1st Set

Question 1

how much elemental iron should be given daily to correct iron deficiency?

Answer 1

200-300 mg of ferrous elemental iron

Question 2

Where is iron absorbed?

Answer 2

small intestine. Must give parenteral iron if patient has had small bowel resection

Question 3

What drug is used to treat acute iron overdose?

Answer 3

deferoxamine. potent iron-chelater. Gives urine a red discoloration. Can cause hypotension and add to cardiovascular stress caused by iron overload.

Question 4

What drug is used to treat chronic iron overload?

Answer 4

deferasirox. Orally with OJ. Increases serum creatinine and hepatic enzyme levels. Auditory and visual disturbances.

Question 5

What is the scientific name for Vitamin B12?

Answer 5

cobalamin

Question 6

What is B12 deficiency most commonly caused by?

Answer 6

malabsorption

Question 7

What types of foods are rich in B12?

Answer 7

animal products

Question 8

What type of RBCs would you expect in B12 deficiency? What other findings?

Answer 8

macrocytic, megaloblastic, hypercellular bone marrow, PERIPHERAL NEUROPATHY

Question 9

Where is B12 abosrbed?

Answer 9

distal ileum

Question 10

What drugs are used to treat B12 deficiency? are they oral or parentarel?

Answer 10

Cyanocobalamin
AND
hydroxocobalamin - preferred because highly protein-bound and stays in system longer.

Both parentarel because B12 deficiency is usually caused by malabsorption so oral would be pointless.

Question 11

What drugs can induce folate deficiency? What mechanism?

Answer 11

methotrexate, trimethoprim (antimicrobial), pyrimethamine (antimalarial), Phyenytoin (antiepileptic)
They all attack DHFR to some extent

Question 12

What is folate deficiency treated with?

Answer 12

leucovorin.
AND
Levomofolate - biologically active form of folate found in circulation. Readily crosses blood-brain barrier.

Question 13

What does erythropoietin do?

Answer 13

stimulates erythroid proliferation and differentiation.

Induces release of reticulocytes from the bone marrow.

Question 14

Where is erythropoietin primarily produced?

Answer 14

kidney

Question 15

What is the driving factor for EPO production?

Answer 15

hypoxia

Question 16

What are normal EPO levels?

Answer 16

<20 IU/L

Question 17

What are some serious adverse effects of ESA (erythropoietin stimulating)?

Answer 17

chronic kidney disease if patient has Hgb > 11 g/dL.
Cancer.
Increased risk of DVT (deep vein thrombosis)

Question 18

What is epoetin alfa?

Answer 18

agonist of EPO receptors expressed by RBC rpogenitors. IV admin. Can cause hypertension, thrombosis, pure red cell aplasia. Try to keep Hgb < 12 g/dL

Question 19

What is darbepoetin alfa?

Answer 19

long-acting ESA administered weekly

Question 20

What is methoxy polyethylene glycol-epoetin beta?

Answer 20

long-acting form administered 1-2 times/month. Can not use to treat anemia from cancer chemo because it kills.

Question 21

What is G-CSF filgrastim?

Answer 21

granulocyte-macrophage colony stimulating factor. Stimulate G-CSF receptors on neutros and progenitors. Useful to treat neutropenia, aplastic anemia, preventing anemia in chemotherapy. Subcutaneous. Causes bone pain upon discontinuation and SPLENIC RUPTURE rarely.

Secondary use - mobilizes hematopoietic stem cells to peripheral blood, where they can be collected for PBSC

Question 22

What is pegfilgrastim?

Answer 22

long acting form of filgrastim

Question 23

What is sargramostim?

Answer 23

GM-CSF. Myeloid growth factor that stimulates prolif and iff of early and late granulocytic progenitors, erythroids, and megakaryocytes. Similar to G-CSF, but more likely to cause fever arthralgia, myalgia, and capillary leak syndrome

Question 24

Is G-CSF filgrastim useful to help treat neutropenia caused by chemo?

Answer 24

yes, but it does NOT improve patient survival.

Question 25

What is oprelvekin?

Answer 25

IL-11; stimulates growth of lymphoid and myeloid cells including megakaryocytes. Increases platelets and neutros. Treats thrombocytopenia in chemo patients. Subcu. Causes anemia, dsypnea, fluid accumulation in lungs and transient atrial arrythmias, hypokalemia.

Question 26

What is romiplostim?

Answer 26

Fc component of IgG1 antibody fused with peptide that stimulates thrombopoietin receptors (TPO). Treats idiopathic thrombocytopenic purpura. Eliminated by RE system.