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Roomies Collab Deck 1: Infectious Disease and CV > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Treatment of iron deficiency anaemia with an iron preparation is only justified in the presence of a demonstrable iron-deficiency state. However, under which contexts is prophylaxis with an iron preparation suitable?

A
  1. Malabsorption
  2. Menorrhagia
  3. Pregnancy
  4. After subtotal or total gastrectomy
  5. Haemodialysis patients
  6. In the management of low birth-weight infants such as preterm neonates
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2
Q

Name 4 preparations of iron that can be administered parenterally?

A

Iron dextran
Iron sucrose
Ferric carboxymaltose
Ferric derisomaltose

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3
Q

What are the 5 indications to administer iron parenterally?

A
  1. Patient cannot tolerate oral iron
  2. Patient does not reliably take oral iron
  3. Continuing blood loss
  4. Malabsorption
  5. Chronic renal failure receiving haemodialysis (and sometimes peritoneal dialysis)
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4
Q

Generally, does parenteral iron produce a faster haemoglobin response than oral iron?

A

NO

Exception - severe renal failure

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5
Q

In what context may parenteral iron produce a faster haemoglobin response than oral iron?

A

Severe renal failure receiving haemodialysis

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6
Q

In pregnant women compound preparations containing iron and (?) can be used

A

Folic acid

In pregnant women who are at high risk of developing iron and folic acid deficiency

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7
Q

Should women who are planning a pregnancy take the compound preparations of iron and folic acid to prevent neural tube defects?

A

NO

Preparations containing iron and folic acid are used during pregnancy in women who are at high risk of developing iron and folic acid deficiency; they should be distinguished from those used for the prevention of neural tube defects in women planning a pregnancy.

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8
Q

In the compound preparations of iron and folic acid used in pregnancy, are the doses of folic acid sufficient to treat megaloblastic anaemia?

A

NO - the dose of folic acid is too small

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9
Q

What is the cause of megaloblastic anaemia in patients with pernicious anaemia?

A

Lack of gastric intrinsic factor leading to malabsorption of vitamin B12

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10
Q

Prolonged nitrous oxid anaesthesia inactivates (?) leading to megaloblastosis

A

Vitamin B12

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11
Q

What is needed in the treatment of megaloblastosis in a patient with congenital transcobalamin II deficiency?

A

Vitamin B12

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12
Q

What form of vitamin B12 is the first choice for therapy of vitamin B12 deficiency?

A

Hydroxocobalamin

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13
Q

Why is hydroxocobalamin replaced cyanocobalamin as the choice therapy for vitamin B12 deficiency?

A

Retained in the body for longer

Maintenance therapy is given at intervals of up to 3 months

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14
Q

For vitamin B12 deficiency treated with hydroxocobalamin, how often is maintenance therapy given?

A

Intervals of up to 3 months

Dose: 1 mg

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15
Q

What is the mode of administration of hydroxocobalamin?

A

IM injection

- 1 mg

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16
Q

Why should you not give folic acid alone if you do not know the cause of megaloblastic anaemia?

A

Neuropathy may be precipitated unless vitamin B12 is administered concurrently

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17
Q

In folate-deficient megaloblastic anaemia, how long do you require daily folic acid supplementation to bring about haematological remission and replenish body stores?

A

4 months

Folic acid has few indications for long-term therapy since most causes of folate deficiency are self-limiting or will yield to a short course of treatment.

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18
Q

Folic acid is used for the prevention of (drug?)-induced side-effects in Crohn’s disease, rheumatic disease, and severe psoriasis

A

Methotrexate

19
Q

What is the most common mode of administration of folic acid supplementation?

A

Oral

Can be given if patient is receiving parenteral nutrition

20
Q

What form of folic acid is used in association with cytotoxic drugs for the treatment of folate deficient megaloblastic anaemia?

A

Folinic acid (calcium folinate) (IM or IV)

E.g. used as an adjunct to fluorouracil in colorectal cancer

21
Q

Vitamin B12 should be given prophylactically after which surgeries? (3)

A
  1. Total gastrectomy
  2. Total ileal resection
  3. Partial gastrectomy if vitamin B12 absorption test shows vitamin B12 malabsorption
22
Q

Folic acid is given for prophylaxis in which conditions?

A
  1. Chronic haemolytic states
  2. Malabsorption
  3. Renal dialysis

Folic acid is given daily or sometimes weekly, depending on the diet and the rate of haemolysis

23
Q

What dose of folic acid is given to adults with folate-deficient megaloplastic anaemia?

A

5 mg daily for 4 months (oral)

Doses up to 15 mg daily may be required in malabsorption states

24
Q

What is given to patients with sickle-cell anaemia to reduce the risk of infection? (4)

A
  1. Pneumococcal vaccine
  2. Haemophilus influenzae type b vaccine
  3. Annual influenza vaccine
  4. Lifelong prophylactic penicillin
25
Q

Why is folic acid supplementation recommended in sickle-cell patients?

A

Haemolytic anaemia is often present accompanied by increased erythropoiesis which may increase folate requirements

26
Q

What drug can be used to prevent acute chest syndrome, reduce the frequency of painful crises and reduce transfusion requirements in sickle-cell disease patients?

A

Hydroxycarbamide

  • Xromi (trade name): Initially 15 mg/kg daily, increased in steps of 5 mg/kg daily, dose to be increased every 8 weeks according to response; usual maintenance 20–25 mg/kg daily; maximum 35 mg/kg per day. (adult; oral)
  • Siklos (trade name): Initially 15 mg/kg daily, increased in steps of 2.5–5 mg/kg daily, dose to be increased every 12 weeks according to response; usual dose 15–30 mg/kg daily; maximum 35 mg/kg per day. (adult; oral)
27
Q

Why is hydroxycarbamide used in the treatment of sickle-cell disease? (3)

A
  1. Prevent acute chest syndrome
  2. Reduce the frequency of painful crises
  3. Reduce transfusion requirements

The benefit may not become evident for several months

28
Q

At what eGFR should you not use hydroxycarbamide in patients with sickle-cell disease?

A

eGFR < 30 mL/minute/1.73m^2

Reduce dose by 50% if eGFR < 60 mL/minute/1.73m^2

29
Q

What needs to be monitored in patients taking hydroxycarbamide? (4)

A
  1. Renal function
  2. Hepatic function
  3. Full blood count
  4. Secondary malignancies (if receiving long-term therapy for malignant disease)
30
Q

What advice must you give patients receiving long-term therapy with hydroxycarbamide?

A

Protect skin from sun exposure

31
Q

Is G6PD deficiency more common in males or females?

A

Males

32
Q

In a patient with G6PD deficiency, what is favism?

A

Developing haemolytic anaemia when they eat fava beans (broad beans)

33
Q

Name 8 drugs that have DEFINITE risk of haemolysis in most G6PD deficient individuals

A
  1. Dapsone with other sulfones
  2. Fluoroquiolones (ciprofloxacin, moxifloxacin, norfloxacin, ofloxacin)
  3. Methylthioninium chloride
  4. Nitrofurantoin
  5. Primaquine
  6. Quinolones
  7. Rasburicase
  8. Sulfonamides (including co-trimoxazole)

Two others which are not on UK market:

  • Niridazole
  • Pamaquin
34
Q

Name 5 drugs with a POSSIBLE risk of haemolysis in some G6PD-deficient individuals

A
  1. Aspirin
  2. Chloroquine
  3. Menadione, water-soluble derivatives (e.g. menadiol sodium phosphate)
  4. Quinine (may be acceptable in acute malaria)
  5. Sulfonylureas
35
Q

What drugs are used as immunosuppressive treatment for aplastic anaemia? (2)

A

IV horse antithymocyte globulin in combination with ciclosporin

36
Q

When IV horse antithymocyte globulin in combination with cyclosporin is given as immunosuppressive treatment for aplastic anaemia, what drug is also given to prevent adverse effects associated with antithymocyte globulin?

A

Prednisolone

Early adverse effects include: fever, rash, fluid retention, rigors, acute respiratory distress syndrome, anaphylaxis

Serum sickness may occur 7-14 days later

37
Q

Which drug is licensed for the treatment of idiopathic sideroblastic anaemia?

A

Pyridoxine hydrochloride
- 100-400 mg daily in divided doses (oral)

(the dose required is usually high)

38
Q

What is used to treat anaemia associated with erythropoietin deficiency in chronic renal failure?

A

Epoetins (recombinant human erythropoietins)

They increase the yield of autologous blood in normal individuals and to shorten the period of symptomatic anaemia in patients receiving cytotoxic chemotherapy.

39
Q

Which drug is licensed for the prevention of anaemia in preterm neonates of low birth weight?

A

Epoetin beta

40
Q

(Drug?) is a hyperglycosylated derivative of epoetin which has a longer half-life and can be administered less frequently than epoetin

A

Darbepoetin alfa

Used to treat anaemia associated with erythropoetin deficiency in chronic renal failure

41
Q

What drug is a continuous erythropoietin receptor activator that is licensed for the treatment of symptomatic anaemia associated with chronic kidney disease?

A

Methoxy polyethylene glycol-epoetin beta

It has a longer duration of action than epoetin.

42
Q

When treating iron deficiency anaemia with oral iron supplements, What should you monitor to determine the therapeutic response?

A

Haemoglobin concentration

Should rise by about 100-200 mg/100mL (1-2 g/L) per day or 2g/100 mL (20 g/L) over 3-4 weeks

43
Q

When treating iron deficiency anaemia with oral iron supplements, what rise in haemoglobin concentration would you expect per day?

A

100-200 mg/100 mL (1-2 g/L)

3-4 weeks: 2 g/100 mL (20 g/L)

44
Q

When treating iron deficiency anaemia with oral iron supplements, how long after the haemoglobin is within normal range should you continue the treatment?

A

3 months

To replenish the iron stores

Roomies Collab Deck 1: Infectious Disease and CV (84 decks)

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