Cytotoxic alkylating agents

Question 1

Name the Alkylating agents

Answer 1

Cyclophosphamide
(“Cyclops Polyphemus”)

Busulfan
(“Beautiful sirens”)

Nitrosureas
(“Mustang”)

• Carmustine
• ​Lomustine

​Ifosfamide

Question 2

Cyclophosphamide
Busulfan
Nitroureas
MOA

Answer 2

alkylating agents donate an alkyl group → DNA cross-links

• cell cycle NON-specific

**Cyclophosphamide is activated by CYP450**

Question 3

Cyclophosphamide can be used to treat …

Answer 3

treats many hematologic and solid malignancies

• leukemias and lymphomas,
• breast cancer,
• ​ ovarian cancer
  (“Torn cancer crab”)

potent immunosuppressive therapy
treatment of

• nephrotic syndrome,
• nephritic syndrome,
• vasculitis,
• ​autoimmune hemolytic anemia
  (“Torn antibody”)

Question 4

Cyclophosphamide Side Effects

Answer 4

can cause myelosuppression
(“Broken marrow”)

-can cause hemorrhagic cystitis
(“Red urine kid fountain”)

• co-administration of 2-mercaptoethanesulfonate (MESNA) prevents hemorrhagic cystitis
  (“Protective maze surrounding red urine fountain”)

-increases risk of bladder cancer
(“Cancer crab belt buckle”)

• high grade transitional cell carcinoma

can cause hyponatremia due to SIADH
(“Inappropriately wet head”)

-cause infertility and premature menopause
(“Dried up fruit tree”)

​

​

Question 5

Busulfan can be used to treat …

(“beautiful sirens”)

Answer 5

useful as a conditioning agent prior to bone marrow transplantation
(“Severely depleted marrow”)

Question 6

Busulfan Side Effects

(“Beautiful Sirens”)

Answer 6

-can cause lung toxicity

• acute lung injury
• interstitial fibrosis
• ​alveolar hemorrhage

-can cause a hyperpigmentation reaction
(“Beautiful TAN sirens”)

Question 7

Nitrosoureas

Carmustine
Lomustine
(“Mustang Centaurs”)

Streptozotocin
(“Striped zebra centaur”)

are used to treat …

Answer 7

highly lipophilic →cross BBB → treat brain tumors

• glioblastoma multiform
  (“Brain tree”)

Question 8

Nitrosoureas

Carmustine
Lomustine
(“Mustang Centaurs”)

Streptozotocin
(“Striped zebra centaur”)

Side Effects

Answer 8

can cause neurotoxicity
(“Dizzy centaur”)

• convulsions
• dizziness
• ​ataxia