Oncology, Hematology and Immunosuppressive Therapy
Core concepts
Know the classes of antineoplastic agents (alkylating agents, antimetabolites, topoisomerase inhibitors, tubulin inhibitors, targeted therapies, immunotherapy) and their hallmark toxicities. Anthracyclines cause cardiotoxicity (monitor ejection fraction). Cisplatin is nephrotoxic and emetogenic. Methotrexate requires leucovorin rescue at high doses. Immunosuppressants (tacrolimus, ciclosporin, mycophenolate, azathioprine) have narrow therapeutic indices and require monitoring. Biologic and checkpoint inhibitor therapy can cause immune-related adverse events affecting any organ.
Traps in questions
A frequent trap is confusing neutropenic fever management - empiric broad-spectrum antibiotics within one hour. Another is forgetting that live vaccines are contraindicated in immunosuppressed patients. Watch for questions on tumour lysis syndrome (allopurinol or rasburicase prophylaxis) and on methotrexate interactions with NSAIDs and trimethoprim (increased toxicity).
Worked rule of thumb
Use the "toxicity fingerprint" approach: match each drug to its signature toxicity - anthracycline to heart, cisplatin to kidney and ears, vincristine to neuropathy, bleomycin to lung, methotrexate to marrow and mucosa. For neutropenic fever, act within one hour with empiric antipseudomonal beta-lactam.