SALIU DNA and RNA synthesis Examples:. Dactinomycin




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 PCL assignment

Antineoplastic drugs / Anticancer Drugs are
not only used prominently in different types of cancers but also in conjunction
with surgery, radiotherapy and immunotherapy in the combined modality approach
for many solid tumors, especially metastatic.

Classification of Antineoplastic Agents.

1.Alkylating Agents

Nitrogen mustards: Melphalan,
Cyclophosphamide, Ifosfamide





Methyl Hydrazines

Platinum Coordination complexes: Cisplatin,
Carboplatin, Oxaliplatin


Folate Antagonists: Methotrexate

Purine antagonists

Pyrimidine antagonists: 5-Fluorouracil,

Natural Products

Plant Products

Vinca Alkaloids: Vincristine, Vinblastine

Taxanes: Paclitaxel, Docetaxel

Epipodophyllotoxins: Etoposide

Camptothecins: Irinoteca

Microorganism Products

3.Antibiotics: Doxorubicin, Bleomycin



Mechanisms of Action

cyclophosphamide is an alkylating agent. It
is a widely used as a DNA crosslinking and cytotoxic chemotherapeutic agent.

It is given orally as well as intravenously
with efficacy.

It is inactive in parent form, and must be
activated to cytotoxic form by liver CYT450 liver microsomaal system to 4-
Hydroxycyclophamide and Aldophosphamide.

4-Hydroxycyclophamide and Aldophosphamide
are delivered to the dividing normal and tumor cells. 

Aldophosphamide is converted into acrolein
and phosphoramide mustard.

They crosslink DNAs resulting in inhibition
of DNA synthesis 

Clinical Applications:Breast Cancer,Ovarian
Cancer ,Non-Hodgkin’s Lymphoma 

Chronic Lymphocytic Leukemia (CLL) ,Soft
tissue sarcoma ,Neuroblastoma 

Wilms’ tumor ,Rhabdomyosarcoma .


Mechanism of Action: Inhibits
formation of FH4 (tetrahydrofolate) from folic acid by inhibiting the enzyme
dihydrofolate reductase (DHFR); since FH4 transfers methyl groups essential to
DNA  synthesis and hence DNA synthesis blocked.Examples;Methotrexate

Clinical application: Choriocarcinoma,
acute lymphoblastic leukemia (children), osteogenic,sarcoma, Burkitt’s and
other non-Hodgkin’s lymphomas, cancer of breast, ovary, bladder, head &

Antibiotics :Doxorubicin.

Mechanism of Action:It binds to DNA and
inhibits RNA synthesis, impaired mRNA production, and protein synthesis and
inhibit DNA and RNA synthesis Examples:. Dactinomycin .
Daunorubicin, Doxorubicin,Bleomycin.

Clinical application:Rhabdomyosarcoma and
Wilm’s tumor in children;choriocarcinoma (used with methotrexate.

Acute lymphocytic/granulocytic leukemias;
treatment of choice in nonlymphoblastic leukemia in adults when given with

Acute leukemia, Hodgkin’s disease, non
Hodgkin’s,lymphomas (BACOP regimen), CA of breast & ovary,small cell CA of
lung, sarcomas, best available agent for metastatic thyroid CA.

Germ cell tumors of testes and ovary, e.g.,
testicular carcinoma (can be curative when used with vinblastine &
cisplatin), squamous cell carcinoma.

Question 2:Food as an essentials  component of infection control discuss.

Starve a cold, feed a fever.” These
oft-heard words of wisdom may not be so wise. Scientific research shows that
some foods contain compounds that enhance immune system function and make
humans better able to fight infection. These compounds may not prevent
infections from developing, but they help activate infection-fighting white
blood cells and trigger increased production of cells that kill foreign

-Citrus Fruits

Vitamin C helps fight infection by
increasing the production of white blood cells, which defend the body against
bacteria and viruses. Vitamin C also increases the production of interferon, a
substance that coats the surfaces of cells to prevent viruses from entering.
The Food and Nutrition Board of the Institute of Medicine recommends a daily
intake of 75 mg for men and 60 mg for women. Just one navel orange contains
82.7 mg of vitamin C, more than 100 percent of the DRI.


Garlic has antimicrobial properties
confirmed by scientific research. In a study led by Edward C. Delaha of
Georgetown University Hospital, investigators extracted allicin from 10 bulbs
of garlic and created a thick paste by mixing the extract with sterile
distilled water. They prepared 30 different strains of Mycobacterium and added
them to petri dishes containing the garlic extract. The researchers examined
each petri dish daily for 28 days and recorded the growth of the bacteria. At
the conclusion of the study, they determined that the garlic extract paste
inhibited the growth of all 30 strains. The results of this study appeared in
the April 1985 issue of “Antimicrobial Agents and Chemotherapy.”

-Meat and Shellfish

Meat and shellfish contain zinc, a mineral
that affects immune system function. Zinc deficiency impairs the function of
infection-fighting monocytes, reduces the toxicity of natural “killer cells”
and inhibits the immune response designed to engulf foreign particles. Eating
meat and shellfish may help replenish zinc stores and ward off infection. The
dietary reference intake for zinc is 9.4 mg per day for adult men and 6.8 mg per
day for adult women. One serving of battered oysters — six pieces — has 15.64
mg of zinc.

-Fish, Seeds and Nuts

Some fish, seeds and nuts contain selenium,
a mineral that enhances the function of killer cells in the immune system.
Tuna, sunflower seeds, red snapper and Brazil nuts contain high amounts of this
mineral. One 3-oz. serving of bluefin tuna, for example, contains 39.8 mcg of
selenium. Adult men and women need 45 mcg of selenium per day, as recommended
by the Food and Nutrition Board of the Institute of Medicine.

-Colorful Vegetables

Colorful vegetables, such as red peppers,
carrots, squash, spinach and sweet potatoes, contain carotenoids. These
compounds enhance immune system function, making you better able to fight
infection. Carotenoids, particularly beta-carotene, may also increase the
number of T-helper lymphocytes in the body. These cells activate and coordinate
the response of macrophages and cytotoxic T-cells, which fight infectious
organisms.ounds derived from ammonia.


Question 3:list the principle of chemotherapeutic  resistance.

1:Pre-chemotherapy  assessment.





6:Management  of side effect and follow up.

Most consider important  is pre -chemotherapeutic  assessment.

Aim:Establishes  diagnosis 
fitness of patient.

Method:clinical evaluation and laboratory  test.

Clinical evaluation.

History:detail history

Systemic  involvement.


Performance status.

status  : ls an attempt  to qualify 
the general wellbeing  and daily activities
of the patient.

-Whether they can receive chemotherapy

dose adjustment  is necessary

-As a measure for the require d intensity of
a palliative  care.

-Measure of quality of life.

test includes

Diagnostic :histology

Extent:imaging,chest xray,CT,MRI,PET,USS,LFT.

Baseline:FBC,PCV,WBC,Stool microscopy.

Others depending  on the type of cancer eg tumor marker.