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NAPLEX: CUTANEOUS MELANOMA MCGRAW HILL EXAM 2024/2025
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NAPLEX: CUTANEOUS MELANOMA MCGRAW HILL EXAM2024/2025
CD is a 28-year-old woman who is to start immunotherapy treatment
with high-dose interferon-alfa 2b. Select the side effect(s) associated
with interferon. Select all that apply.
A
Flu-like symptoms requiring premedication with antipyretic
B
Fatigue
C
Depression
D
Somnolence and confusion - Precise Answer ✔✔all
Majority of patients (>80%) develop flu-like symptoms with fever, chills
headache, myalgias, and arthralgias. Symptoms usually occur few hours
after treatment and can last up to 24 hours and can be dose-limiting for
some patients. Incidence of symptoms is lower with subsequent
injections. Premedication with an antipyretic (ie, acetaminophen or
indomethacin) is recommended to minimize risk and severity of fever
and chills.
Answer b is correct. Fatigue (8%-96%) has been reported as dose-
limiting side effects commonly associated with high-dose interferon-alfa
2b. Caution is used in patients (>65 years) as these patients are at
,increased risk of developing fatigue and neurological toxicities
secondary to high dose interferon-alfa 2b.
Answer c is correct. Depression (3%-40%) has been reported as side
effect commonly associated with high dose interferon-alfa 2b. Caution is
used in patients with history of depression and/or other psychological
disorders, or in patients (>65 years of age) as these patients are at
increased risk of developing neurological toxicities secondary to high
dose interferon-alfa 2b.
Answer d is correct. Somnolence (<33%) and confusion (<12%) have
been reported as side effects commonly associated with high dose
interferon-alfa 2b. Caution is used in patients (>65 years of age) as these
patients are at increased risk of developing neurological toxicities
secondary to high-dose interferon-alfa 2b.
GS is a 52-year old man who has developed severe immune-mediated
colitis after receiving 12 cycles of pembrolizumab. He was started on
prednisone 2 mg/kg/d, but has not improved after 1 week of treatment.
Which of the following is the most appropriate treatment option for GS
now?
A
Prednisone 4 mg/kg/d
B
Infliximab 5 mg/kg IVPB
C
Tacrolimus 0.06 mg/kg PO twice daily
, D
Loperamide 2 mg PO every 2 hours
E
Atropine 0.4 mg IV - Precise Answer ✔✔B
Based on a growing number of case reports, the immunosuppressant
infliximab can provide rapid improvement in patients with serious or
steroid-refractory immune-mediated colitis. It works by binding to
human tumor necrosis factor alpha (TNFα), whose biological activities
include the induction of pro-inflammatory cytokines, enhancement of
leukocyte migration, activation of neutrophils and eosinophils, and the
induction of acute phase reactants and tissue degrading enzymes. Many
cases reported only one dose of infliximab was needed to dramatically
improve symptoms. Infliximab should not be used in cases of
perforation or sepsis. In addition, it should not be used for immune-
mediated hepatitis as it confers its own risk of hepatotoxicity.
Answer a is incorrect. Patient has been on HD corticosteroid treatment
for 1 week, now considered to be steroid-refractory, will need to switch
to a different immunosuppressant for optimal outcome.
Answer c is incorrect.Tacrolimus has been used in attempts to manage
high-grade immune-mediated hepatitis.
Answer d is incorrect.Loperamide is not effective in managing immune-
mediated colitis.
Answer e is incorrect.Atropine is not effective in managing immune-
mediated colitis.
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