Antineoplastic Drugs Part 1: Cell Cycle-Specific Drugs

• -cell-cycle specific analogues
• -they either falsely substitute for purines, pyrimidines, or folic acid
• -or they inhibit critical enzymes involved in the synthesis or function of these compounds
• -ultimately inhibit the synthesis of DNA, RNA, and proteins

-Methotrexate: used in treatment of solid tumors (breast, neck, and head); used in treatment of rheumatoid arthritis b/c it has immunosuppressive activity which inhibits lymphocyte multiplication; antidote is Leucovorin

• -hair loss, nausea, vomiting, diarrhea, and myeolosuppression
• -common general symptoms are fever and malaise
• -tumor lysis syndrome; may include hyperphosphatemia, hyperkalemia, and hypocalcemia; electrolyte abnormalities treated with diuretics such as mannitol, IV calcium supplementation,
• -severe: palmar-plantar dysesthesia; mild symptoms are painless swelling and erythema to painful blistering of the pt's palms and soles

• -indications: treatment of acute lymphocytic leukemia
• -adverse effects: impaired pancreatic function, can lead to hyperflycemia and severe or fatal pancreatitis
• -drug exmaple: asparaginase and pegaspargase

• -killing of normal cells of the GI mucous membrane may result in altered nutritional status, stomatitis, altered bowel function, poor appetitel, nausea, vomiting, and diarrhea
• -...or hair follicles leads to alopecia (loss of hair)
• -...in bone marrow results in dangerously low (life threatening) blood cell counts
• -...germinal epithelial cells leads to sterility (irreversible) in males, damages to the ovaries with amenirrhea in females, and teratogenic effects with possible fetal death

• -oral hygiene before and after eating
• -avoid lemon, glycering, undiluted peroxide, and alcohol containing products b/c of drying/irritating effects
• -use soft bristle tootbrush and solutions of warm saline
• -pt's with dentures, remove and clean frequently, wear at mealtimes only if severe stomatitis
• -helpful to use otc saliva substitutes or sugarless candy/gum to stimulate saliva flow
• -avoid spicy, acidic, hot foods, alcohol, and tobacco
• -if white patches noted oral antifungal suspensions may be ordered

• -hair loss, nausea and vomiting, myelosuppression
• -liver, kidney, lung toxicities
• -convulsions
• -extravasation

• -derived from camptothecin, a substance taken from a chinese shrub
• -inhibit proper DNA function in the S phase by binding to the DNA-topoisomerase 1 complex

• -primarily treat ovarian cancer and colorectal cancer, small cell lung cancer
• -shown to be effective in cases of metastatic ovarian cancer

• -bone marrow suppresion (predictable, reversible, manageable)
• -GI effects; nausea, vomiting, diarrhea
• -Irinotecan causes cholinergic diarrhea (delayed can occur 2 to 10 days after dosage)