• LFT
• Pulmonary function
• Signs of photosensitivity
• Renal function
• Pregnant status
• Folic acid intake
• BMD
• Alcohol intake

C:

• Take this medication ONCE WEEKLY. It is not to be taken every day.
• Choose one day and stick to that date always.
• This medication could interact with different medication and cause toxicity. If you want to initiate anything new, talk to your pharmacist or doctor before doing so.
• Avoid sun exposure while you’re on this medication. Wear sunscreen and protective clothings.
• May experience nausea and vomiting when starting this medication. However, if experience SOB, cough, yellowing of skin and whites of the eyes, pale stool dark urine, signs of infection, unexplained bleed or bruise, tell your doctor immediately.
• Avoid alcohol as it could increase the SE of this medication

PP:

• Methoblastin.
• ?Regular folic acid use 5mg.
• Require to stop the medication for >3 months before getting pregnant. And to be on 5mg folic acid.

Question 2

Imatinib

Answer 2

DC: Tyrosine Kinase Inhibitor

I:
- According to treatment protocol: eg CML (chronic myeloid leukaemia)

D:

• 400mg to 800mg D
• If use bigger than 400mg, could do BD instead

M:

• Signs of infection
• LFT
• FBE
• Weight changes
• Skin changes and reaction

C:
- Take this medication with food and full glass of water to decrease tummy upset. You could put the tablets into water or apple juice and drink it straight away. Rinse the glass with water and drink it too.
- If you notice any increase in weight, swelling of the hands and feet, do inform your doctor straight away.
Avoid sunlight and wear protective clothing and sun screen. (Anything about SPF30+ is good). Avoid suntan and tanning beds.

PP:
- Monitor for signs of fluid retention and also blood count and liver function

Question 3

Azathioprine

Answer 3

DC: Purine antimetabolite

I:

• Prevention of rejection in organ transplant
• Immune and inflammatory disease (IBD, SLE)

D:
- 1-3mg/kg daily in 1-2 doses

M:

• Improvement of symptoms
• FBC
• Liver function
• Signs of infection
• Vaccination status
• Allergy reaction
• Skin changes
• Skin hypersensitivity
• Renal function

C:

• Take with food to decrease stomach upset
• Swallow the tablet whole
• If you experience unexplained bleeding or bruising, any signs of infection tell doctor immediately
• Avoid excessive sun exposure. Wear protective clothes and use sunscreen

PP: