test Flashcards
(111 cards)
1
Q
What is the definition of inflammatory bowel disease?
A
It describes two conditions: ulcerative colitis and Crohn’s disease.
2
Q
What part of the digestive system does ulcerative colitis affect?
A
It only affects the colon.
3
Q
What part of the digestive system can Crohn’s disease affect?
A
It can affect any part of the digestive system.
4
Q
Name two medications used in the treatment of inflammatory bowel disease.
A
- Azathioprine
- Methotrexate
5
Q
What should be given to reduce the possibility of methotrexate toxicity?
A
Folic acid.
6
Q
What are immunosuppressants used for?
A
To treat autoimmune and inflammatory conditions and rejection in organ transplant patients.
7
Q
List two types of drugs prescribed to solid organ transplant patients.
A
- Antiproliferative drugs
- Calcineurin inhibitors
8
Q
Name an example of an antiproliferative drug.
A
Azathioprine.
9
Q
What is a common calcineurin inhibitor used in organ transplantation?
A
Tacrolimus.
10
Q
True or False: Corticosteroids can suppress the clinical signs of infection.
A
True.
11
Q
What serious conditions can arise from suppressed clinical signs of infection due to corticosteroids?
one is a respiratory condition
A
- Septicaemia
- Tuberculosis
12
Q
When corticosteroids do not provide adequate control, what may be prescribed?
A
Azathioprine or mycophenolate mofetil.
13
Q
Which drug has a more selective action, azathioprine or mycophenolate?
A
Mycophenolate.
14
Q
Fill in the blank: Cyclophosphamide is less commonly prescribed as an _______.
A
immunosuppressant.
15
Q
A
16
Q
What is azathioprine used for?
A
Transplant recipients and auto-immune conditions
Azathioprine is metabolised to mercaptopurine.
17
Q
What should be done with doses of azathioprine when allopurinol is given concurrently?
A
Doses should be reduced due to risk of bone marrow suppression.
18
Q
How does mycophenolate’s mode of action compare to azathioprine?
A
Mycophenolate has a more selective mode of action than azathioprine.
19
Q
What is the dosage of mycophenolate for prophylaxis of acute rejection in renal transplantation?
A
1g twice daily by mouth within 72 hours of transplantation
Also, 1g twice daily by intravenous infusion for a maximum of 14 days, then switched to oral therapy.
20
Q
What is the dosage of mycophenolate for cardiac transplantation?
A
1.5g twice daily by mouth within 5 days of transplantation.
21
Q
What is the dosage of mycophenolate for hepatic transplantation?
A
1g twice daily by intravenous infusion for 4 days, then switched to oral therapy.
22
Q
What is the equivalence of mycophenolic acid to mycophenolate mofetil?
A
720mg of mycophenolic acid is approximately equivalent to 1g of mycophenolate mofetil.
23
Q
What should patients be warned about regarding bone marrow suppression?
A
Patients should report any signs or symptoms such as infection or inexplicable bruising or bleeding.
24
Q
What should be measured if a patient develops recurrent infections?
A
Serum immunoglobulin levels.
25
What is red cell aplasia associated with?
Mycophenolate mofetil; dose reduction or discontinuation should be considered under specialist supervision.
26
What precautions should be taken regarding pregnancy when using azathioprine?
Exclude pregnancy in females of child-bearing age before treatment and use effective contraception.
27
What is the dosage of azathioprine for severe acute Crohn's disease?
2-2.5mg/kg daily by mouth, some patients may respond to lower doses.
28
What is the dosage of azathioprine for autoimmune conditions?
1-3mg/kg daily, adjusted according to response by mouth, intravenous injection, or intravenous infusion.
29
What are the monitoring requirements for patients on azathioprine?
Full blood count weekly for 4 weeks, then every 3 months.
30
What is the role of thiopurine methyltransferase (TPMT) in relation to thiopurine drugs?
TPMT metabolises thiopurine drugs; reduced activity increases the risk of myelosuppression.
31
What side effects are commonly associated with azathioprine treatment?
| 2 penia
* Nausea
* Hypersensitivity reactions
* Neutropenia
* Thrombocytopenia
32
What should be done if a patient experiences hypersensitivity reactions to azathioprine?
Immediate withdrawal of azathioprine.
33
What are the risks of using azathioprine during pregnancy?
Premature birth, low birth weight, and spontaneous abortion.
34
True or False: Patients should discontinue azathioprine treatment if they become pregnant.
False.
35
36
What is the primary action of ciclosporin?
Inhibits T cell activation by inhibiting calcineurin
## Footnote
This prevents the dephosphorylation and activation of the nuclear factor of activated T cells responsible for inflammatory reactions.
37
What is the initial dose of ciclosporin for organ transplantation?
10–15mg/kg, administered 4–12 hours before transplantation
## Footnote
Followed by 10–15mg/kg daily for 1–2 weeks postoperatively.
38
What is the maintenance dose of ciclosporin after organ transplantation?
2–6mg/kg daily, with gradual reduction to maintenance
## Footnote
This is after the initial postoperative dosing.
39
What is the recommended dose of ciclosporin for bone marrow transplantation?
3–5mg/kg daily, administered over 2–6 hours
## Footnote
From the day before transplantation to 2 weeks postoperatively by intravenous infusion.
40
What adjustment should be made when ciclosporin is used with octreotide?
Increase dose by 50% or switch to an intravenous formulation
## Footnote
This is due to interactions.
41
What precautions should be taken in patients with hepatic impairment when using ciclosporin?
Use with caution due to risk of increased exposure
## Footnote
The manufacturer advises caution in severe impairment.
42
What monitoring is required when switching ciclosporin brands?
Monitor blood-ciclosporin concentration, serum creatinine, blood pressure, and transplant function
## Footnote
Switching formulations can lead to important changes in blood concentration.
43
What are the potential side effects of ciclosporin?
* Hepatic disorders
* Renal impairment
* Hyperkalaemia
## Footnote
Immediate reporting of certain symptoms like blood in urine is crucial.
44
What is the weekly dosing schedule for methotrexate?
Usually given by mouth once a week
## Footnote
Folic acid may be given on a different day to reduce side effects.
45
What are the indications for methotrexate?
* Severe Crohn's disease (unlicensed use)
* Maintenance of remission in severe Crohn's disease
* Moderate to severe active rheumatoid arthritis
## Footnote
New measures have been introduced to reduce the risk of fatal overdose.
46
What side effects are associated with methotrexate?
* Anaemia
* Diarrhoea
* Gastrointestinal discomfort
* Headache
## Footnote
Treatment should be withdrawn if stomatitis or diarrhoea develops.
47
What precautions should be taken regarding pregnancy and breastfeeding with methotrexate?
Avoid use due to teratogenic effects; discontinue breastfeeding
## Footnote
Methotrexate is present in milk.
48
What is the initial dose of tacrolimus for liver transplantation?
110–130 micrograms/kg by mouth once daily
## Footnote
To be taken in the morning, starting within 24 hours of transplantation.
49
What is the initial dose of tacrolimus for renal transplantation?
170 micrograms/kg once daily by mouth
## Footnote
To be taken in the morning, starting within 24 hours of transplantation.
50
What is the caution regarding tacrolimus prescribing?
Oral tacrolimus should be prescribed and dispensed by brand name only
## Footnote
Inadvertent switching has been associated with toxicity and graft rejection.
51
What are the potential side effects of tacrolimus?
* Increased risk of infection
* Skin reactions
* Abnormal sensation
## Footnote
Monitor patients for these effects.
52
What does the mnemonic TACROLIMUS stand for?
* Tremor
* Alopecia
* Cardiovascular (Hypertension)
* Renal insufficiency
* Oncological (Skin cancer)
* Lipids (Hyperlipidaemia)
* Insulin-dependent diabetes
* Magnesium wastage
* Uric acid elevation
* Seizures
## Footnote
It helps remember the side effects associated with tacrolimus.
53
What monitoring is recommended for patients on tacrolimus?
Monitor by echocardiography for hypertrophic changes
## Footnote
Consider dose reduction or discontinuation if changes occur.
54
What is methotrexate used for?
Methotrexate is a medication used to treat certain types of cancer and autoimmune diseases.
## Footnote
Methotrexate works by inhibiting cell growth and is often used in chemotherapy.
55
What contraception advice is given to patients on methotrexate?
Effective contraception is advised during and for at least 6 months after treatment in men and women.
## Footnote
This is to prevent pregnancy due to the potential teratogenic effects of methotrexate.
56
What pre-treatment screening is required before starting methotrexate?
Patients should have a full blood count and renal and liver function test, and pregnancy should be excluded.
## Footnote
This ensures that the patient is fit for treatment and helps to monitor for any potential side effects.
57
How often should full blood count and renal and liver function tests be monitored during methotrexate therapy?
Tests should be repeated every 1–2 weeks until therapy is stabilized, thereafter every 2–3 months.
## Footnote
Monitoring is crucial to detect any adverse effects early.
58
What should be monitored after initial dosing of tacrolimus?
Whole-blood concentration, blood pressure, ECG, fasting blood glucose, haematological parameters, neurological parameters, coagulation parameters, electrolytes, hepatic and renal function
## Footnote
Monitoring is crucial especially during episodes of diarrhoea.
59
What are the risks of using tacrolimus during pregnancy and breastfeeding?
Crosses the placenta, risk of premature delivery, intrauterine growth restriction, hyperkalaemia
## Footnote
Use should be avoided unless the potential benefit outweighs the risks.
60
What counseling should be provided to patients taking tacrolimus?
Avoid excessive UV light exposure, use wide-spectrum sunscreen, avoid high potassium diet and grapefruit juice, do not receive live vaccines, be cautious of performing skilled tasks
## Footnote
Tacrolimus may affect performance of skilled tasks such as driving.
61
What is chemotherapy?
Treatment of cancer with anticancer medications called chemotherapeutic or cytotoxic drugs
## Footnote
Must be used under specialist supervision.
62
What are the two types of chemotherapy treatment in relation to surgery?
* Neoadjuvant treatment
* Adjuvant treatment
63
What is the purpose of neoadjuvant chemotherapy?
To shrink the primary tumour, making local therapy more effective or less destructive.
64
What is the purpose of adjuvant chemotherapy?
To treat subclinical metastatic disease following the primary definitive treatment.
65
What is the effect of combination therapy compared to monotherapy in chemotherapy?
Combination therapy typically causes more toxicity but can reduce drug resistance and enhance response.
66
What are anthracyclines?
A common class of cytotoxic drugs used in cancer treatment, including daunorubicin, epirubicin, doxorubicin, and idarubicin.
67
What should be avoided when using anthracyclines?
Simultaneous radiotherapy.
68
What are the indications for conventional doxorubicin hydrochloride?
* Paediatric malignancies
* Acute leukaemias
* Hodgkin’s and non-Hodgkin’s lymphomas
* Solid tumours such as breast cancer
69
What is the relationship between epirubicin hydrochloride and doxorubicin?
Epirubicin hydrochloride is structurally related to doxorubicin and is another option for breast cancer treatment.
70
For which type of malignancies is idarubicin hydrochloride often used?
Haematological malignancies.
71
What is pixantrone licensed for?
Monotherapy to treat non-Hodgkin B-cell lymphomas, either refractory or multiply relapsed.
72
What is dactinomycin mainly used for?
Paediatric cancers.
73
What is the administration route for bleomycin?
Intramuscularly or intravenously.
74
What types of cancers is mytomycin used to treat?
* Non-small cell lung cancer
* Breast cancer
* Gastro-intestinal cancers
* Metastatic pancreatic cancers
* Superficial bladder tumours
75
What is a significant side effect of mytomycin?
Delayed bone marrow toxicity.
76
What are the three main vinca alkaloids used to treat various cancers?
Vincristine sulphate, vinblastine sulphate, and vindesine sulphate
## Footnote
These drugs are used for lymphomas, solid tumours, and leukaemia
77
What is vinorelbine?
A semisynthetic vinca alkaloid
## Footnote
It is derived from the natural vinca alkaloids
78
What are antimetabolites?
Drugs that combine irreversibly with cellular enzymes or are incorporated into new nuclear material to prevent normal cell division
79
Which drug is typically used with other agents to treat various malignancies?
Cyclophosphamide
## Footnote
It is administered intravenously or orally and is inactive until metabolized by the liver
80
What is melphalan used to treat?
Polycythaemia vera, multiple myeloma, advanced ovarian adenocarcinoma, advanced breast cancer, childhood neuroblastoma
81
Carmustine can be used for which conditions?
Non-Hodgkin’s lymphoma, brain tumours, Hodgkin’s disease, multiple myeloma
82
What factors can affect cytotoxic drug dosing?
Hepatic or renal impairment, bone marrow suppression, cytotoxic drug side effects
83
What are the phases of nausea and vomiting related to chemotherapy?
Acute, delayed, anticipatory
84
What pretreatment can be used for patients with a low emesis risk?
Lorazepam or dexamethasone
85
What medications are recommended for high-risk emesis patients?
5HT3-receptor antagonists (e.g., ondansetron), dexamethasone, neurokinin receptor antagonists (e.g., aprepitant)
86
What is the best way to prevent anticipatory nausea and vomiting?
Effective symptom control
## Footnote
Lorazepam can be used for its anxiolytic, sedative, and amnesiac effects
87
What can cause serious local tissue necrosis if extravasated?
Some cytotoxic drugs
88
What can chemotherapy cause in terms of oral health?
Oral mucositis
## Footnote
Particularly with methotrexate, anthracyclines, or fluorouracil
89
What are the features of tumour lysis syndrome?
Hyperphosphataemia, hyperuricaemia, hyperkalaemia
90
What predisposing factors contribute to tumour lysis syndrome?
Dehydration, renal impairment, hyperuricaemia
91
What medication can be used to manage hyperuricaemia?
Allopurinol
## Footnote
Start 24 hours before treating the tumour
92
Which drugs can cause bone marrow suppression?
All cytotoxic drugs except bleomycin and vincristine
93
What is the typical timing for bone marrow suppression to occur after drug administration?
Between 7 and 10 days
94
What should be done if bone marrow has not recovered before treatment?
Delay or reduce the doses
95
What is the immediate treatment for a neutropenic patient with a fever?
Broad-spectrum antibacterial treatment
96
What should be monitored to prevent complications from cytotoxic drugs?
Blood counts before every treatment
97
What can be used to reduce the severity and duration of neutropenia?
Recombinant human granulocyte-colony stimulating factors
98
What is the effect of cytotoxic drugs on pregnancy and reproduction?
Can shorten reproductive lifespan and may lead to early menopause
99
What guidelines should be followed for handling cytotoxic drugs?
Monitor staff exposure, trained personnel for reconstitution, protective clothing, designated areas
100
What is the purpose of NHS cancer networks in the UK?
To collaborate and plan the best quality cancer services
101
What is alopecia?
Reversible hair loss that varies from patient to patient and is a common complication
## Footnote
There are no pharmacological ways of preventing alopecia.
102
What is a potential complication of having cancer?
Venous thromboembolism
## Footnote
The risk increases with chemotherapy.
103
Why should most cytotoxic drugs be avoided during pregnancy?
They are teratogenic
## Footnote
Especially during the first trimester.
104
What should be done for a pregnant woman with cancer who needs chemotherapy?
Treat with caution and seek specialist advice
## Footnote
Exclude pregnancy before cytotoxic drug treatment.
105
What contraceptive advice should be given before cytotoxic drug treatment?
Childbearing-age women should use contraception during and after treatment
## Footnote
This is to prevent complications related to pregnancy.
106
What effect might regimens excluding procarbazine or an alkylating drug have on fertility?
Might not affect fertility but could result in permanent male sterility
## Footnote
There is no effect on potency.
107
What should be discussed before treatment regarding male patients?
Counselling and sperm storage consideration
## Footnote
This is important prior to cytotoxic drug treatment.
108
Who creates the pathway of care for cytotoxic drugs?
A multidisciplinary team
## Footnote
This is essential for treating cancer.
109
Under what conditions should injectable cytotoxic drugs be dispensed?
Only if prepared for administration
## Footnote
This ensures safety and effectiveness.
110
What must be followed when prescribing, dispensing, and administering cytotoxic drugs?
The treatment plan or written protocol
## Footnote
This is crucial for patient safety.
111
What must be included with cytotoxic medicines when dispensed?
Clear instructions for usage
## Footnote
This aids in correct administration.
