Sketchy Pharm: Cyclophosphamide, Ifosfamide, Busulifan, Nitrosoureas (Carmustine, Lomustine, Streptozocin)

Question 1

How does cyclophosphamide work?

Answer 1

It adds an alkyl group to the 7’ nitrogen in guanine which causes DNA to crosslink (like the crosslinked ankles of the Cyclops Phosphamus).

Question 2

What needs to happen to cyclophosphamide prior to it crosslinking DNA?

Answer 2

Cyclophosphamide must be activated by CYP450 (like the guy throwing the javelin at the cyclops and aggravating him from the CYP chariot).

Question 3

Cyclophosphamide is used to treat ________________.

Answer 3

cancer (crab sail) and autoimmune disorders (antibody lanterns)

Question 4

The most significant acute side effect of cyclophosphamide is _______________.

Answer 4

myelosuppression (like the bone marrow leaking from the bone wielded by the cyclops)

Question 5

Long-term, cyclophosphamide can cause ________________.

Answer 5

hemorrhagic cystitis (like the statue peeing blood) which can be prevented with administration of mesna (like the mesna maze)

Note: this can progress to urothelial cancer (represented by the golden crab over the cyclops’ pelvis).

Question 6

Cyclophosphamide can cause what electrolyte imbalance?

Answer 6

SIADH (like the water bucket on the cyclops’ head)

Question 7

Cyclophosphamide can cause what adverse effect in women (if used long-term)?

Answer 7

Premature ovarian failure (like the uterus-shaped tree with rotting fruit)

Note: can cause irreversible azoospermia in men.

Question 8

How does busulfan work?

Answer 8

Like cyclophosphamide, it is an alkylating agent that causes crosslinking.

Question 9

Busulfan is commonly used to _______________.

Answer 9

eliminate native bone marrow prior to transplantation (like the emptied out bones next to the SireNs)

Question 10

What are the adverse effects of busulfan?

Answer 10

• Hyperpigmentation (dark skinned sirens)
• Immunosuppression (emptied out bones)
• Pulmonary damage, either acute or chronic and fibrotic (like the lung patterns on the sirens’ blouses)

Question 11

The nitrosureas have what suffix?

Answer 11

-mustine (like the centaur mustangs!)

Question 12

There is one nitrosurea that does not end in -mustine: __________________.

Answer 12

streptozocin (like the STRiPed centaur)

Question 13

The nitrosureas are used to treat _____________.

Answer 13

brain cancers (like the brain tree behind the centaurs)

Question 14

What is an important side effect of the nitrosureas?

Answer 14

Neurotoxicity (like the mustang going crazy)