1. ANTINEOPLASTIC MEDICATIONS BY: MELODY VARGAS ANDRES ZEA AIDA PLAZAS

2. WHAT ARE ANTINEOPLASTIC MEDICATIONS?  Antineoplastic medications are several drugs that control or kill neoplastic cells (cancer cells).  Antineoplastics medication are sometimes called cancer chemotherapeutic agents, cancer drugs and cytotoxic agents.  They prevent or inhibit the maturation and proliferation of neoplasms.  Antineoplastic medications are the most toxic drugs in use today, act by killing cancer cells through damaging DNA or interfering with DNA synthesis.  They are divided in the following categories: alkylating agents, antimetabolites, antitumor antibiotics, inmunomodulators and plant extracts (mitotic inhibitors). CONDITIONS THEY ARE INTENDED TO TREAT  Antineoplastic drugs are not only used prominently in different types of cancers but also in conjunction with: Surgery Radiotherapy immunotherapy  These drugs are also used to treat inflammatory disorders such as Psoriasis Rheumatoid arthritis Systemic lupus erythematosus.

3. Overview of the Process where Antineoplastic Drugs work  Antineoplastic drugs work by interfering with DNA replication. Because cancer cells are rapidly dividing they are rapidly synthesizing new DNA — and when this DNA is damaged by the antineoplastic agent the cell will die. Unfortunately, anticancer agents are non-selective in their actions and also disrupt the growth and function of healthy (non-cancerous) cells causing adverse health effects in the patients who receive them and the workers who administer them.

4. Overview of the Process where Antineoplastic Drugs work There are three goals associated with the use of the most commonly-used anticancer agents.  1. Damage the DNA of the affected cancer cells.  2. Inhibit the synthesis of new DNA strands to stop the cell from replicating, because the replication of the cell is what allows the tumor to grow.  3. Stop mitosis or the actual splitting of the original cell into two new cells. Stopping mitosis stops cell division (replication) of the cancer and may ultimately halt the progression of the cancer.

6. ANTINEOPLASTIC DRUGS Generic name: MELPHALAN Brand name: Alkeran Melphalanis an antineoplastic drug in the class of alkylating agents and is used to treat various types of cancer including ovarian, breast, and prostate cancer. Drug receptor interaction: Alkylating agents stop tumor growth by cross-linking guanine bases in DNA double-helix strands, directly attacking DNA. This makes the strands unable to separate. As this is necessary in DNA replication, the cells can no longer divide. Besides this, these drugs add methyl or other alkyl groups onto molecules where they do not belong which in turn inhibits their correct utilization by base pairing and causes a miscoding of DNA. Alkylating drugs work by three different mechanisms all of which achieve the same end result: disruption of DNA function and cell death. MOA: 1. It attaches to DNA bases and forms monoadducts, resulting in the fragmentation of DNA by repair enzymes, which try to replace the alkylated bases. This process prevents DNA synthesis and RNA transcription from the affected DNA 2) it damages DNA via the formation of cross-links (bonds between atoms in the DNA) which prevents DNA from being separated for synthesis or transcription 3) It causes induction of mispairing of the nucleotides leading to mutations

7. ANTINEOPLASTIC DRUGS Generic Name: Methotrexate Brand names: Abitrexate, Alltrex, Artrait, Atrexel, Bendatrexat, Carditrex, Dermotrex, Ebetrex, Emtexate, Ledertrexate, Maxtrex, Mexate, Meisusheng, Otrexup, Rheumatrex, Trexall, Trexan, Zexate Methotrexate is an antineoplastic from the class anti-metabolite. It is used for treatment of acute lymphocytic leukemia, meningeal leukemia. Also in combination with other chemotherapeutic agents for treatment of breast cancer, epidermoid cancers of the head and neck and lung cancer, and in combination with other chemotherapeutic agents in the treatment of advanced stage non-Hodgkin’s lymphomas. Methotrexate is also used for treatment of rheumatoid arthritis. Drug receptor interaction: Anti-metabolites act as purine or pyrimidine - which become the building blocks of DNA. They prevent these substances becoming incorporated in to DNA during the "S" phase (of the cell cycle), stopping normal development and division. Methotrexate inhibits folic acid reductase which is responsible for the conversion of folic acid to tetrahydrofolic acid. Tetrahydrofolic acid itself is synthesized in the cell from folic acid with the help of an enzyme, folic acid reductase. Methotrexate looks a lot like folic acid to the enzyme, so it binds to it quite strongly and inhibits the enzyme. Thus, DNA synthesis cannot proceed because the coenzymes needed for one-carbon transfer reactions are not produced from tetrahydrofolic acid because there is no tetrahydrofolic acid. Methotrexate selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells). MOA: Methotrexate anti-tumor activity is a result of the inhibition of folic acid reductase, which leads to inhibition of DNA synthesis and inhibition of cell replication. Its MOA for rheumatoid arthritis is not known..

8. ANTINEOPLASTIC DRUGS Adverse Effects  Alopecia  Diarrhea  Hair loss  Nausea and Vomiting  Hyperuricaemia: high concentration of uric acid in the blood.  Lymphocytopenia: blood lack of enough white blood cells: lymphocytes which increases the risk of getting an infection  Bone marrow depression: decreased ability or inability of the bone marrow to produce blood cells.

9. ORAL/DENTAL SIDE EFFECTS AND ROLE OF THE DENTAL HYGIENIST Antineoplastic drugs can cause:  oral discomfort  sensitivity of the teeth and gums  mucosal pain and ulceration  gingival hemorrhage  xerostomia  impaired taste sensation.  Recommend Ice chips and nonalcohol mouth rinses to help with the dry mouth.  Suggest patients rinse with a dilution of lukewarm water and baking soda after vomiting.  Maintenance of oral health exams and other dental procedures should be performed prior to starting therapy with antineoplastic drugs or within 3 months of beginning therapy. ORAL CARE OF CANCER PATIENTS BEFORE, DURING, AND AFTER THERAPY BEFORE  Extract all questionable/hopeless teeth.  Instruct patient in proper oral home care regimen.  Treat any infection. DURING  Medical consultation before any dental treatment.  Examine and monitor patients’ oral status: development of ulcerations.  May require antibiotic coverage.  Treatment depends on neutrophil count (treatment only if below 1,000 mm3. AFTER Follow and maintain oral health. BEFORE  Extract all questionable/hopeless teeth.  Instruct patient in proper oral home care regimen.  Treat any infection. DURING  Medical consultation before any dental treatment.  Examine and monitor patients’ oral status: development of ulcerations.  May require antibiotic coverage.  Treatment depends on neutrophil count (treatment only if below 1,000 mm3. AFTER Follow and maintain oral health.

10. REFERENCES  http://www.fda.gov/downloads/medicaldevices/newsevents/workshopscon ferences/ucm402062.pdf+Melphalan&client=FDAgov&site=FDAgov&lr=&prox ystylesheet=FDAgov&output=xml_no_dtd&ie=UTF-8&access=p&oe=UTF-8 http://www.fda.gov/downloads/medicaldevices/newsevents/workshopscon ferences/ucm402062.pdf+Melphalan&client=FDAgov&site=FDAgov&lr=&prox ystylesheet=FDAgov&output=xml_no_dtd&ie=UTF-8&access=p&oe=UTF-8  http://www.srspharma.com/antineoplastic-agents.htm http://www.srspharma.com/antineoplastic-agents.htm  http://www.medscape.com/viewarticle/775552 http://www.medscape.com/viewarticle/775552  http://www.srspharma.com/antineoplastic-agents.htm http://www.srspharma.com/antineoplastic-agents.htm  http://www.nature.com/nrd/journal/v13/n8/full/nrd4399.html http://www.nature.com/nrd/journal/v13/n8/full/nrd4399.html  http://www.ona.org/documents/File/healthandsafety/ONA_AntineoplasticD rugs_201302.pdf http://www.ona.org/documents/File/healthandsafety/ONA_AntineoplasticD rugs_201302.pdf