chapter 8 - maligancy

Question 1

antiproliferative immunosuppressants

Answer 1

azathioprine
mercaptopurine
mycophenolate

Question 2

other immunosuppressants

Answer 2

ciclosporin
tacrolimus
corticosteroids

Question 3

what vaccine should you avoid when taking immunosuppressants

Answer 3

LIVE

Question 4

azathioprine/mercaptopurine MOA

Answer 4

inhibit purine metablosism

stop dna/rna/protein synthesis

aza is metabolised to mercaptopurine

Question 5

immunosuppressant side effects

Answer 5

hypersensitivity e.g. fever rash myalgia malaise NAV diarrhoea

bone marrow suppression

Question 6

what to screen for before taking immunosuppressants

Answer 6

thiopurine methyl transferase

low enzyme activity = high risk

Question 7

immunosuppressant interaction

Answer 7

allopurinol

reduce dose as allopurinol is a xanthine oxidase inhibitor + inhibits purine metabolism

Question 8

mycophenolate metabolside effects

Answer 8

hypogammaglobinaemia - recurrant infections to mesure serum Ig

bronchiectasis

BMS

Question 9

mycophenolate + fertility

Answer 9

gentoxic + teratogenic

Question 10

women + mycophenolate

Answer 10

2 contraceptive methods until 2 weeks after discontinuing

Question 11

men + mycophenolate

Answer 11

condoms until 90 days after discontinuing OR female contraception

Question 12

tacrolimus MOA

Answer 12

calcineurin inhibitor

Question 13

tacrolimus side effects

Answer 13

heart arryth
renal tox
liver tox
blood dys
hypertension/glycaemia/kalaemia/uricaemia
neurotox
blurred vision/photophobia
skin rashes / TEN

Question 14

tacrolimus counselling

Answer 14

photosensitive

avoid high potassium & grapefruit juice

driving may be affected

Question 15

MHRA tacrolimus

Answer 15

stay on same brand - toxicity & transplant rejected upon switching

Question 16

ciclosporin MOA

Answer 16

lowers t cell activity

Question 17

ciclosporin side effects

Answer 17

renal tox
liver tox
neuro tox
blood dys
hyperlipid
hypertension
hyperkalaemia
hypomagnesaemia
BIH - visual disturbances
gingival hyperplasia

Question 18

ciclosporin counselling

Answer 18

photosensitive

avoid high potassium & grapefruit juice

Question 19

ciclosporin MHRA

Answer 19

stay on same brand - changes in plasma conc

Question 20

neoadjuvant therapy

Answer 20

shrinking primary tumour

Question 21

adjuvant therapy

Answer 21

follows treatment of primary disease when there’s a high risk of sub clinical metastatic disease

Question 22

requirements for cytotoxics

Answer 22

prescribed dispensed & administered according to a treatment plan

injectables can only be dispensed if they are already prepared for admin

oral should be dispensed with clear directions

Question 23

can cytotoxics be repeated

Answer 23

no unless specialist instructs

Question 24

what cytotoxics carry the risk of infertility after treatment

Answer 24

alkylating drugs + procarbazine

Question 25

alkylating drugs + procarbazine

Answer 25

men - permenant male sterility women - early menopause

Question 26

what is tumour lysis syndrome

Answer 26

rapid destruction of malignant cells

Question 27

tumour lysis syndrome highest risk in

Answer 27

lymphomas/leukaemias

Question 28

clinical features of tumour lysis syndrome

Answer 28

hyperkalaemia hyperurea hyperphosphataemia hypocalcaemia renal failure + arrythmias

Question 29

patients at risk of TLS

Answer 29

renal impairment dehydration hyperuricaemia

Question 30

cytoxics with highest risk of VTE

Answer 30

tamoxifen | thalidomide/linadamide

Question 31

counselling to reduce oral mucositis

Answer 31

``` rinse mouth soft toothbrush suck on ice saline mouthwash folinic acid ```

Question 32

cytotoxics with highest risk of oral mucositis

Answer 32

anthracyclines | antimetabolites (MTX/FU/capecitabine)

Question 33

what is urothelial toxicity

Answer 33

haemorrhagic cystitis

Question 34

urothelial toxicity treatment

Answer 34

mesna

Question 35

cytotoxics with highest risk of urothelial toxicity

Answer 35

cyclophosphamide

Question 36

what cytotoxics dont have a risk of BMS

Answer 36

vincristine + bleomycin

Question 37

cytotoxics are CI in

Answer 37

infections

Question 38

fever with neutropoenia

Answer 38

broad spectrum abx + filgrastrim

Question 39

symptomatic fe-deficient anaemia

Answer 39

erythpoietin/RBC transfusion

Question 40

hyperuricaemia is present in

Answer 40

high grade lymphoma + leukaemia

Question 41

hyperuricaemia treatment

Answer 41

allopurinol - 24hrs before chemo febuxostat if allo CI - 2 days before

Question 42

treatment for hyperuricaemia if associated w blood cancer

Answer 42

rasburicase

Question 43

mild emetogenics

Answer 43

MTX FU vinca alkaloids

Question 44

moderate emetogenics

Answer 44

taxanes doxorubicin cyclophosphamide high dose MTX

Question 45

high emetogenics

Answer 45

cisplatin | high dose cyclophosphamide

Question 46

treatment for anticipatory emesis

Answer 46

lorazepam

Question 47

treatment for acute emesis <24 after chemo

Answer 47

low risk - dexamathasone/lorazepam high risk - 5HT3 antagonist/arprepitant + dex

Question 48

treatment for acute emesis >24 after chemo

Answer 48

moderate emetogenics - dex + 5HT3 antag highly emetogenics = dex + arprep

Question 49

extravasation of iv cytotoxics most common with

Answer 49

vinca alklaoids | anthracyclines

Question 50

cytotoxic antibiotics

Answer 50

anthracyclines | antineoplastics

Question 51

anthracyclines

Answer 51

doxo epi ida dauno

Question 52

anthracycline side effects

Answer 52

cardiotoxicity | red urine

Question 53

reducing cardiotox + extravasation with anthracyclines

Answer 53

liposomal formulation

Question 54

liposomal anthracyclines formulations cause

Answer 54

hand and foot syndrome

Question 55

preventing hand and foot syndrome

Answer 55

keep hands and feet cool avoid socks and gloves 4-7 days after treatment

Question 56

treating anthracycline side effects

Answer 56

dexrazoxane

Question 57

antineoplastic antibiotics

Answer 57

bleomycin

Question 58

antineoplastic side effects

Answer 58

pulmonary fibrosis respiratory failure hypersensitivity (IV hydrocortisone helps prevent) dermatological toxicity

Question 59

vinca alkaloid route

Answer 59

IV

Question 60

IT vinca alkaloid

Answer 60

fatal neurotox

Question 61

npsa alert for vinca alkaloids

Answer 61

adult + teens receive dose in 50ml mini bag childrens unit receive dose by syringe

Question 62

vinca alkaloid side effects

Answer 62

CNS toxicity peripheral/autonomic neuropathy

Question 63

antimetabolites

Answer 63

MTX FU capecitabine - PD of FU

Question 64

cyclophosphamide class

Answer 64

alkylating drugs

Question 65

side effects of alkylators

Answer 65

permanent male sterility | non-lymphocytic leukaemia

Question 66

aromatase inhibitors

Answer 66

anastrazole letrozole

Question 67

CI group for aromatase inhibitors

Answer 67

pre-meno women

Question 68

taxanes

Answer 68

paclitaxel

Question 69

taxanes side effects

Answer 69

cardiac disease pneumonitis sepsis