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RD Polytechnic Year 2 Semester 2 > 252 Pharmacology - Anemia > Flashcards

252 Pharmacology - Anemia Flashcards

1
Q

What is one of the primary functions of bones/

A

The formation of new blood cells (hematopoiesis).

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2
Q

What types of cells are created as part of hematopoeisis?

A
  • Red blood cells (RBCs)
  • White blood cells (WBCs)
  • Platelets
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3
Q

How much of a red blood cell is made up of hemoglobin?

A

More than one third

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4
Q

What are erythrocytes?

A

Red blood cells (just another name for them)

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5
Q

What is erythropietin?

A

A hormone secreted by the kidneys that increases the rate of production of red blood cells in the bone marrow in response to decreasing oxygen levels in the tissues.

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6
Q

What is globin?

A

The protein part of the hemoglobin molecule (see later); the four different structural chains most often found in adults are the α1, α2, β1, and β2 chains.

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7
Q

What is heme?

A

Part of the hemoglobin molecule; a nonprotein, iron-containing pigment.

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8
Q

What is hemoglobin?

A

A complex protein–iron compound in the blood that carries oxygen to the cells from the lungs and carbon dioxide away from the cells to the lungs.

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9
Q

What are hemolytic anemias?

A

Anemias resulting from excessive destruction of erythrocytes.

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10
Q

Define hypochromic.

A

Pertaining to less than normal colour; usually describes a red blood cell with decreased hemoglobin content and helps further characterize anemias associated with reduced synthesis of hemoglobin.

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11
Q

What is a microcytic cell?

A

Pertaining to or characterized by smaller than normal cells.

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12
Q

What is pernicious anemia?

A

A type of megaloblastic anemia usually seen in older adults and caused by inadequate intestinal absorption of vitamin B12 (cyanocobalamin) due to lack of availability of intrinsic factor.

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13
Q

What are reticulocytes?

A

Immature erythrocytes characterized by a meshlike pattern of threads and particles at the former site of the nucleus.

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14
Q

What are spherocytes?

A

Small, globular, completely hemoglobinated erythrocytes without the usual central concavity or pallor.

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15
Q

What drug is a biosynthetic form of the natural hormone erythropoietin?

A

epoetin alfa

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16
Q

What medication is used for treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and anemia associated with zidovudine therapy

A

epoeitin alfa

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17
Q

What must be present in the body for epoetin alfa to work?

A

Iron and bone marrow function

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18
Q

What is the longer-acting form of epoetin alfa called?

A

darbepoetin (Aranesp®)

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19
Q

What is the mode of action of epoetin alfa?

A

Promotes the synthesis of RBCs by stimulating RBC progenitor cells in the bone marrow

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20
Q

What is the advantage of darbepoetin over epoetin?

A

Darbepoetin is longer acting and requires fewer injections.

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21
Q

When is the use of epoetin and darbepoetin contraindicated?

A
  • In cases of uncontrolled hypertension
  • When Hgb levels are above 100 mmol/L for cancer patients
  • When Hgb levels are above 130 mmol/L for patients with kidney disease
  • Head or neck cancers or patients at risk for thrombosis
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22
Q

What are the most frequent side effects of epoetin alfa?

A
  • Hypertension
  • fever
  • headache
  • pruritis
  • rash
  • nausea
  • vomiting
  • arthralgia
  • injection site reaction
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23
Q

How are epoetin and darbepoetin given?

A

Injection; IV or SUBCUT

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24
Q

What are some key characteristics of iron?

A
  • Essential mineral in the body
  • Oxygen carrier in hemoglobin and myoglobin
  • Stored in the liver, spleen, and bone marrow
  • Deficiency results in anemia
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25
Q

What groups require the highest amount of iron?

A
  • Women
  • Children

They are the groups most likely to develop iron-deficient anemia

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26
Q

What are some dietary sources of iron?

A
  • Meats
  • Certain vegetables and grains
  • Beans
  • Dried fruits
  • Eggs

*** These forms must be broken down by gastric juices before the iron can be absorbed ***

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27
Q

Which foods may enhance iron absorption?

A
  • Orange juice
  • Veal
  • Fish
  • Ascorbic acid
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28
Q

Which foods might impair iron absorption?

A
  • Eggs
  • Corn
  • Beans
  • Many cereal products containing phytates
29
Q

True or false: Supplemental iron may be given as a single drug or as part of a multivitamin preparation.

A

True

30
Q

How is iron supplemented orally?

A

With ferrous salts.

31
Q

List the various oral ferrous salts?

A
  • ferrous fumarate
  • ferrous gluconate
  • ferrous sulphate
32
Q

When might an IV preparation of iron be used?

A
  • When a patient can’t tolerate oral iron
  • if rapid replenishment is necessary
  • if oral iron therapy is unsuccessful
33
Q

List the parenteral iron products.

A
  • iron dextran (Dexiron®, Infufer®)
  • iron sucrose (Venofer®)
  • ferric gluconate (Ferrlecit®)
34
Q

What are the common adverse effects of iron?

A
  • Most common cause of pediatric poisoning deaths
  • Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain
  • Causes black, tarry stools
  • Liquid oral preparations temporarily discolour teeth.
  • Injectable forms cause pain upon injection.
35
Q

What happens with iron once it is in ferrous form and in the bloodstream?

A

Iron is used in the bone marrow to make hemoglobin and the excess is stored as ferritin, primarily in the liver and some in the spleen.

36
Q

What are contraindications of iron products?

A
  • known drug allergy
  • hemochromatosis (iron overload)
  • hemolytic anemia
  • any other anemia not associated with iron deficiency
37
Q

Do older individuals tend to respond slower or faster to iron supplementation?

A

slower

38
Q

How is iron overdose treated?

A

Symptomatic and supportive measures:

  • Suction and maintenance of airway
  • Correction of acidosis
  • Control of shock and dehydration with IV fluids, blood, oxygen, and vasopressors
  • GI tract is decontaminated via whole-bowel irrigation
  • Chelation therapy with IV deferoxamine mesylate
39
Q

At what serum iron concentration places the patient at serious potential for toxicity?

A

54 mmol/L

40
Q

What is the treatment in patients with severe symptoms of iron intoxication, such as coma, shock, or seizures?

A

chelation therapy with deferoxamine mesylate

41
Q

What decreases the absorption of iron?

A
  • antacids
  • calcium
42
Q

What can iron preparations decrease the absorption of?

A
  • Certain antibiotics, including tetracyclines and quinolones
43
Q

What are contraindications of iron preparations?

A
  • Ulcerative colitis
  • Regional enteritis
  • Conditions involving excessive stores of iron in the body
  • Peptic ulcer disease
  • hemolytic anemia
  • cirrhosis
  • gastritis
  • esophagitis
44
Q

What are some goals of iron therapy?

A
  • Normal hemoglobin and hematocrit levels
  • Improved energy levels
45
Q

What are normal ranges for hemoglobin in females and males?

A

Females: 120 - 160 g/L

Males: 140 - 180 g/L

46
Q

What is the normal hematocrit level for males and females?

A

0.37 to 0.47 volume fraction

47
Q

What type of iron supplement may cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis?

A

iron dextran

48
Q

What approach is usually taken with iron dextran?

A

A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of dose is given after 1 hour.

Used less frequently now; replaced by newer products ferric gluconate and iron sucrose

49
Q

What is ferric gluconate indicated for?

A

Indicated for repletion of total body iron content in patients with iron deficiency anemia who are undergoing hemodialysis

50
Q

Is a test dose required for ferric gluconate?

A

No

51
Q

What dose of ferric gluconate is associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching?

A

doses higher than 125 mg

52
Q

Which iron salt contains the largest amount of iron per gram of salt consumed?

A

ferrous fumarate

53
Q

What is the most frequently used form of oral iron?

A

ferrous sulphate

54
Q

Who is iron sucrose indicated for?

A

Patients with chronic renal disease

55
Q

What is the most common side effect of iron sucrose?

A

Hypotension resulting from infusion rate. large doses of iron sucrose are infused over 2.5 to 3.5 hours.

56
Q

What are some key characteristics of folic acid?

A
  • Water-soluble, B-complex vitamin
  • Essential for erythropoiesis
  • Primary uses
    • Folic acid deficiency
    • During pregnancy, to prevent neural tube defects
    • Malabsorption syndromes are the most common causes of deficiency.
57
Q

What are dietary sources of folic acid?

A
  • dried beans
  • peas
  • oranges
  • green vegetables
58
Q

What is folic acid used for?

A
  • erythropoiesis
  • synthesis of nucleic acids (DNA and RNA)
59
Q

Is folic acid active in the ingested form?

A

No, must be converted first

60
Q

Indications of folic acid

A
  • anemias caused by folic acid deficiency
  • prevention of neural tube defects in pregnancy (start 1 month prior)
  • Tropical sprue
61
Q

Contraindications of folic acid

A
  • known drug allergy
  • any anemia not resulting from folic acid anemia
62
Q

What are adverse effects of folic acid

A

They are rare, but are as follows:

  • allergic reaction
  • yellow discoloration of urine
63
Q

What other things can cause signs of folic acid deficiency (but are not affected by folic acid adminsitration)

A
  • oral contraceptives
  • corticosteroids
  • sulfonamides
  • dihydrofolate reductase inhibitors
  • antibiotic trimethoprim
64
Q

What is cyanocobalamin used to treat?

A
  • Used to treat pernicious anemia and other megaloblastic anemias
  • Administered orally or parentally.
  • Usually administered by deep intramuscular injection to treat pernicious anemia
65
Q

How can patients avoid esophageal corrosion?

A

To avoid esophageal corrosion, patients should remain upright for up to 30 minutes after taking oral iron doses

66
Q

How is iron dextran administered?

A

For iron dextran, a small test dose should be given.

  • If there is no reaction after 1 hour, the remainder of the dose can be given.
  • Administer the dose deeply into a large muscle mass, using the Z-track method.
67
Q

What are we worried about with anemia?

A

Not enough oxygen; not adequate tissue perfusion.

68
Q

Are oral iron salt supplementation types interchangeable?

A

No

RD Polytechnic Year 2 Semester 2 (25 decks)

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