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cialis without prescription Alkylating Agent Mechanism of Action Clinical Applications Acute Toxicity Delayed Toxicity Mechlorethamine Forms DNA cross links, resulting in inhibition of DNA synthesis and function Hodgkin s and non Hodgkin s lymphoma Nausea and vomiting Moderate depression of peripheral blood count; excessive doses produce severe bone marrow depression with leukopenia, thrombocytopenia, and bleeding; alopecia and hemorrhagic cystitis occasionally occur with cyclophosphamide; cystitis can be prevented with adequate hydration; busulfan is associated with skin pigmentation, pulmonary fibrosis, and adrenal insufficiency Chlorambucil Same as above CLL and non Hodgkin s lymphoma Nausea and vomiting Cyclophosphamide Same as above Breast cancer, ovarian cancer, non Hodgkin s lymphoma, CLL, soft tissue sarcoma, neuroblastoma, Wilms tumor, rhabdomyosarcoma Nausea and vomiting Bendamustine Same as above CLL and non Hodgkin s lymphoma Nausea and vomiting Melphalan Same as above Multiple myeloma, breast cancer, ovarian cancer Nausea and vomiting Thiotepa Same as above Breast cancer, ovarian cancer, superficial bladder cancer Nausea and vomiting Busulfan Same as above CML Nausea and vomiting Carmustine Same as above Brain cancer, Hodgkin s and non Hodgkin s lymphoma Nausea and vomiting Myelosuppression; rarely interstitial lung disease and interstitial nephritis Lomustine Same as above Brain cancer Nausea and vomiting Altretamine Same as above Ovarian cancer Nausea and vomiting Myelosuppression, peripheral neuropathy, flu like syndrome Temozolomide Methylates DNA and inhibits DNA synthesis and function Brain cancer, melanoma Nausea and vomiting, headache and fatigue Myelosuppression, mild elevation in liver function tests, photosensitivity Procarbazine Methylates DNA and inhibits DNA synthesis and function Hodgkin s and non Hodgkin s lymphoma, brain tumors Central nervous system depression Myelosuppression, hypersensitivity reactions Dacarbazine Methylates DNA and inhibits DNA synthesis and function Hodgkin s lymphoma, melanoma, soft tissue sarcoma Nausea and vomiting Myelosuppression, central nervous system toxicity with neuropathy, ataxia, lethargy, and confusion Cisplatin Forms intrastrand and interstrand DNA cross links; binding to nuclear and cytoplasmic proteins Non small cell and small cell lung cancer, breast cancer, bladder cancer, cholangiocarcinoma, gastroesophageal cancer, head and neck cancer, ovarian cancer, germ cell cancer Nausea and vomiting Nephrotoxicity, peripheral sensory neuropathy, ototoxicity, nerve dysfunction Carboplatin Same as cisplatin Non small cell and small cell lung cancer, breast cancer, bladder cancer, head and neck cancer, ovarian cancer Nausea and vomiting Myelosuppression; rarely peripheral neuropathy, renal toxicity, hepatic dysfunction Oxaliplatin Same as cisplatin Colorectal cancer, gastroesophageal cancer, pancreatic cancer Nausea and vomiting, laryngopharyngeal dysesthesias Myelosuppression, peripheral sensory neuropathy, diarrhea
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