Immunosuppression and Chemo

Question 1

T/F: NSAIDs are COX-1 inhibitors

Answer 1

FALSE, COX-2 inhibitors

Question 2

T/F: carprofen, flunixin meglumine, and phenylbutazone are all examples of NSAIDs

Answer 2

TRUE

Question 3

is dexamethasone more or less potent than prednisone/prednisolone?

Answer 3

more, 7-8x more

Question 4

would you use a high or low dose when treating an animal with glucocorticoids for anti-inflammatory therapy?

Answer 4

LOW, avoided unless needed

Question 5

given the overlapping adverse effects (esp. on the GIT) would you consider it safe to use glucocorticoids and NSAIDs together?

Answer 5

NO

Question 6

what is your first-line of therapy for general immunosuppression when it comes to immunosuppressive therapy?

Answer 6

HIGH dose glucocorticoids, 2 mg/kg/day or more

Question 7

T/F: glucocorticoids may be used initially and combined with other drugs that take longer to achieve immunosuppression allowing you to taper off and discontinue glucocorticoid when the other drug is ‘on board’

Answer 7

TRUE, i.e. start high-dose pred and azathioprine at same time, after two weeks taper off pred

Question 8

which of the following is a calcineurin T-cell inhibitor?

a. azathioprine
b. mycophenolate
c. leflunomide
d. cyclosporine

Answer 8

d. cyclosporine, the other drugs inhibit nucleotide synthesis

Question 9

which of the following adverse events is NOT typical of cyclosporine?

a. gastrointestinal upset
b. gingival hyperplasia
c. decreased efficacy with ketoconazole
d. increased risk of protozoal infection

Answer 9

c. decreased efficacy with ketoconazole (inhibits the breakdown of cyclosporin, increasing efficacy)

Question 10

T/F: sandimune and atopica are bioequivalent

Answer 10

FALSE, sandiummune = human product, it’s cheaper but it doesn’t work! beware of brand-name vs generic

Question 11

which of the following is generally contraindicated in cats?

a. azathioprine
b. mycophenolate
c. leflunomide
d. cyclosporine

Answer 11

a. azathioprine, causes more toxicity in cats> dogs

Question 12

T/F: azathioprine, mycophenolate mofetil, and leflunomide are all examples of t-cell inhibitors

Answer 12

FALSE, they are antimetabolites used for immunosuppressive therapy

Question 13

which metabolite do you not want to use with cats?

Answer 13

azathioprine, can cause toxicity of liver/bone marrow

Question 14

does azathioprine have a fast or slow onset?

Answer 14

SLOW, often started w/ prednisone in difficult cases

Question 15

which antimetabolite has relatively few side effects?

Answer 15

leflunomide

Question 16

what is a common t-cell inhibitor used for immunosuppressive therapy?

Answer 16

cyclosporine

Question 17

what is cyclosporine used to treat for?

Answer 17

• keratoconjunctivitis sicca (KCS) in dogs
• perianal fistulas or as adjunct for other immune diseases (IMHA)
• allergic/autoimmune dermatitis in dogs and cats

Question 18

what drug would you use to treat dermatologic dz, perianal fistulas?

Answer 18

tacrolimus (cyclosporine also used for perianal fistulas)

Question 19

what might you be mindful of with vesicant drugs used in chemotherapy?

Answer 19

• catheter placement (first try!) to avoid extravasation
• long infusions
• body surface area dosing (better reflects metabolic ‘size’ of patient) mg/m2

Question 20

“BAG” =

Answer 20

bone marrow, alopecia, GI

generally only worry about bone marrow and GI in veterinary practice

Question 21

“nadir” =

Answer 21

lowest neutrophil count

Question 22

T/F: acute tumor lysis syndrome is when you have massive killing of cancer cells leading to severe systemic disease (shock, DIC, etc)

Answer 22

TRUE

Question 23

what might you use a multi-drug chemotherapy protocol?

Answer 23

to reduce resistance developing in cancer cell population and minimize toxicity, hit cancer cells in different ways by giving multiple drugs at different times

Question 24

with metronomic chemotherapy do you give higher doses of drugs over a shorter period of time or lower doses of drugs over longer period of time?

Answer 24

lower doses over longer periods of time (PO, risk of owner exposure)