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GPhC Exam: Malignant Disease & Immunosuppression

GPhC Pre-Reg Exam Preparation Specialists

What are the key topics in the malignant disease & immunosuppression section?

This section falls into the medium-weighted category for the GPhC exam, and you should identify that a large proportion of the topics are related to oncology. You will need to focus on the following topics: cytotoxic drugs (i.e. alkylating drugs, antimetabolites), drugs that affect the immune response (i.e. corticosteroids, immunosuppressants, immunomodulating drugs), and sex hormones/hormone antagonists (drugs that are used in cancer).

Some of the key diseases that appear in this section include inflammatory bowel disease, organ transplantation/bone marrow, rheumatoid arthritis, ulcerative colitis, severe psoriasis, leukaemia, lymphomas, and autoimmune conditions.

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Top tips on the malignant disease & immunosuppression GPhC exam questions

  • In practice, many drugs that are in this section will be prescribed/administered to weights based on their weight/body mass index/body surface area. Therefore, it would be a good idea to practice as many of these types of calculation questions as you possibly can. If you like to work in pairs/groups, each individual can generate their own questions and answers which you can then share and practice amongst one another.
  • Some drugs or combination of drugs (i.e. Methotrexate and Folic Acid) will appear quite commonly during your pre-registration year, so use the opportunities to discuss these with your tutor or study group. In particular, you will find that you have studied a certain drug/drug class (i.e. Prednisolone) within a different chapter, so it is essential to understand the reason for it to be a focus in immunosuppression/malignant disease.
  • As mentioned previously, oncology is a key focus here. As a result, students in a hospital setting might be more familiar with the drugs in comparison to the large proportion of students that are based in community/retail pharmacy. Therefore, you may feel that this section will “not come up in the exam” purely because you are not so familiar with it in practice. Do not fall into this trap and remember that any part of this section can be examined upon.
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Narrow therapeutic index drugs in this section

ANTIMETABOLITE: METHOTREXATE

Drug action

What is it used for?

Cautions

(Very) common side effects

·        Inhibits the enzyme dihydrofolate reductase (DHFR) thus, prevents the synthesis of purines and pyrimidines (which are essential in DNA synthesis)

·        Severe Crohn’s disease; maintenance of remission of severe Crohn’s disease

·        Moderate to severe active rheumatoid arthritis

·        Neoplastic diseases (malignant or benign tumour development)

·        Blood count – bone marrow suppression, reduced white cell count, reduced platelet count

·        GI toxicity – stomatitis, diarrhoea

·        Liver toxicity – increased liver transaminases, liver cirrhosis

·        Pulmonary toxicity – dyspnoea, cough, fever, pneumonitis

·        Anaemia

·        Reduced appetite

·        Nausea, vomiting, diarrhoea, GI discomfort, throat ulcer

·        Drowsiness, fatigue, headache

·        Higher risk of infections

·        Leucopenia, thrombocytopenia

·        Skin reactions

CALCINEURIN INHIBITOR: CICLOSPORIN

Drug action

What is it used for?

Cautions

(Very) common side effects

 

·        Inhibits the production and release of lymphokines thus, suppresses cell-mediated immune responses

·        Severe acute ulcerative colitis refractory to corticosteroid treatment

·        Severe active rheumatoid arthritis

·        Short-term treatment of (very) severe atopic dermatitis

·        Severe psoriasis

·        Organ/bone marrow transplant

·        Nephrotic syndrome (protein leaks into urine)

·        Following functions/parameters need to be monitored: hepatic, renal, serum potassium & magnesium, blood lipids, serum creatinine (when used in psoriasis/atopic dermatitis), blood pressure

·        Reduced appetite

·        Nausea, vomiting, diarrhoea, GI discomfort

·        Electrolyte imbalance

·        Fatigue

·        Leucopenia, fever

·        Headaches, seizures

·        Hyperglycaemia

·        Hyperlipidaemia

·        Hypertension

·        Hyperuricaemia

 

Example questions

  1. Miss L has been prescribed Ciclosporin for the short-term treatment of atopic dermatitis at a dose of 2.5mg/kg twice daily. Miss L weighs 9 stones. Calculate the total daily dose of Ciclosporin that needs to be administered.

1 stone = 6.35kg

  1. Mr T collects his regular repeat prescription medication from your pharmacy and recently he has been started on Azathioprine tablets. He tells you that he is very concerned about the side effects of this medication as he has come across a lot of information about the side effects on the internet and is now feeling hesitant to take them. From the following options, which is the most common side effect that may occur?
  • Anaemia
  • Thrombocytopenia
  • Hypersensitivity
  • Hepatic disorders
  • Gastrointestinal disorders

Written by Fatima Sazzad, GPhC Reg No. 2212805

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