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Pharmacology- Block 2 > 4- Anemia and Hematopoiesis > Flashcards

4- Anemia and Hematopoiesis Flashcards

1
Q

Name three classes of medications that can reduce iron absorption

A
  1. Acid reducing meds
  2. Antibiotics
  3. Fiber supplements
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2
Q

Name two classes of antibiotics known to reduce iron absorption

A

Tetracyclines (doxycycline, minocycline, tigecycline)

Fluroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, etc)

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3
Q

Discuss different types of acid reducing medications and their effect on iron absorption

A

H2 blockers (Zantac, etc)
Proton Pump Inhibitors (Prilosec)
Antacids (TUMS, calcium)

Reduce iron absorption b/c need acidic environment

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4
Q

Name the types of oral iron supplementation

A 
Ferrous sulfate, gumarate, gluconate
Polysaccharide iron complex (Niferex)
Carbonyl iron (Ferralet)
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5
Q

What are the side effects of oral iron therapy?

A

Constipation, nausea/ vomiting, stomach cramping, heartburn, black tarry stools, stained teeth

Directly related to amount of iron ingested

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6
Q

Iron deficiency causes what type of anemia?

A

microcytic, hypochromic anemia

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7
Q

Where and how is iron stored in the body?

A

Reticuloendothelial cells, hepatocytes, and intestinal cells as ferritin and hemosiderin

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8
Q

What form of iron is absorbed and where is it absorbed?

A

Fe 2+ (Fe2+ intwo the cell) in the duodenum via enterocytes

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9
Q

How does iron travel in the bloodstream?

A

Bound to transferrin (glycoprotein)

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10
Q

True or false: there are mechanisms to actively eliminate iron from the body

A

FALSE.

There are no active mechanisms to eliminate iron from the body besides bleeding

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11
Q

Name 4 general mechanisms of iron deficiency anemia

A
  1. Bleeding
  2. Dietary deficiency
  3. Malabsorption syndrome
  4. Increased iron demands (pregnancy)
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12
Q

Discuss the general characteristics of oral iron agents

A
  • iron content: gluconate 12%, sulfate 20%, and fumarate 30%
  • 25% orally administered iron absorbed
  • Requires 3-6 months to replenish stores
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13
Q

What are some reasons oral iron therapy might not work?

A
  • ongoing blood loss
  • non-compliance
  • absorbance issues: GI diseases such as celiac & atrophic gastritis/ H. pylori
  • Concurrent folate/ B12 deficiency
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14
Q

When is parenteral iron given?

A
  • significant blood loss
  • intolerance to oral therapy
  • absorption issues
  • allergies to oral
  • prep for erythropoietin therapy
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15
Q

Ferrlecit (class, administration, uses)

A

Class: ferric gluconate complex
Admin: IV
Uses: hemodialysis patients with erythropoietin therapy

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16
Q

Venofer (class, administration, uses)

A

Class: Iron sucrose
Admin: IV
Uses: hemodialysis patients with erythropoietin

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17
Q

Iron dextran (class, admin, uses, adverse reaction)

A

Class: parenteral iron
Admin: IM or IV
Uses: unable to take oral iron
Adverse rxn: anaphylactic reaction, nausea, diarrhea, injection site reaction

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18
Q

Generally how does megaloblastic anemia occur?

A

Impaired DNA synthesis affecting rapidly growing cells (RBC’s)

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19
Q

Deficiency in what vitamins can cause megaloblastic anemia?

A

Vitamin B12 (cobalamin) and folic acid (B9)

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20
Q

Describe the mechanism of pernicious anemia

A

lack of intrinsic factor due to GI destruction of parietal cells - inhibited B12 absorption

21
Q

Causes of vitamin B12 deficiency

A
  • pernicious anemia
  • achlorhydria (decreased gastric acid)
  • Gastritis/ H. pylori infection
  • Proton pump inhibitors, metformin
  • Alcohol abuse
  • nitrous oxide
22
Q

Deferoxamine (Class, Admin, Uses)

A

Class: iron-chelating agent
Admin: parenteral/ gastric lavage
Uses: txt for iron toxicity

23
Q

What is the txt for B12 deficiency?

A

Oral or intranasal gel (Nascolbal) B12 therapy

24
Q

How does dosing differ for B12 therapy for diet deficiency vs. impaired absorption/ pernicous anemia

A

Diet: 1-10 mcg daily
Absorption: 1000 mcg (1mg) daily

25
Q

Discuss the causes of folic acid deficiency

A
  • Malnutrition: ALCOHOLICS
  • Increased requirements in pregnancy, malignancy, infancy, increased hematopoiesis
  • Malabsorption
  • Drug-induced
26
Q

Name 6 drugs that can reduce the absorption of folic acid

A

Ethanol, Metformin, Cholestyramine, Sulfasalzine, Sulfamethoxazole, Oral contraceptive

27
Q

Name 3 drugs that can alter the metabolism of folic acid (as starred by Dr. R)

A
  1. Anticonvulsants
  2. Methotrexate
  3. Ethanol
28
Q

What is an important fact to realize if there is concurrent folic acid and B12 deficiency?

A

Folic acid supplementation w/ untreated B12 deficiency with correct the megaloblastic anemia but neurologic damage will continue

29
Q

Describe anemia of chronic kidney disease

A

Growth factor for erythropoietin from kidneys is deficient & kidneys can’t produce erythropoietin

30
Q

What type of anemia does CKD cause?

A

Normochromic, normocytic anemia (not enough erythropoietin)

31
Q 
Epoetin alfa (Epogen, Procit)
(class, admin, uses)
A

Class: recombinant human erythropoietin preparation
Admin: 2-3x weekly SC or IV
Uses: dialysis patients/ chronic kidney disease

32
Q 
Darbepoetin alfa (Aranesp)
(Class, admin, use)
A

Class: erythropoietin prep
Admin: once weekly SC or IV
Uses: dialysis patients/ chronic kidney disease
**T1/2 is twice that of epoetin alfa

33
Q

Peginesatide (Omontys)

Class, Admin, Uses

A

Class: erythropoietin prepartation
Admin: IV or SC monthly**
Uses: hemodialysis/ CKD

34
Q

What are the therapeutic uses for EPO?

A

Anemia due to :

  • AZT txt for AIDS
  • Chemotherapy
  • Renal failure/ CKD
35
Q

What are the adverse/ toxic effects of EPO?

A
  • hypertension, seizures, HA (rapid expansion of blood volume)
  • MI, stroke (emboli formation), CHF
  • Cancer patients: increased tumor progression
36
Q

What is sideroblastic anemia?

A

defective protoporphyrin synthesis - decreased hemoglobin and increased intracellular iron stores

37
Q

What are the common causes of sideroblastic anemia?

A

Agents to decrease pyridoxal phosphate (Isoniazid txt for TB)
-Congenital ALAS deficiency (X-linked)

38
Q

What is the txt for sideroblastic anemia?

A

oral pyridoxine (B6) administration

39
Q

What are colony stimulating factors used for?

A

Txt of neutropenia secondary to chemotherapy and BMT

40
Q

What does granulocyte CSF stimulate and what are two examples?

A

Neutrophil production:
Filgrastim
Pegfilgastrim (increased T1/2)

41
Q

What does granulocyte-macrophage CSF do and what is an example?

A

Stimulate neutrophil and macrophage production

-Sargramostim

42
Q

Sargramostim (Class, Admin, Uses, adverse effects)

A

Class: granulocyte-macrophage CSF
Admin: IV
Uses: neutropenia, mobilization of peripheral blood progenitor cells, BM failure
Adverse effects: bone pain, fever, nausea, rash

43
Q

What does transfusion with whole blood give and when is it used?

A
  • oxygen carrying capacity & volume expansion

- acute hemorrhage, anemia, exchange transfusion

44
Q

What are the effects of transfusing packed RBCs and when is it used?

A

Increased Hgb and oxygen carrying capacity

Used in acute blood loss and severe anemia

45
Q

What is the dosage effect of platelet transfusions and when are they used?

A

Increase platelet count
Used in significant bleeding due to thrombocytopenia, open heart surgery, DIC
-Acute leukemia

46
Q

What is the dosage effect of fresh frozen plasma and when is it used?

A

Increases coagulation factor levels

Uses: DIC, cirrhosis, warfarin overdose, TTP/ HUS exchange transfusion

47
Q

What is the dosage effect of cryoprecipitate transfusion and when is it used?

A

Contains fibrinogen, factor VIII, Factor XIII, Factor IX, vWF and fibronectin
Uses: DIC, fibrinogen depletion,

48
Q

What are the risks for blood transfusions?

A

Infection, transfusion reaction, iron overload, hypocalcemia (citrate = calcium chelator), hyperkalemia (RBC lysis)

Pharmacology- Block 2 (5 decks)

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