Pharmacology - Malignancy / Immunology Flashcards

1
Q

Cyclophosphamide

A
  • *Indications:** Malignancies (leukaemias, lymphomas, solid tumours) RA, SLE, systemic sclerosis, Wegener’s
  • *MOA:** Alkylates DNA, affects B > T cells
  • *SE’s:** BM suppression, haemorrhagic cystitis, alopecia, sterility esp in men
  • *CI’s:** Haemorrhagic cystitis
  • *Interactions:** Clozapine - increased risk of agranulocytosis
  • *Other:** Give mesna to prevent haemorrhagic cystitis. Activated by P450
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2
Q

Cisplatin

A
  • *Indications:** Testicular, lung (SSLC), cervical, bladder, head/neck and ovarian cancers
  • *MOA:** Alkylates DNA
  • *SE’s:** BM suppression, severe N+V, nephrotoxic, ototoxic, peripheral neuropathy
  • *CI’s:**
  • *Interactions:** Methotrexate (increased risk of pulmonary toxicity), aminoglycosides, clozapine
  • *Other:** Given IV. Carboplatin is associated with less severe SE’s. Requires pre-admin hydration
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3
Q

Azathioprine

A
  • *Indications:** Prevent transplant rejection, IBD, SLE RA (steroid sparing agent)
  • *MOA:** Blocks de novo purine synthesis. Metabolised to active 6-mercaptopurine. Affects T > B cells
  • *SE’s:** BM suppression, hepatotoxicity, N+V+D, arthralgia
  • *CI’s:** Hypersensitivity - do TPMT assay before use
  • *Interactions:** Allopurinol increases toxicity
  • *Other:** 50% of patients intolerant of azathioprine will tolerate 6-MP
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4
Q

Mycophenolate mofetil

A

Indications: Prophylaxis of acute rejection in renal, hepatic or cardiac transplants (in combination with ciclosporin + corticosteroids). Autoimmune disease
MOA: Metabolised to mycophenolic acid → blocks de novo nucleotide synthesis. Affects T > B cells
SE’s: BM suppression, skin malignancy, GI upset
CI’s: Monitor FBC
Interactions:
Other:

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5
Q

Methotrexate

A
  • *Indications:** Cancer, RA psoriasis, Crohn’s
  • *MOA:** Dihydrofolate reductase inhibitor
  • *SE’s:** BM suppression, pulmonary fibrosis, hepatotoxicity, mucositis
  • *CI’s:** Renal + Liver impairment
  • *Interactions:** Increased toxicity with NSAIDs, ciclosporin, steroids
  • *Other:** Give with folinic acid to reduce risk of myelosuppression. Monitor U+Es, FBC, LFTs

If a pt has sepsis, methotrexate should be withheld - until neutropenic sepsis has been excluded. If in doubt, withhold.

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6
Q

Chlorambucil

A

Indications: Some lymphomas and chronic leukaemias
MOA: Alkylates DNA
SE’s: BM suppression, EM → SJS
CI’s:
Interactions:
Other:

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7
Q

Ciclosporin

A

Indications: Prevent transplant rejection, GvHD, UC RA, psoriasis
MOA: Calcineurin inhibitor → blocks IL-2 production
SE’s: Nephrotoxic, hepatic dysfunction, tremor, hypertrichosis, gingival hypertrophy, encephalopathy
CI’s:
Interactions:
P450 metabolism
Other: Monitor LFTs

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8
Q

Tacrolimus

A

Indications: Prevent transplant rejection
MOA: Calcineurin inhibitor → blocks IL-2 production
SE’s: Nephrotoxic, diabetogenic, neurotoxic
CI’s:
Interactions:
P450 metabolism
Other:

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9
Q

Sirolimus

A

Indications: Prevent transplant rejection
MOA: Blocks mTOR pathway
SE’s: Dyslipidaemia
CI’s:
Interactions:
Other:

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