1. Methotrexate (Antimetabolite)

    L-Leucovarin antidote
    S- S phase
    MOA: Works in the S phase of the cell cycle.

    Blocks the enzyme dihydrofolate reductase and thus prevents formation of Tetrahydrolfate 

    The binding to DHFR is competitive and reversible which is beneficial for the use of Leucovorin. 

    Leucovorin is an antidote that saves the host cells but have no effect on the cancer cells

    Used for acute lymphoblastic leukemia, osteogenic sarcoma 

    AE include nephrotoxicity, neutoropenia, thrombocytopenia and pulmonary and hepatotoxicity.
  2. 5-FU (Antimetabolite) 

    FU I'll bust you a CAP in your Pancreas, Breast, Colon. Take (that) Sucker
    inhibits synthesis of pyrimidine (C, T, U)

    inhibits Thymidate synthase thus decreased dTMP, decreased DNA and protein synthesis

    When used with Leucovarin, it acts as an amplifying agent

    Used for metastatic breast cancer,carcinoma of GI, ovary,bladder, pancreas, prostate. Also metastatic cancer of the colon

    AE is nausea and alopecia. Also diarrhea. Also myelosuppression.
  3. Cytabarine (antimetabolite)

    Crazy Arabs Are Muslim Lovers and hate seeing my Long Strands of hair
    It is incorporated into the DNA and blocks the elongation of DNA thus decreased DNA synthesis. 

    Used for AML

    AE is neurotoxicity
  4. Azthroprine and Mercaptopurine (Antimetabolites)
    Purine analog 

    Used for cancer chemotherapy and immunosupresants.
  5. Cyclophosphamide (Alkylating Agent)
    Cell Cycle non specific---so goes and affects DNA directly 

    Converted in the liver to become active and nitrogen mustard. Transcription and Translation inhibited

    Used for Chronic Lymphatic Leukemia, Non-Hodgkins, Ovarian carcinoma 

    Acrolein can cause cystitis in the bladder which can be treated with the antidote, MESNA since it binds to the acroelin in the urine

    • AE is myelosuppression
    • Can also cause SIADH and water intoxication causing hyponatremia. Antidote needed is DEMECLOCYCLINE by interfering with the insertion of water channels in the collecting ducts
  6. Busulfan (Alkylating)
    Alkylates DNA

    Used for CML

    AE is pulmonary fibrosis and hyperpigmentation
  7. Nitrosureas (Alkylating Agent)
    Crosses the BBB

    brain tumors including astrocytomas. 

    AE is CNS toxicity
  8. Cisplatin (Platinum)
    Breaking the cross link between DNA

    Used for testicular, bladder, ovarian, urogenital 

    Don't use aluminum needles when injecting it since this inactivates the drug

    AE is nephrotoxicity which can also cause elctrolyte imbalances. This can be prevented by the antidote AMIFOSTINE which wil scavenge free radicals. 

    Other adverse effects of ototoxicity and marked nausea and vomiting.
  9. Doxorubicin (Cytotoxic Abx)
    It is a Topoisomerase 2 poision thus preventing it from relieving stress and thus decreased DNA replication.Also causes free radical formation 

    Used for Hodgkins lymphoma, sarcomas, and brest, ovary and lung cancer. 

    The free radicals can cause excesive bleeding at the site of injection. Can be prevented by the antidote, DIMETHYL SULFOXIDE

    AE is CARDIOTOXICITY and the antidote for this is DEXARZOXANE which is an iron chelator
  10. Daunoribicin
    Similar to Doxorubicin but its special use is Leukemia
  11. Dactinomycin
    Binds to DNA helix and thus prevents the transcription of DNA

    Used for Wilm's Tumor, Ewing Sarcoma, rhabomyosarcoma

    AE is hepatopoeitic supression, and pancytopenia
  12. Bleomycin
    Causes DNA fragmentation due to free radical formation. 

    Used as a combination therapy for testicular cancers. Also used for lymphomas and squamous cell carcinomas 

    AE is pulmonary fibrosis and pulmonary toxicity
  13. Vincristine and Vinblastine (Natural Products)
    Both drugs affect the assembly of spindles and thus is affecting the M phase.

    Vincristine is used for Hodgkins and AE is peripheral neuropathy,sensory and motor parethesias. 

    Vinblastine AE are myelotoxic and thus bone marrow suppression
  14. Etoposide (Natural Product
    Inhibits Topo 2 and thus increases DNA degradation.  Specific for late S and early G2 phase

    Used for testicular cancer in part of the combination therapy with Vinblastine and Bleomycin. 

    AE is dose limiting leukopenia.
  15. Campotothecins and Topotecan
    MOA is inhibiting Topo 1

    Used for colorectal cancer, ovarian and small cell cancers.
  16. Paclitaxels
    Inhibits microtubules dissassembly so the microtubules become too big and are non functional. Thus affecting M phase  

    Used for breast and ovarian carcinomas 

    AE are CARDIAC. Also cause peripheral peripheral neuropathy

    Clearance is reduced if this drug is given with Cisplatin so higher toxicitiy
  17. Tamoxifen (anti hormonal)
    Blocks binding of estrogen to estrogen receptor in estrogen receptor positive breast carcinoma. 

    It can be used as a treatment and as a prophylaxis for breast cancer. 

    There is an increased risk of endometrial cancer with long time use of this drug since it acts as an agonist at endometrial receptors.
  18. Fulvestrant
    Used in pt's who aren't responding to Tamoxifen for breast cancer. However only give to POSTMENOPAUSAL women
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