9. Pharmacology of Anemia and Hematopoietic Growth Factors Flashcards
Iron deficiency anemia is the MC nutritional cause of anemia and should be treated with RBC transfusion if severe, it causes hypochromic microcytic anemia because there is not enough hemoglobin, MCV less than 80, this is best treated with diet iron from meat fish and poultry. What type of oral iron is given divided into 2 doses with water, SE include nausea, constipation, anorexia, heartburn, vomiting and diarrhea?
Oral elemental Ferrous iron 200-400mg
Give ferrous iron because ferrous sulfate, ferrous gluconate, and ferrous fumarate are not enteric coated and non sustained release so there is minimal absorption. What drug is required if there is iron malabsorption, intolerance of oral therapy or noncompliance, given IV/IM?
- Iron dextran = prototype (sodium ferric gluconate and iron sucrose)
- expect reticulocytosis in a few days and inc in Hb in 2 weeks
What is a new nanoparticle based iron preparation that can be administered quickly (time increased from 15s to 5 mins) and is much better tolerated than iron dextran, causes anaphylactic shock but rare, does not hasten recovery and has same SE as oral?
Ferumoxytol
Iron toxicity is MC in children, sx inlcude necrotizing gasteroenteritis, vomiting, abdominal pain, bloody diarrhea, shock lethargy and dyspnea, urgent treatment is required- NOT with active charcoal because it does not bind iron, but with what?
Parenteral Deferoxamine (potent iron chelating compound)
Megaloblastic Anemia is commonly due to folate or vitamin b 12 deficiency, takes years to become B12 deficient cause there are large stores in the body, nitrous oxide inactivates cyanocobalamin which is acommon form of B12, if body stores are depleted there is rapid onset of what, associated with paresthesias, weakness, spasticity that may be IRreversible?
Neurologic Dysfunctions
Cobalamin Cbl- is bound by R factors from the saliva and gastric juice and is transfered into the small bowel, Cbl is free from r factors in alkaline pancreatic enzyme milieu of duodenum, Cbl binds intrinsic factor that is secreted by parietal cells of stomach, IF-Cbl complex bind what receptor in the ileum for absorption?
Cubulin
Sx of vitamin B12 deficiency include vitiligo, hyperpigmentation, jaundice, glossitis, anemia (macrocytic), neutropenia (hypersegmented neutrophils), and thrombocytopenia, and is associated with neuropsychiatric issues, tx is oral b12, or what if there are neuro symptoms?
Parenteral therapy with cyanocobalamin 1000/day for 1 weeks
Folate is found in yeast liver kidney and green leafy veggie (B9), need 800mg during pregnancy to prevent neural tube defects, absorbed in jejunum to plasma to liver where it is rapidly cleared, MCC of folate deficiency is inadequate dietary intake and?
Alcoholism* or malabsorption in jejunum
Sx of folate def include neural tube defects, jaundice, mouth ulcers, anemia, neutropenia, thrombocytopenia (same as b12), but NO** psychiatric issues, treat with what, which is well tolerated but higher doses can cause hypotension and hypoglycemia?
Oral folate 1mg/day for 4 months
What drug for for anemia of chronic disease is a 165 amino acid erythropoiesis stimulating glycoprotein, manufactured by recombinant DNA, stimulates erythropoietin, inc reticulocyte count, RBC, Hg,Hct, for anemia due to chronic kidney disease, cancer chemo, zidovudine for HIV, reduced allogeneic RBC transfusion, admin IV, *50% have DAP (diastolic) > 10mm Hg despite keeping Hct 30-35, inc risk of death, MI, stroke, with cough HA, muscle spasms, and bone pain?
Epoetin Alta
Darbepoetin Alfa has 3x longer 1/2life of 21hrs
What drug targets ribonucleotide reductase resulting in S phase cell cycle arrest, but somehow boosts levels of fetal hemoglobin HbF, which lowers the concentration of HbS within a cell- only disease modifying therapy for sickle cell disease, admin orally, SE include hoarseness, fever chills, lower back pain, painful or difficult urination?
Hydroxyurea
What is a mab that binds complement C5, inhibits C5a to C5b preventing generation of MAC, inhibits terminal complement mediated intravascular hemolysis in paroxysmal nocturnal hemoglobinuria, and complement mediated events in atypical HUS, only avail via REMS system, give IV for 35min, most expensive drug on the market, SE: infections, URI infection, anemia, hypertension, headache?
Eculizumab
Neutropenia presents as low grade fever, sore mouth, odynophagia, gingival pain and swelling, recurrent sinusitis and otitis, pneumonia perirectal pain and irritation…
MEOW
What drug for neutropenia is a human G-CSF produce by recomb DNA, regulates production of neutrophils in BM, inc generation, and enhances phagocytic ability, resp burst, and ab dependent killing, indicated to dec infection in pt with nonmyeloid maligs receiving myelosuppressive anticancer drugs or in those getting a BM transplant, also used in severe chronic neutropenia, given as 24hr IV 24 hours after chemo, SE: well tolerated, moderate bone pain, splenic rupture, ARDS?
Filgrastim (G-CSF)
Pegfilgrastim= longer lasting version due to conjugation with monomethoxypolyethylene glycol = 80hrs
What is a recomb for of granulocyte macrophage CSF (GM-CSF) made in yeast, acts in BM to inc production of neutrophils eosinophils monocytes and mo, used to accel recovery of myeloid cells after BM transplant, can be used to mobilize blood for leukapheresis, used following induction of chemo in pt with AML, given IV/SC, 60 min 1/2 life, SE: gasping syndrome in infants, fluid retention- pleural effusion and pericardial perfusion, dyspnea, tachycardia and renal and hepatic dysfunction?
Sargramostim (GM-CSF)
*USE filgrastim since fewer SE, clinical benefits are the same
