CHEMO
AGENTS
CHEMOTHERAPEUTIC DRUGS
Chemotherapeutic Drugs: classified by their action on the cell or their source.
ALKYLATING AGENTS: not cell cycle specific but rather work throughout the cycle,
they bond with nucleic acids, thereby interfering with their action. Associated with an
increased risk of acute myelogenous leukemia and is related to the total drug dose.
 Side Effects Include: bone marrow depression, amenorrhea in women and
azoospermia in men, and carcinogenesis.
 Busulfan: nausea and vomiting, diarrhea, pulmonary fibrosis, bone marrow
suppression, impotence, amenorrhea, and skin hyperpigmentation
 Carboplatin: nausea and vomiting, bone marrow suppression, ototoxicity,
neurotoxicity, and hyperuricemia
 Chlorambucil: myelosuppression and interstitial pneumonia-pulmonary fibrosis
 Cisplatin: neurotoxicity, myelosuppression, nephrotoxicity, nausea and vomiting,
hyperkalemia, and hypomagnesemia
 Cyclophosphamide: myelosuppression, anorexia, stomatitis, alopecia, gonadal
suppression, nail hyperpigmentation, nausea and vomiting, diarrhea, and
hemorrhagic cystitis
 Dacarbazine: nausea and vomiting, anorexia, vein irritation, alopecia,
myelosuppression, facial flushing, and radiation recall
 Hexamethylmelamine: nausea and vomiting, diarrhea, abdominal cramps,
alopecia, myelosuppression, and neuropathy
 Melphalan: hypersensitivity, nausea, myelosuppression, amenorrhea, pulmonary
infiltrates, and sterility
 Nitrogen mustard: nausea and vomiting, fever, chills, anorexia, vesication,
gonadal suppression, myelosuppression, hyperpigmentation and alopecia
 Thiotepa: nausea and vomiting, bone marrow suppression, mucositis, and
gonadal dysfunction
ANTIMETABOLITES: act by interfering with the synthesis of new nucleic acids, cell
cycle specific, much more toxic to proliferating cells, but not associated with delayed
bone marrow suppression or carcinogenesis, often used with intrathecal administration
and 5-fluorouracil.
 Side Effects Include: gastrointestinal toxicity and acute bone marrow suppression
 Cytarabone: myelosuppression, diarrhea, nausea and vomiting, alopecia, rash,
fever, conjunctivitis, neurotoxicity, hepatotoxicity, pulmonary edema, and skin
desquamation of the palms and soles of the feet
 Floxuridine: nausea and vomiting, diarrhea, oral and gastrointestinal ulcers, bone
marrow suppression, alopecia, and hepatotoxicity
 Fludarabine: chills, fever, hyperuricemia, nausea and vomiting, bone marrow
suppression, neurotoxicity, and pulmonary toxicity
 Fluorouracil (5-FU): oral and gastrointestinal ulcers, nausea and vomiting,
diarrhea, alopecia, vein hyperpigmentation, and radiation recall
 6-Mercaptopurine: nausea and vomiting, anorexia, myelosuppression, diarrhea,
hepatotoxicity, and hyperpugmentation
 6-Thioguanine: anorexia, stomatitis, rash, vein irritation, hepatotoxicity,
myelosuppression, and nausea and vomiting.
ANTITUMOR ANTIBIOTICS: derived from microbial fermentation, act on the DNA
to disrupt DNA and RNA transcription, not cell cycle specific, though the effects of the
antibiotics are more pronounced in the S or G2 phase
Side Effects Include: cardiac toxicity, skin ulceration with extravasation, pulmonary
toxicities, bone marrow suppression and increased effects of radiation therapy.
 Bleomycin: anaphylaxis, pneumonitis, pulmonary fibrosis, alopecia, stomatitis,
anorexia, radiation recall, skin hyperpigmentation, fever, chills, and nausea and
vomiting
 Dactinomycin (actinomycin D): nausea and vomiting, stomatitis, vesication,
alopecia, radiation recall, myelosuppression, and diarrhea
 Daunorubicin: myelosuppression, vesication, cardiotoxicity, stomatitis, radiation
recall, nausea and vomiting, alopecia, and facial flushing
 Doxorubicin (Adriamycin): myelosuppression, vesication, cardiotoxicity,
stomatitis, alopecia, nausea and vomiting, radiation recall, and diarrhea
 Idarubicin: myelosuppression, alopecia, stomatitis, cardiotoxicity, nausea and
vomiting, and vesication
 Mithramycin: myelosuppression, hepatotoxicity, hyperpugmentation, nausea and
vomiting, facial flushing, and nephrotoxicity
 Mitomycin: myelosuppression, vesication, nausea and vomiting, alopecia,
pulmonary fibrosis, hepatotoxicity, stomatitis, and hyperuricemia
HORMONAL AGENTS: act to eliminate or displace natural hormones, used to
clinically manipulate cells by binding to specific intracellular receptors and interacting
with DNA to change cellular function, the most common use is in the treatment of breast
cancer when the tumor is positive for estrogen and progesterone receptors,
 Side Effects Include: hot flashes, depression, loss of libido, and an increase in
endometrial cancers
 Corticosteroids (Dexamethasone, Hydrocortisone, Prednisone, Solu-Cortef):
nausea, suppression of immune function, weight gain, hyperglycemia, increased
appetite, cataracts, impaired wound healing, menstrual irregularity, and
interruption in sleep and rest patterns
 Antiandrogen (Flutamide): impotence and gynecomastia
 Antiestrogen (Tamoxifen, Zoladex): nausea and vomiting, hot flashes, fluid
retention, changes in menstrual pattern, increase in bone pain, and hypercalcemia
 Gonadotropin-releasing hormone (Leuprolide): impotence, decreased libido,
increase in bone and tumor pain, genital atrophy and gynecomastia
NITROSOUREAS: not cell cycle specific, but they are lipid soluble and able to cross
the blood brain barrier, interfere with DNA synthesis
 Side Effects Include: delayed myelosuppression, gastrointestinal toxicity, and
delayed nephrotoxicity
 Carmustine (BCNU): nausea and vomiting, vein irritation, myelosuppression,
stomatitis, nephrotoxicity, and pulmonary fibrosis
 Lomustine: nausea and vomiting, stomatitis, anorexia, myelosuppression,
pulmonary fibrosis, and nephrotoxicity
 Semustine: myelosuppression, nausea and vomiting, hepatotoxicity,
nephrotoxicity, and pulmonary fibrosis
 Streptozocin: nausea and vomiting, fever, chills, nephrotoxicity, diarrhea,
myelosuppression, and hypoglycemia
PLANT (VINCA) ALKALOID: derived from the periwinkle plant, by binding to a
substance that is needed for mitosis and solute transport, the vinca alkaloids stop cell
replication in metaphase.
 Side Effects Include: neurotoxicity, severe ulceration of the skin if extravasation
occurs, and myelosuppression
 Etoposide: nausea and vomiting, diarrhea, stomatitis, parotitis, anaphylaxis,
hypotension, myelosuppression, radiation recall, hepatotoxicity, and alopecia
 Taxol: anaphylaxis, hypotension, nausea and vomiting, cardiotoxicity,
myelosuppression, neurotoxicity, alopecia, stomatitis, and diarrhea
 Teniposide: nausea and vomiting, hypertension, anaphylaxis, myelosuppression,
neuropathy, alopecia, and phlebitis
 Vinblastine: neurotoxicity, anorexia, myelosuppression, stomatitis, alopecia,
gonadal suppression, peripheral neuropathy, and vesication
 Vincristine: neurotoxicity, constipation, myelosuppression, alopecia, vesication,
peripheral neuropathy, and paralytic ileus
 Vindestine: nausea and vomiting, jaw pain, myelosuppression, paresthesia,
alopecia, paralytic ileus, and stomatitis
MISCELLANEOUS AGENTS:
 Asparaginase: anaphylaxis, nausea and vomiting, fever, chills,
myelosuppression, hyperglycemia, abdominal pain, diarrhea, pancreatitis, and
anorexia
 Hydroxyurea: nausea and vomiting, alopecia, myelosuppression, allergic
reactions, radiation recall, rash, azotemia, and dysuria
 Pentostatin: nausea and vomiting, rash, myelosuppression, vein irritation,
nephrotoxicity, and hyperuricemia
 Procarbazine: nausea and vomiting, stomatitis, peripheral neuropathy, and
severe gastrointestinal and central nervous system effects if taken with foods
containing tyramine, alcohol, and monoamine oxidase inhibitor medications
 Tototecan: diarrhea, nausea and vomiting, myelosuppression, anorexia, and
influenza like symptoms