Anticancer & Immunosupresive Drugs & Toxicology
- Alkylating agents form covalent bonds, are radio-mimetic agents. Cause both apoptosis and necrosis and cause is their most common side effect.
- Doxorubicin is broadest spectrum anticancer drug, causes cardio toxicity (Dexrozoxane is DOC)
- Cyclophosphamide causes hemorrhagic cystitis (MESNA is DOC and is given IV)
- Bleomycin (MC-s\e pulmonary fibrosis) causes minimal bone marrow suppression (Busulfan-DOC for CML causes MAXIMUM suppression)
- Vinca-alkaloids (vincristine & vinblastine) cause peripheral neuropathy (vincristine>>vinblastine). These are used in leukemia and lymphoas. Importantly, vincristine is free from bone marrow suppression effect.
- Taxanes (paclitaxel, docetaxel) promote microtubule polymerization and are used in breast and ovarian cancers. Side effects are neuropathy and hypersensitity. Bone marrow depression also occur.
- Platinum compounds e.g. cisplatin act iun same manner as alkylating agents. Cisplatin is given as continuous IV infusion and is DOC for reproductive cancers (e.g. cervical, ovarian etc). Side effects include nephrotoxicity, neuropathy, ototoxicity and bone marrow depression.
- Cyclosporine is MC immunosuppressive drug, acts by binding to CYCLOPHILLINS and reduce expression of IL-2
- Tacrolimus binds to FKBP-12 and is free from hirsutism and gums enlargement.
- Azathioprine, given with allopurinol should be used in reduced doses to avoid bone marrow toxicity
- L-asparginase causes pancreatitis and hypersensitivity reactions
- Amifostine is DOC for reducing anti-cancer drug associated toxicity
- Dimercaprol (BAL) has two SH groups, which interact with sulfhydryl containing enzymes in the body-CI in iron & Cadmium poisoning
- EDTA is used in lead intoxication but not in Hg poisoning.
- Peniciilamine is used for copper, lead, mercury, zinc and is DOC for Wilsonâ€™s disease; also DOC for cystinuria
- Deferroxamine (1gm for 85 mg) is obtained from actinomycetes-iron chelator-MC side effect is hypotension on IV injection
- Deferiprone-new iron chelator for patients with multiple blood transfusion