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Medium Weighted Topics > Immune System And Malignant Disease > Flashcards

Immune System And Malignant Disease Flashcards

1
Q

Immune response drugs used in IBD

A

Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate - HIGH RISK DRUG

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2
Q

Folic acid

A

Given to reduce the possibility of methotrexate toxicity
Given weekly on different day to methotrexate

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3
Q

Immunosuppressant therapy

A

Used to suppress rejection in organ transplant recipients (choice depends on; organ type, time after transplantation and clinical condition of the patient)
Treat a variety of chronic inflammatory and autoimmune diseases
Drugs used for immune suppression;
Anti-proliferative drugs (azathioprine, mycophenolate mofetil)
Calcineurin inhibitors (ciclosporin, tacrolimus)
Corticosteroids
Sirolimus

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4
Q

Azathioprine

A

Used widely for transplant recipients
Used to treat a number of auto immune conditions when corticosteroids alone are inadequate
Metabolised to mercaptopurine
Measure TPMT; thiopurine methyltransferase breaks it down; lower enzyme concentration will build up causing toxicity, CI if levels are low as risk mylosuppression
CI; in hypersensitivity to mercaptopurine

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5
Q

Side effects of azathioprine

A

Bone marrow depression ; hence screen TPMT
Increase risk of infections
Thrombocytopenia
Neutropenia (blood disorders)
Side effects may require withdrawal
Hypersensitivity reactions; dizziness, malaise, N/V, fever, rash; immediate withdrawal

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6
Q

Azathioprine and allopurinol

A

Reduce allopurinol dose by 1/4 - to prevent haematological toxicity

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7
Q

Azathioprine monitoring requirements

A

TPMT measurement before treatment
Monitor for toxicity throughout treatment
Monitor FBC weekly for the first 4-8 weeks then every 3 months
Blood tests and monitoring for signs of myelosuppression essential in long term treatment

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8
Q

Azathioprine and patient and carer advice

A

Report signs of bone marrow suppression - careful in elderly
E.g inexplicable bruising or bleeding, infections

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9
Q

Mercaptopurine

A

Active ingredient / drug
Azathioprine is metabolise to mercaptopurine

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10
Q

Mycophenolate mofetil

A

Anti-proliferative Immunosuppressant
Metabolised into mycophenolic acid
More selective action than azathioprine
Addition with azathioprine reduced risk of rejection BUT increases risk infection and blood disorders
Teratogenic - women need 2 effective methods of contraception and until 6 weeks after discontinuing, men need condoms (or their partner) for further 90 days after stopping

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11
Q

Mycophenolate mofetil side effects

A

Bone marrow suppression
Bronchietasis (respiratory symptoms; cough or dyspnoea)
Hypogaimmaglobinaemia; recurrent infections; measure serum immunoglobulin

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12
Q

Predinisolone

A

Used in oncology, anti tumour effect in leukaemia, Hodgkin disease and non Hodgkin lymphomas
Enhances appetite and sense of wellbeing in end stage malignant disease
Corticosteroids are powerful immunosuppressant
Used to prevent organ rejection

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13
Q

Ciclosporin

A

Potent immunosuppressant
Calcineurin inhibitor
Used in organ and tissue transplant, prevention graft rejection following transplant, acute ulcerative colitis, active RA, atopic dermatitis, psoriasis, in eye drops for severe keratitis
Prescribe by brand name

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14
Q

Ciclosporin monitoring requirements

A

FBC ; causes blood dyscrasia
Liver function; causes hepatoxicity
blood lipids
Blood pressure
Dermatological and physical examinations
Renal function; nephrotoxic
U&Es enhances risk hyperkalemia and causes HYPOmagnesium

Monitor FBC weekly for 1st months then monthly for 1st 3 months then every 3 months for the next year
If stable for 12 months frequency of monitoring can be reduced to every 3 months (individual basis)

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15
Q

Ciclosporin side effects

A

Hypertension
Gingival hyperplasia
Blood disorders
Liver toxicity
Nephrotoxicity
Hyperlipidaemia
Hyperglycaemia
Intracranial hypertension (rare)

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16
Q

Caution and CI of Ciclosporin

A

CI - malignancy, uncontrolled hypertension, systemic infection, concomitant use of Rosuvastatin, Dabigatran or oral tacrolimus
Caution - hyperuricaemia, elderly (monitor renal function closely)

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17
Q

Ciclosporin patient and carer advice

A

Avoid excess exposure to UV light including sunlight - use wisespectrum SPF
Counsel on administration of different formulations solution, capsules, infusions
Avoid use of UVB and PUVA photo chemotherapy in psoriasis and atopic dermatitis as risk of malignancy
Report signs of infection
Avoid live vaccines

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18
Q

Ciclosporin interactions

A

Decreased concentration with; carbamezapine, phenytoin, phenobarbital, St John’s, Rifampicin
Increased concentration with; statins, be a fibrate, macrolides, colchicine, DOACs, NSAIDs, diltiazem, digoxin tacrolimus, verapamil, grapefruit juice

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19
Q

Tacrolimus

A

Calcineurin inhibitor
Similar mode of action to Ciclosporin but has greater neurotoxicity
Cardiomyopathy reported
Prescribe and maintained on same brand
Can cause glucose metabolism disturbances (signs hyperglycaemia)
Avoid high potassium, excess UV exposure
Monitor kidney and liver function
S/e; neurotoxic, nephrotoxicity, eye disorder, skin reactions, hyperglycaemia, hyperuricaemia

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20
Q

Sirolimus

A

Liecensed for renal transplantation and prophylaxis of organ transplant rejection in kidney recipients
Monitor blood-Sirolimus trough concentration
Afro Caribbean patients may require higher doses
Avoid excess exposure to UV light

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21
Q

Cytotoxic drugs

A

Have both anti cancer activity and potential to damage normal tissue
Given to prolong life, cure or help symptoms
Balance risk Vs benefits
Side effects can occur days or weeks after administration
Teratogenic; exclude pregnancy before treatment

22
Q

Neo-adjuvant therapy

A

Treatment before the primary cancer treatment
Initial therapy aimed at shrinking primary tumour before primary treatment
E.g chemotherapy, radiotherapy, hormone therapy

23
Q

Adjuvant therapy

A

Therapies administered after primary cancer treatment
E.g after surgery, to prevent cancer after neo-adjuvant treatment
E.g chemotherapy + radiotherapy + surgery

24
Q

Guidelines for handling cytotoxic drugs

A

Trained personnel should reconstitute cytotoxics
Reconstitution should be carried out in designated pharmacy areas
Protective; gloves, gowns and masks should be worn
Pregnant staff should avoid handling
Dispense; confirm dose, don’t repeat rx unless stated, patients must have written information, pharmacist to have access of info and to experienced cancer pharmacist

25
Q

Cytotoxic side effects

A

Extravasion of IV drugs - severe local tissue necrosis of leakage into extra vascular compartment occur. Reduce risks by using trained staff
Oral mucositis - sore mouth (common; have good oral hygiene, brush teeth, saline mouthwash)
Tumour lysis syndrome - rapid destruction of malignant cells causing hyperkalaemia, hyperuricaemia, hyperphosphocaemia, renal damage and arrhythmias
Hyperuricaemia - worsen by chemo, associated with acute renal failure, treat allopurinol, fexubostat
Bone marrow depression - FBC before, treat fever with abx, blood transfusion anaemia, dr infection signs
Thromboembolism - increased cytotoxic drugs, malignant disease risk factor
Alopecia - reversible hair loss common
Teratogenic - avoid 1st trimester, exclude pregnancy before treatment, advice contraception

26
Q

Nausea and vomiting in cytotoxics

A

Anticipatory - lorazepam
Acute <24 h chemo; low risk (dexamethasone / lorazepam), high risk (5HT3 antagonists)
Delayed >24 h chemo; moderate (5HT3 antagonists, dexamaethsone) high (aprepitant, dexamethasone)

Highest risk cisplatin

27
Q

Vincristine and bleomycin

A

Don’t cause bone marrow suppression
Antineoplastic
S/e; pulmonary fibrosis, hypersensitivity,

28
Q

Vinca alkaloids

A

IV only NEVER for intrathecal use
Vincristine, vinblastine, vindesine
Severe neurotoxicity intratheacally
Adults and teens receive in 50 mL mini bag and children receive in a syringe
S/e vincristine; bronchospasm, neurotoxicity

29
Q

Cytotoxic

A

Drugs that kill cell and can cause tumour shrinkage

30
Q

Cytostatic

A

Drugs which inhibit growth without toxic effects on other cells

31
Q

Immunomodulator

A

Drugs which help normal is the immune system

32
Q

Antiproliferative

A

Drugs which slow down the rapid growth of cells

33
Q

Antineoplastic

A

Drugs used to treat cancer

34
Q

Immunosuppressant

A

Drugs which lower the body’s ability to reject a transplanted organ

35
Q

What is used in methotrexate overdose?

A

Calcium folinate

36
Q

Methotrexate

A

Weekly dose
Only 2.5 mg is dispensed and available on prescription
Prescription and dispensing label should show dose and frequency
Report; blood disorder (sore throat, bruising, mouth ulcers), liver toxicity (n/v, abdominal pain, dark urine), respiratory effects (SOB- pulmonary toxicity), GI
Avoid OTC aspirin and ibuprofen
Issue methotrexate booklets
Contraception during and 6 months after

37
Q

Methotrexate monitoring requirements

A

FBC, renal and liver function tests every 1-2 weeks until stabilised (then every 2-3 months)
Advice patients to report all signs of infections especially sore throats
Folinic acid treatment in acute toxicity; prevent mucositis and myelosuppression

38
Q

Cisplatin

A

Testicular cancer
Highly emetogenic - sick
Platinum compound

39
Q

Alkylating drugs

A

Damage DNA and interfere with cell replication
Widely used on cancer therapy
E.g cyclophosphamide, carmustine
S/e; permanent male sterility (counsel sperm storage), non-lymphocytic leukaemia

40
Q

Bicalutamide

A

Prostate cancer
Photosensitivity consider sunscreen

41
Q

Multiple sclerosis

A

Chronic, immune mediated inflammatory conditions of the CNS
Affects brain, optic nerve and spinal cord
Leads to severe disability
No cure
Treatment aimed at reducing frequency and duration of relapses and preventing or slowing disabiltiy

42
Q

Multiple sclerosis drug management

A

Interferon beta
Glatiramer acetate
Fingolimod (orally taken for highly active disease)
Natralizumab (only recommended for treating rapidly evolving severe replasing-remitting MS)

43
Q

Cytotoxic abx

A

Radiomimetics avoid concomitant radiotherapy = toxicity
Anthracycline ‘rubicin’; doxorubicin, epiribucin, idarubicin, daunomubicin
S/e; cardiotoxicity, red urine
Liposomal formulations of doxorubicin reduce incidence of cardiotoxicity and extravation but cause hand and foot syndrome (macular red skin eruptio; cool hand and feet and gloves 4-7 days after treatment)
Dexrazoxane given in overdose or for induced s/e of extravation

44
Q

Bleomycin

A

S/e; pulmonary fibrosis, respiratory failure, hypersensitivity, dermatological toxicity

45
Q

Breast cancer

A

Risk factors; elderly, age, early onset menstruation, late menopause, family history, oral contraception
Management; surgery, radiotherapy or drug treatment or combination of all

46
Q

Early and locally advanced breast cancer

A

Surgery, radiotherapy or drug treatment
Tamoxifen; given after surgery alone or with other chemo meds pre menopausal women
Women who decline chemo may have gosenelin
Anastrasole and letrazole (aromatise inhibitors); post menopausal women

  • treatment continued for 5 years
47
Q

Advanced breast cancer treatment

A

1st line endocrine therapy
Aromatise inhibitors (anastrazole, letrazole and extemestane) offered to patients with no history of endocrine therapy or in previously treated with tamoxifen

48
Q

Red flags for breast cancer

A

Inverted nipple
Discharge
Change in size and shape
Skin changes
Unexplained breast lumps or lump in axila (armpit)

49
Q

Breast cancer checking

A

Biopsy, mammograms and ultrasound
From ages 50 to 70
Every 3 years

50
Q

Tamoxifen

A

Anti-oestrogen; treat breast cancer for the first time treatment duration for 5 years
Can cause
Cerebral isachaemia
Endometrial cancer risk; report vaginal bleeds, menstrual irregularities, pelvic pain, discharge
Thromboembolism
Retinopathy
Thrombocytopenia

51
Q

Cancer referral

A

Immediate - within a few hours or even more quickly
Very urgent - within 48 hours
Urgent - within 2 weeks
Non-urgent - all other refferals

Medium Weighted Topics (5 decks)

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