16, Immunomodulators & Antineoplasts

Front 1

Methotrexate Indications

Back 1

Treatment and palliation of solid tumours, lymphoma
and leukaemia
Severe disabling psoriasis
Rheumatoid arthritis

Front 2

Methotrexate SE

Back 2

Myelosuppression (neutropenia, thrombocytopenia)
GI side effects (mucositis, ulceration, n, v)
Pulmonary toxicity
Hepatotoxicity
Rash, urticaria, itch
Photosensitivity

Front 3

Methotrexate Counselling

Back 3

8, 10a, 20, 21
! Take tablets strictly as directed. They should be taken ONE A WEEK on the same day each week; they must not be taken every day.
! Tell your doctor if you have a cough, difficulty breathing or signs of infection.
! Use of some medications together with methotrexate may lead to toxicity; tell your doctor and pharmacist that you are taking this drug.
! You may need to attend regular blood tests and medical consultations while being treated with this medication.
! Take a folic acid (5 mg) tablet on every other day than that of the methotrexate to reduce GI side effects.

Front 4

Methotrexate Monitoring

Back 4

FBC, RF, LFT every 2-3weeks for the first 3 months
TDM- MTX [ ]
Sx of pneumonitis

Front 5

Cyclosporin Indications

Back 5

Prevention of organ transplant rejection
Severe active rheumatoid arthritis
Severe psoriasis

Front 6

Cyclosporin SE

Back 6

gingival hyperplasia
hirsutism
nephrotoxicity
neurotoxicity (seizures)
hypertension
hyperkalaemia (care with other drugs that cause this)
hypercholesterolaemia
hyperglycaemia, increased insulin requirements,
diabetes
opportunistic infections
myopathy, muscle weakness

Front 7

Cyclosporin Counselling

Back 7

5, 8, 18
! Clean your teeth and gums regularly.
! Swallow capsules whole and at the same times each day.
! If you forget to take a dose at the usual time take it as soon as you remember. If it is almost time for your next dose, skip the dose you missed. Take your next dose (normal amount) at the usual time. note: can be used with diltiazem to increase its t& and decrease dose required

Front 8

Cyclosporin Monitoring

Back 8

QT intervals
Blood conc.
RF (electrolytes)
LFTs
Glucose
Cholestrol levels
BP

Front 9

Aromatase inhibitors

Back 9

Anastrozole
Letrozole
Exemestane

Front 10

Aromatase inhibitors Indications

Back 10

Breast cancer

Front 11

Aromatase inhibitors SE

Back 11

hot flushes
headache
n/v
vaginal dryness (anastrozole)
vaginal bleeding and spotting (letrozole, exemestane)
musculoskeletal pain
fractures
hair thinning

Front 12

Aromatase inhibitors Counselling

Back 12

Exemestane best absorbed if taken
with food

Front 13

Aromatase inhibitors Monitoring

Back 13

BMD
Ca/VitD
VTE
Liver enzymes

Front 14

Tamoxifen Indications

Back 14

Hormone receptor-positive advanced breast cancer

Front 15

Tamoxifen SE

Back 15

hot flushes, nausea, fluid retention, headache, vaginal
discharge, menstrual irregularity
musculoskeletal pain,
increased bone and tumour pain
deep vein thrombosis,
pulmonary embolism

Front 16

Tamoxifen Counselling

Back 16

12+
If abnormal vaginal bleeding or discharge, pain or pressure in the pelvic region, blurred vision, or bone
pain occur, seek medical advice.

Front 17

Tamoxifen Monitoring

Back 17

plasma Ca

Front 18

Azathioprine Indications

Back 18

Prevention of organ transplant rejection
Immunosuppression in severe rheumatoid arthritis,
systemic lupus erythematosus
Inflammatory bowel disease

Front 19

Azathioprine SE

Back 19

bone marrow suppression - leucopenia, thrombocytopenia, anaemia

immunosuppression INC. infection
alopecia
GI upset (diarrhoea, anorexia, nausea and vomiting, mouth ulceration and oesophagitis)
hepatitis

Front 20

Azathioprine Counselling

Back 20

8, 21, A, B
! Tell your doctor immediately if you have bleeding, increased bruising or infection.

Front 21

Azathioprine Monitoring

Back 21

WBC
LFTs

Front 22

Corticosteriods

Back 22

prednisolone
prednisone
dexamethasone
cortisone
fludrocortisone

Front 23

Corticosteriods Indications

Back 23

Immunosuppression in autoimmune disease and
transplantation.
Anti-inflammatory (IBD, asthma, allergy and skin
conditions).
Chemotherapy-induced nausea and vomiting.
Replacement therapy in adrenal insufficiency

Front 24

Corticosteriods SE

Back 24

Glucocorticoid
GI effects (dyspepsia, peptic ulceration, gastric bleeding)
Metabolic effects (hyperglycaemia, diabetes)
Increased appetite, weight gain
Insomnia
Psychological disturbances (psychosis, euphoria,
depression)
Immunosuppression and increase risk of infection
Myopathy, muscle weakness
Osteoporosis (long-term)

Mineralocorticoid
Salt retention
Oedema
Hypertension

Front 25

Corticosteriods Counselling

Back 25

9, B
! Take in the morning if once daily dosing as may cause insomnia if taken close to bedtime
! If you become ill, or have close contact with someone with an infection, chickenpox or shingles, see your doctor
! This medication may affect your mood, if affected speak to your doctor

Front 26

Corticosteriods Monitoring

Back 26

BP
BGL
BMD
Electrolytes

Front 27

CS Practice Points

Back 27

Prednisone is converted to prednisolone in the liver.
Dexamethasone is potent glucocortical steroid with no mineralocorticoid activity.
Fludrocortisone has predominantly mineralocorticoid activity and is thus used for Mineralocorticoid replacement in adrenal insufficiency, with a
glucocorticoid.
Risk of osteoporosis is dependent on dosage and duration of use.