Malignant disease Flashcards
What should be done if azathioprine or mercaptopurine is used concurrently with allopurinol?
Reduce the dose of azathioprine/ mercaptopurine to 1/4 of the usual dose.
Because allopurinol inhibits the metabolism and will lead to toxic levels if dose not reduced.
What is the relation with azathioprine and mercaptopurine?
What is the MOA?
What is the relation to TPMT?
MOA- inhibit purine metabolism hence inhibits DNA synthesis.
Azathioprine is metabolised to mercaptopurine.
TPMT metabolises thiopurine drugs in the body,
The risk of myelosuppression whilst on these drugs is increased in patients who have low TPMT.
Hence CONTRAINDICATED in patients with LOW TPMT.
What is antithromocyte (rabbit) immunoglobulin for?
What improves its tolerability?
Rejection prophylaxis in renal and heart transplants.
Pretreatment with IV cortiosteroids, an antihistamine and and antipyretic (paracetamol) improves tolerability.
Which are the calcineurin inhibitors?
What is the MHRA alert associated with them?
Ciclosporin and Tacrolimus
MHRA alert: Prescribe by brand- for steady blood concentrations
What should be avoided in excess in patients on Tacrolimus and ciclosporin?
Avoid excessive sunlight (and other UV lights)
What is the MHRA alert regarding mycophenolate?
Genotoxic
Males to use contraception during and 90 days after treatment.
Females to exclude pregnancy and be on PPP during and 6 weeks after treatment.
NOTE: increased risk of skin cancer avoid sunlight
Which medicines can be used for muscle spasms related to MS?
Baclofen Tizanidine/ dantrolene Gabapentin Benzos Cannabis extract (not NICE approved)
How is emesis related to the use of cytotoxic drugs managed?
Low risk: pre-treat with dex or lorazepam
High risk: ondansetron + dex + aprepitant
What is mesna for?
Cytotoxic (mostly cyclophosphamide) related urothelial toxicity.
Causes haemorragic cystitis.
What are some of the serious side effects of methotrexate?
blood disorders
liver toxicity (dark urine, abdominal pain, jaundice)
respiratory effects
GI toxicity
How long should a patient who has been on methotrexate continue contraception?
6 months
Which common medicines should not be used with methotrexate?
NSAIDs.
What should be done before treatment with taxanes (e.g docetaxel, paclitaxel) ?
Pretreatment with dex and H2 antagonist (ranitidine) to prevent severe hypersensitivity.
Via which route should vinca alkaloids be given?
IV ONLY.
NOT to be given intrathecally under any circumstances- neurotoxic and fatal.
What is the difference between folic and folinic acid?
Both forms of folate (vitamin B9)
Folinic acid is the metabolically active form of folic acid, that doesn’t need enzymatic conversion.
Folinic acid is IV/IM only, folic acid is oral
Which are the anthracyclines?
What are the side effects?
RUBICINs- Doxorubicin, epirubicin, daunorubimcin.
Cause cardiotoxicity- dexrazoxane can prevent this.
Red urine
Hand and foot syndrome (keep hands and feet cool to prevent this)
Which drugs can be used for breast cancer?
How does treatment differ depending on if the woman is pre or post menopausal?
Pre- menopausal: tamoxifen should be used.
Post-menopausal: first line: aromatase inhibitors (anastrozole or letrozole)
2nd line is tamoxifen.
Adjuvant bisphosphonates can be of benefit if metastatic.
Aromatase inhibitors NOT for pre-menopausal women.
If advanced breast cancer, go with tamoxifen first line.
What should be done if a woman on HRT develops breast cancer?
STOP the HRT.
How is prostate cancer managed?
Anti androgen therapy: cyproterone, goserelin, buserelin
Bicalutamide can be used in prostate cancer to maintain sexual function but it can case gynaecomastia (this can be treated with weekly tamoxifen)
Medroxyprogesterone can be used for hot flushes
Osteoporosis can become a problem- bisphosphonates
What is a major contraindication of immunosuppressants when it comes to vaccines?
AVOID live vaccines- high risk of infections
For which drug should patients avoid potassium and grapefruit juice?
Tacrolimus and ciclosporin- increases levels
Which are the cytotoxic induced side effects?
Thromboembolism Hyperuricaemia Alopecia Nausea + vomitting bone marrow suppression urothelial toxicity oral mucositis extravasation of IVs effects on reproductive function.
Which cytotoxic drugs may cause permanent male sterility?
Alkylating drugs (most cytotoxics) and procarbazine. Advise patients on sperm storage.
What are some risks with use of tamoxifen?
Thromboembolism
Endometrial cancer
