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Inori Pre Reg > Malignancy > Flashcards

Malignancy Flashcards

1
Q

Names of antiproliferative Immunosuporessants?

A

Azathioprine (metabolised to mercaptopurine)
Mycophenolate (more selective mode of action that azathioprine)
Cyclophosphamide (less commonly prescribed)

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2
Q

Names of calcineurin inhibitors?

A

Ciclosporin

Tacrolimus

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3
Q

Mode of action of azathioprine/mercaptopurine?

A

Inhibits purine metabolism therefore DNA, RNA and protein synthesis

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4
Q

Side effects of azathioprine /mercaptopurine?

A

Hypersensitivity reactions (rash, fever, N&V, diarrhoea) = stop immediately

Bone marrow suppression (neutropenia and thrombocytopenia) neutropenia is dose dependent

Nausea

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5
Q

How to manage nausea with azathioprine?

A

Common side effect early in the course and usually resolves after few weeks without dose alteration.

Can be managed by dividing daily dose, taking dose after food, using antiemetic or reducing dose temporarily

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6
Q

Pre treatment screening for azathioprine ?

A 
Thiopurine methyltransferase (TPMT)
Risk of myelosupression is increased in pts with reduced activity of TPMT
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7
Q

Interaction between allopurinol and azathioprine?

A

Toxicity risk because allopurinol is a xanthine oxidase inhibitor which inhibits metabolism of purines
So reduce dose of azathioprine to 1/4 with concurrent use of allopurinol

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8
Q

Side effects of Mycophenolate?

A

Hypogammaglobinaemia which causes recurrent infection

Bronchiectasis causes Respiratory symptoms like cough and dyspnoea

Bone marrow suppression

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9
Q

Monitoring requirements for azathioprine?

A

FBC weekly for the first 4wks then at least every 3 months

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10
Q

Pregnancy advice and Mycophenolate?

A

Gentoxic and teratogenic
Women need to use 2 methods of effective contraception until 6wks after discontinuing

Men need to use condoms 90 days after discontinuing or female partners of the male pt use effective contraception until 90 days after discontinuing

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11
Q

Side effect of tacrolimus?

A

Heart = cardiomyopathy e. G. Arrhythmia

Kidney = Nephrotoxicity

Liver = hepatotoxicity

Bone marrow = blood dyscrasias

Blood = hypertention, hyperglycaemia, Hyperkalaemia, hyperuricaemia

Neurotoxicity = headaches and tremors

Eye disorders = blurred vision, photophobia

Skin = Rashes, toxic epidermal necrolysis

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12
Q

Pt counselling on tacrolimus?

A

Avoid exposure to sunlight/UV light, use Wide spectrum SPF

Diet = avoid high potassium and grapefruit juice = leads to high tacrolimus level

Driving may be affected

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13
Q

MHRA warning on tacrolimus?

A

Maintain on the same brand for oral tacrolimus

Different use of brads have reports of toxicity and graft rejection

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14
Q

Mode of action of ciclosporin?

A

Lowers activity of T cells and their immune response

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15
Q

Side effects of ciclosporin?

A

Similar to tacrolimus
Kidney = Nephrotoxicity

Liver = hepatotoxicty

Bone marrow = blood dyscrasias

Blood = hyperlipidaemia, hypertention, Hyperkalaemia, Hypomagnesium

Visual disturbances = secondary to benign intracranial Hypertension

Gingival hyperplasia

Neurotoxicity

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16
Q

Patient counselling on ciclosporin?

A

Avoid excess sun exposure /UV light, use Wide spectrum SPF

Diet wise avoid high potassium and grapefruit juice

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17
Q

MHRA warning on ciclosporin?

A

Maintain on the same brand

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18
Q

Mycophenolate MHRA warning?

A

Male pts need contraception

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19
Q

How are vinka alkaloid administered?

A

intravenous administration only. Inadvertent intrathecal administration can cause severe neurotoxicity, which is usually fatal.

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20
Q

What’s neoadjunctive therapy?

A

Initial Chemotherapy aimed at shrinking the primary tumour delivered before the main treatment
This makes local therapy less destructive or more effective

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21
Q

What’s adjuvant therapy?

A

Follows neoadjuvant to destroy remaining cancer cells

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22
Q

Guidelines for handling cytotoxic drugs?

A

Trained person should reconstitute cytotoxic drugs
Designated pharmacy area for reconstitution drugs
Wear protective clothing and cover eyes
First aid should be specified
Pregnant staff should avoid exposure to cytotoxic. Females should be informed of reproductive hazard
Local procedures for spillages and safe waste disposal
Monitor staff exposure

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23
Q

Safe system requirements for cytotoxics?

A

Chemotherapy is given as a part of a wider pathway of coordinated care by multidisciplinary team
So should be prescribed, dispensed and administered according to written protocol or treatment plan

Injectable cytotoxic drugs should only be dispensed if they are prepared for administration

Oral cytotoxic meds should be dispensed with clear directions for use

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24
Q

Non specials protocol on handling cytotoxic drugs?

A

The standards for prescribing and using parenteral cytotoxics should also be the same for oral cytotoxics

Have access to written protocol or treatment plan when prescribing or administering

Protocol include guidance on monitoring and treatment of toxicity

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25
Q

Dispensing cytotoxics protocol?

A

Confirm dose prescribed is appropriate

Prescriptions should not be repeated unless specialist instructs

Pts must have written information on their regimen which includes treatment plan and monitoring arrangements taken from the original hospital protocol

Pharmacist’s must have access to experienced cancer pharmacist

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26
Q

Cytotoxic side effects?

A 
Extravasatoon of IV drugs
Tumour lysis syndrome
Thromboembolism
Hyperuricaemia
Alopecia
N&V
Bone marrow suppression
Urothelial toxicity
Oral mucositis
Pregnancy and reproductive dysfunction
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27
Q

Pregnancy and cytotoxic drugs?

A

Most cytotoxic drugs are teratogenic
So exclude pregnancy before treatment
And offer contraceptive advice to men and women

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28
Q

Which cytotoxic drugs cause permanent male sterility?

A

Alkylating drugs and procarbazine

  • counsel pts on sperm storage
  • women are less affected but early Menopause may occur
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29
Q

What is tumour lysis syndrome?

A

A condition that occurs when a large number of cancer cells die within a short period, releasing their contents into the blood

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30
Q

Symptoms of tumour lysis syndrome?

A 
N&V
Diarrhoea
Muscle cramps and twitches
Weakness
Fatigur
Numbness or tingling
Decreased urination
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31
Q

Clinical features of tumour lysis syndrome?

A 
Hyperkalaemua
Hyperuricaemia
Hyperphosphataemia
Hypocalcaemia
Renal damage
Arrhythmia
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32
Q

At risk pts of tumour lysis syndrome?

A

Renal imapirment
Dehydration
Hyperuricaemia

33
Q

Anti cancer drugs that especially increase the risk of thromboembolism?

A

Tamoxifen which can also cause endometrial cancer

Thalidomide /Linadamide

34
Q

How to prevent oral mucositis?

A 
Good oral hygiene prevents a sore mouth
Rinse mouth frequently
Use a soft toothbrush 2-3times/daily
Suck in ice cubes (for fluorouracil, sucking ice chips during short infusions of the drug also help) 
Saline mouthwash
35
Q

What cytotoxic drugs commonly cause oral mucositis?

A

Anthracyclines

Anti metabolites like methotrexate, fluorouracil, capecitabine

36
Q

How to prevent oral mucositis caused by antimetabolites?

A

Good hygiene
And
Folinic acid

37
Q

What’s Urothelial toxicity?

A

Causes Haorrhagic cystitis = an inflammation of the Bladder

38
Q

How to treat Urothelial toxicity?

A

Mesna

39
Q

What cytotoxic drug commonly cause Urothelial toxicity?

A

Cyclophosphamide

40
Q

All cytotoxic drugs cause bone marrow suppression except which drugs?

A

Vincristine

Bleomycin

41
Q

FBC should be measured how often when using cytotoxic drugs for cancer?

A

Before each treatment

Doses should be reduced or therapy delayed if bone marrow has not recovered

42
Q

Treatment of fever with neutropenia caused by bone marrow suppression caused by cytotoxic drugs

A

Broad spectrum antibiotics if signs of infection
(avoid paracetamol as can delay starting an antibiotic)

Filgtastrim can reduce the duration and severity of neutropenia

43
Q

Treatment of symptomatic iron deficient anaemia caused by cytotoxic bone marrow suppression

A

Erythropoietin
Or
RBC transfusions

44
Q

Hyperuricaemia tends to be present in what kind of condition?

A

High grade lymphoma and leukaemia

Markedly worsened by Chemotherapy and associated with renal failure

45
Q

Treatment if Hyperuricaemia caused by cytotoxics?

A

Allopurinol
= start 24hrs before treating high grade lymphoma and leukaemia
=reduce dose if Co administering purines

Febuxostat
= start 2 days before if allopurinol is contraindicated

Rasburicase
= for Hyperuricaemia associated with blood cancer

46
Q

Mild emetogenic cytotoxic drugs?

A 
Methotrexate
Fluorouracil
Vinca alkaloids
Etoposide
Abdominal radiotherapy
47
Q

Moderately emetogenic cytotoxic drugs?

A 
Taxanes
Doxorubicin
Cyclophosphamide
High dose methotrexate
Mitoxantrone
48
Q

Highly emetogenic cytotoxic drugs?

A

Cisplatin
Decarbazine
High dose Cyclophosphamide

49
Q

Anticipatory N&V treatment?

A

Lorazepam

50
Q

Treatment of acute symptoms of N&V within 24hrs after low risk of emesis Chemotherapy

A

Dexamethasone or lorazepam

51
Q

Treatment of acute symptoms of N&V within 24hrs after high risk of emesis Chemotherapy

A

Seratonin antagonist

Aprepitant + dexamethasone

52
Q

Delayed N&V symptoms 24hrs after moderately emetogenic Chemotherapy?

A

Dexamethasone + seratonin antagonist

53
Q

Delayed N&V symptoms 24hrs after highly emetogenic Chemotherapy?

A

Dexamethasone + Aprepitant

54
Q

What is extravasation of IV drugs and what happens?

A

Severe local tissue necrosis if they leak from the veins into the surrounding subcutaneous of sub dermal tissue

In worst cases, it can lead to amputation

55
Q

Which cytotoxic drugs are likely to cause extravasation?

A

Vinca alkaloids

anthracyclines

56
Q

What are cytotoxic antibiotics?

A

They are radiomimetics

So avoid concomitant radiotherapy as can lead to toxicity

57
Q

Drugs of cytotoxic antibiotics?

A

Anthracyclines

Anti neoplastic antibiotics

58
Q

Drugs of anthracyclines?

A 
RUBICINS
doxorubicin
Epirubicin
Idarubicin
Daunorubicin
59
Q

Side effects of anthracyclines?

A

Cardio toxicity = dose related, higher risk if given with herceptin

Red urine

60
Q

What formation go doxorubicin can reduce the incidence of cardio toxicity and extravasation?

A

Liposomal formulation of doxorubicin
But!
Cause hand and foot syndrome
Which is macula, red skin eruptions

61
Q

How to prevent hand and foot syndrome caused by liposomal formulations of doxorubicin?

A

Cool hands and feet

Avoid socks and gloves for 4-7days after treatment

62
Q

What can be given to treat anthracyclines induced side effects such as extravasation and overdose?

A

Dexrazoxane

63
Q

Drugs of Anti neoplastic antibiotics?

A

Bleomycin

64
Q

Side effects of Anti neoplastic antibiotics?

A 
Pulmonary fibrosis
Respiratory failure in anaesthesia
Hypersensitivity = chills and fever
Dermatological toxicity
= hyperpigmentation, sclerotic plagues
65
Q

How to prevent hypersensitivity reaction with Anti neoplastic antibiotics?

A

IV hydrocortisone

66
Q

Drugs of Vinca alkaloids?

A 
Vincristine
Vinblastine
Vindesine
Vinflunine
Vinirelbine
67
Q

What happens when you give Vinca alkaloids intrathecally?

A

Fatal neurotoxicity

68
Q

NPSA alert of Vinca alkaloids?

A

Adult and teenagers unit receive doses in 50ml mini bag

Children’s unit receive doses by syringe

69
Q

Side effects of Vinca alkaloids?

A

CNS toxicity (peripheral / autonomic neuropathy)

70
Q

Drugs of antimetabolites?

A

Methotrexate
Capecitabine
Fluorouracil

71
Q

Side effect of antimetabolites?

A

Oral mucosutus

Myelosupression

72
Q

Drugs of alkylating drugs?

A 
Cyclophosphamide
Carmustine
Konustine
Mephalan
Chlorambucil
Ifosfamide
73
Q

Side effects of alkylating drugs?

A

Permanent male sterility

Non lymphocytic leukaemia

74
Q

Drugs of aromatase inhibitors?

A

Anastrazole

Letrozole

75
Q

Aromatase inhibitors are contra indicated in?

A

Pre menopausal women as they are anti oestrogen

76
Q

Drugs of taxanes?

A

Paclitaxel

77
Q

Side effects of paclitaxel?

A

Cardiac disease
Pneumonitis
Sepsis

78
Q

Side effects of paclitaxel?

A

Cardiac disease
Pneumonitis
Sepsis

Inori Pre Reg (22 decks)

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