Malognant Disease And Immunosupression Flashcards
2 main interactions of methotrexate
Penicillin and nsaids both increase risk of methotrexate toxicity. Also live yellow fever vaccine increases infection risk when given with mtx so avoid
What is used to reduce side effects of methotrexate like nausea, loose stool softener
Folic acid ONCE weekly on a day diff to when methotrexate is taken
Cytotoxic drug handling guidelines
Trained personnel to reconstitute cytotoxics
Carry out reconstitution in designated pharmacy area
Wear protective clothing (gloves, gowns, masks)
Protect eyes (means of first aid should be specified)
Pregnant staff to avoid exposure to cytotoxics (warn women of childbearing age of reproductive hazard)
Use local procedures for dealing with spillages + safe disposal of waste material incl. syringes, containers, absorbent material
Monitor staff exposure to cytotoxic drugs
4 safe system requirements for cytotoxics
Cytotoxics given for treating cancer, to be given as part of wider pathway of care coordinated by MDT
Cytotoxics should be prescribed, dispensed + administered only in context of written protocol OR treatment plan
Only dispense injectable cytotoxics if they’re prepared for administration
Dispense oral cytotoxics with clear directions for use
Common Side effects of all cytotoxics
Extravasation of IV cytotoxics drugs… causes tissue necrosis… to reduce risk cytotoxics should
Be administered by appropriately trained staff
Oral mucositis- sore mouth most common with fluorouracil, methotrexate + anthracyclines in particular…best to prevent by good oral hygiene (rinse mouth often, brush teeth 2-3times/day). With flourouracil suck ice
Tumour lysis syndrome… identify those at risk e.g.
Hyperuricaemia
Bone marrow suppression
Alopecia
Thromboembolism
How to reduce risk of extravasation from IV cytotoxics
To reduce risk, recommended that cytotoxics are administered by appropriately trained staff
Common side effect of doxorubicin
Cardiotoxicity
Doxazosin used for heart condition htn.
What is the interaction between azathioprine and allopurinol
Allopurinol potentially increases the risk of haematological toxicity ofAzathioprine, reduce azathioprine dose to 1/4 of usual dose
What test needs to be done before starting azathioprine
TPMT (thiopurine methyltransferase) activity needs to be measured before starting AZA
RISK of Myelosuppression increased with reduce TPMT activity
If No TPMT activity, DO NOT give azathioprine
If reduced TPMT activity, can give AZA under specialist supervision
What must all immunosuppressants be prescribed by I.e. ciclosporin, tacrolimus, azathioprine
Must be prescribed by BRAND
What is azathioprine metabolised to and what is the most common side effect
It’s an immunosuppressant metabolised to
Why must you prescribe ciclosporin by brand
Switching formulations without close monitoring can lead to important changes in blood ciclosporin
Why must you prescribe ciclosporin by brand
Switching formulations requires close monitoring
Why must you prescribe ciclosporin by brand
Switching formulations requires close monitoring
Monitoring requirements for ciclosporin
Monitor blood ciclosporin
