Immunosuppressions + principles of cancer chemo

Question 1

what do immunosuppressants do?

Answer 1

suppress or prevent the immune respone

Question 2

when are immunosuppressants used?

Answer 2

-transplant rejections
-inflammatory disease
e.g. rheumatoid arthritis, severe eczema or inflammatory bowel disease

Question 3

what are some examples of some antiproliferative immunosuppressants?

Answer 3

-azathioprine
-mercaptopurine
-mycophenolate mofetil

Question 4

what are some examples of other immunosuppressants?

Answer 4

-ciclosporin
-tacrolimus
-corticosteroids

Question 5

what can occur from the use of immunosuppressants?

Answer 5

-high risk of infections
-avoid live vaccines

Question 6

what is azathioprine/mercaptopurine?

Answer 6

mercaptopurine inhibits purine metabolism therefore DNA, RNA and protein synthesis. Azathioprine is metabolised to mercaptopurine

Question 7

what are some side effects of azathioprine/ mercaptopurine?

Answer 7

-hypersensitivity reactions: stop immediately! = rash, fever, myalgia, nausea, vomiting and diarrhoea, arthralgia, malaise, interstitial nephritis
-bone marrow suppression: pre-treating screening for thiopurine methyl transferase, low enzyme activity= high risk of myelosuppression

Question 8

what are some interactions azathioprine/ mercaptopurine?

Answer 8

-reduced dose with allopurinol toxicity
-allopurinol is a xanthine oxidase inhibitor; inhibits metabolism of purines

Question 9

how does mycophenolate mofetil work?

Answer 9

-metabolised to mycophenolic acid. A selective mode of action than purine synthesis inhibitors e.g. azathioprine

Question 10

what are some side effects of mycophenolate mofetil?

Answer 10

-hypogammaglobinaemia= recurrent infections, measure serum immunoglobin
-bronchiectasis= respiratory symptoms e.g. cough, dyspnoea
-bone marrow suppression

Question 11

what needs to be done for pregnant women when using mycophenolate mofetil?

Answer 11

women: two methods of effective contraception until 6 weeks after discontinuing
men: use condoms until 90 days after discontinuing OR female partners of male patients use effective contraception until 90 days after discontinuing.

Question 12

what are some side effects of tacrolimus?

Answer 12

-heart: cardiomyopathy e.g. arrhythmias
-kidney: nephrotoxicity
-liver: hepatotoxicity
-bone marrow: blood dyscrasias
-blood: hypertension , hypERglycaemia, hypERkalaemia, hypERuricaemia
-neurotoxicity: headaches and tremors
-eye disorder: blurred vision , photophobia
-skin: rashes, toxic epidermal necrolysis

Question 13

what are some patient counsellings of using tacrolimus?

Answer 13

-avoid exposure to sunlight/UV light: use wide spectrum SPF
-Diet: avoid high potassium and grapefruit juice, high tacrolimus level
-driving may be affected

Question 14

what is important to remember about tacrolimus?

Answer 14

to remember to maintain the same brand. Includes generic products and prolonged-release formulations. Report of toxicity and transplant rejection on switching bewteen products

Question 15

what is ciclosporin?

Answer 15

-lower activity of T cells and their immune response

Question 16

what are some side effects of ciclosporin?

Answer 16

-kidney: nephrotoxicity
-liver: hepatotoxicity
-bone marrow: blood dyscrasias
-blood: hypertension, lipids= hypERlipidaemia, electrolytes= hypERkalaemia, hypOmagnesaemia
-visual disturbances: secondary to benign intracranial hypertension
-gingival hyperplasia
-neurotoxicity

Question 17

what is the patient counselling point for ciclosporin?

Answer 17

-avoid exposure to sunlight/UV light: use wide spectrum SPF
-Diet: avoid high potassium and grapefruit juice, high ciclosporin level

Question 18

what should be remembered when using oral ciclosporin?

Answer 18

maintain on the same brand. changes can lead to clinically important changes in ciclosporin conc

Question 19

what are the 3 possible aims of cancer treatment?

Answer 19

curative intent or prolong life or palliate symptoms

Question 20

what are the 2 different types of cancer treatment?

Answer 20

neoadjuvant therapy
AND
adjuvant therapy

Question 21

what is neoadjuvant therapy?

Answer 21

-initial chemotherapy aimed at shrinking the primary tumour
-this makes local therapy less destructive or more effective

Question 22

what is adjuvant therapy?

Answer 22

-this follows a definitive treatment of the primary disease when there is a high risk of sub-clinical metastatic disease

Question 23

what are the guidelines for handling cytotoxic drugs?

Answer 23

-trained personnel should reconstitute cytotoxic drugs
-designated pharmacy area for reconstituting cytotoxic drugs
-wear protective clothing and cover eyes
-first aid should be specified
-pregnant staff should avoid exposure to cytotoxic drugs
females of child-bearing age should be informed of reproductive hazard
-local procedures for spillages and safe waste disposal
-monitor staff exposure

Question 24

what is the safe system requirements for cytotoxic drugs?

Answer 24

-cytotoxic drugs should be prescribed, dispensed and administered according to written protocol or treatment plan
-Injectable cytotoxic drugs should only be dispensed if they are prepared for administration
-oral cytotoxic drugs should be dispensed with clear directions to use

Question 25

what principles for chemo can non-specialists use?

Answer 25

-have access to written protocols or treatment plan when prescribing/administering ongoing oral cytotoxic drugs -protocols include guidance on monitoring and treatment of toxicity

Question 26

what principles can be used when dispensing chemotherapy?

Answer 26

-confirm dose prescribed is appropriate -prescription should not be repeated unless specialist instructs -patients must have written information on their oral anti-cancer regimen which includes treatment plan and monitoring arrangements taken from the original hospital protocol -pharmacists must have access to this information and to advice from experienced cancer pharmacist in the initiating hospital