Episode 288: Pharmacology 101: Antimetabolites

“I think that there are certain agents that are so foundational in some diseases that they will remain. Whether they remain first-line, maybe not; maybe they’ll go to second line as we see things evolve with new agents. Some of these drugs have been very effective in the diseases in which they are used to treat patients. There’s a long term place in therapy for these, and I think that will still be using these,” Rowena Schwartz, PharmD, BCOP, FHOPA, known to many as “Moe,” professor of pharmacy practice at James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about what oncology nurses need to know about antimetabolites. This episode is part of a series about drug classes, which we’ll include a link to in the episode notes. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD), which may be applied to the oncology nursing practice and treatment ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by December 1, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to antimetabolites. Episode Notes Complete this evaluation for free NCPD. Oncology Nursing Podcast: Pharmacology 101 series ONS Voice oncology drug reference sheets ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice ONS courses: ONS/ONCC Chemotherapy Immunotherapy Certificate Course ONS Fundamentals of Chemotherapy Immunotherapy Administration Clinical Journal of Oncology Nursing article: Chemoprevention: An Overview of Pharmacologic Agents and Nursing Considerations ONS Huddle Cards: Antimetabolites Alkylating Agents Miscellaneous Agents Patient education guides created as a collaboration between ONS, HOPA, NCODA, and the Association of Community Cancer Centers: Oral Chemotherapy Education Sheets Intravenous Cancer Treatment Education Sheets To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email [e-mail]. Highlights From Today’s Episode “Antimetabolites are relatively old agents. They are some of the oldest anti-cancer drugs that we have. They were developed to be similar to naturally occurring compounds that are important in cellular production. They are similar but not the same. So, they sometimes will bind to an enzyme important for cell proliferation. And because it binds to an enzyme, does it mean that it helps the enzyme? It may block it and that may cause cell death. And so, they’ve been used for a long time in oncology.” TS 1:44 “There's different classes of antimetabolites in oncology. If you think of the structure of DNA, there is purines, that’s adenine and guanine, there are pyrimidines, which are things like cytosine and limonene, and then in RNA there's uracil. So, some of the antimetabolites are either purine analogues or pyrimidine analogues, meaning they look very much like the natural parts of DNA, and by being incorporated into the DNA they cause cell death. There's also a class of antimetabolites that interfere with how we use folate in the body, such as methotrexate is an obvious one, and these are called folate antagonists.” TS 2:43 “The purine analogs—and those are things like fludarabine or clofarabine—those drugs are very toxic to lymphocytes. And because they’re very toxic to lymphocytes, these are drugs that we use in lymphocytic diseases. But that also means that these are drugs that we get immunosuppression because of the toxicity to lymphocytes. So, these patients have risk of infections because of their decreased lymphocyte activity after receiving these drugs.

great review

I enjoyed this review and the Pharmaceutical review. The review of side effects was super helpful