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Ask Rezzy/Anticancer drugs: classification, mechanisms and high-yield side effects

Anticancer drugs: classification, mechanisms and high-yield side effects

RezzyRezzy

Anticancer drugs are a massive topic, but they become much easier to manage once you group them by how they attack the cell cycle. It's essentially a tactical war against rapidly dividing cells!

To give you a clear visual of where these drugs strike during the cell cycle, let me find a helpful diagram for you.

That diagram perfectly shows which drugs are phase-specific (like the antimetabolites in the S-phase) and which are non-specific (like alkylating agents).

Cell cycle specificity of anticancer drugs

This diagram illustrates where different classes of chemotherapy act. Notice how Antimetabolites target the S-phase, while Vinca alkaloids and Taxanes target the M-phase.

To make this easier to study, I've put together a master table of the most important drugs you'll encounter in your exams.

ClassMechanism of ActionKey DrugsHigh-Yield Side Effects
Alkylating AgentsCross-link DNA (CCNS)CyclophosphamideHemorrhagic cystitis (prevent with Mesna)
BusulfanPulmonary fibrosis, "Busulfan Tan" (hyperpigmentation)
AntimetabolitesInhibit DNA synthesis (S-phase)MethotrexateMyelosuppression (rescue with Leucovorin), Mucositis
5-FluorouracilHand-foot syndrome
Cytotoxic AntibioticsFree radical formation / IntercalationDoxorubicinDilated Cardiomyopathy (prevent with Dexrazoxane)
BleomycinPulmonary fibrosis, Skin hyperpigmentation
Plant AlkaloidsMicrotubule inhibition (M-phase)VincristinePeripheral neuropathy (Areflexia), Paralytic ileus
PaclitaxelHypersensitivity, Myelosuppression
Platinum AnalogsDNA cross-linkingCisplatinNephrotoxicity, Ototoxicity, Severe vomiting
Topoisomerase InhibitorsDNA strand breaksEtoposideMyelosuppression
IrinotecanSevere diarrhea ("I run to the can")

That table covers the "big hitters" you'll see in almost every exam. One thing to really lock in is the "Rescue/Prevention" agents, as examiners love to pair them with the toxic drugs:

  • Mesna for Cyclophosphamide (prevents hemorrhagic cystitis)
  • Leucovorin (Folinic Acid) for Methotrexate (rescues bone marrow)
  • Dexrazoxane for Doxorubicin (prevents cardiotoxicity)
  • Amifostine for Cisplatin (prevents nephrotoxicity)

To help you dive deeper into each class, I've pulled up some detailed lessons for you.

Those lessons will give you the deep dive you need for each class. To really lock in these side effects and mechanisms, let's pull up some flashcards for active recall.

It looks like my first search for flashcards was a bit too specific. Let me try a broader search for "chemotherapy" and "oncology pharmacology" to find the best cards for you.

That broader search worked! Those flashcards will help you test your memory on the specific toxicities and mechanisms we discussed.

Since there are so many drugs to keep track of, would you like to try a quick game of Synapses? It's a great way to practice grouping these drugs by their class or side effects so you don't mix them up in the exam!

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