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Pharmacology > Anaemia > Flashcards

Anaemia Flashcards

1
Q

Microytic hypochromic

A

Iron deficiency

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2
Q

Macrocytic anemia

A

Megaloblastic anemia

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3
Q

Megaloblastic anemia

A

B12 and folic deficiency

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4
Q

Pernicious anemia

A

Deficiency in intrinsic factor synthesis

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5
Q

Other forms of Deficiency can arise as?

A

Deficiency in blood lineages

Radiation and Chemotherapy

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6
Q

What three proteins are iron bound to

A

Heme

Transferrin

Ferritin

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7
Q

Transferrin

A

Iron transport protein in the plasma

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8
Q

Ferritin

A

Iron storage protein

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9
Q

Most cause for iron deficiency

A

Menses

Vegetarian

Malnutrition

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10
Q

Who need iron the most

A

Children

Pregnant women

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11
Q

True or false: Excessive iron levels are toxic

A

True

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12
Q

How is excessive iron regulated

A

Modulation in intestinal regulation

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13
Q

What two organs absorb iron

A

Intestine and heme

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14
Q

Why what mechanism is iron transferred into the blood

A

Active transport via ferroportin

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15
Q

Where is iron transported to for hemoglobin synthesis

A

Erythrocytes precursors of the bone marrow

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16
Q

Where is iron stored

A

Liver (major)

Heart

Pancreas

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17
Q

How is senescent RBC recycled

A

Through macrophages. They recover its iron and export or store it as ferritin

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18
Q

Hepcidin

A

Liver inhibitory protein released in high iron levels to inhibit ferroportin, decreasing iron absorption

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19
Q

Low hepatocyte iron or increased erythroferron

A

Inhibit hepcidin

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20
Q

What is the only indication for iron administration

A

Iron deficiency in anemia

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21
Q

What are the dietary iron supplement used as a replacement therapy

A

Ferrous sulfate

Ferrous gluconate

Ferrous fumerate

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22
Q

What is used in special cases of anemia

A

Parenteral administration

Iron dextran

Sodium ferric gluconate complex

Iron sucrose

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23
Q

What is a nanotechnology based iron treatment

A

Ferumoxytyl

Ferric carboxymaltose

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24
Q

What is the common toxicity

A

Children via accidental over dose

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25
Q

Hemochromatosis

A

Excessive iron that damage iron storage organs

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26
Q

Which patients are at risk of hemochromatosis

A

Inherited abnormality of iron absorption

Frequent transfusion (thalassemia)

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27
Q

Which iron chelator is used in acute iron toxicity

A

Parenteral Deferoxamine

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28
Q

Which is used in chronic toxicity caused by hemochromatosis

A

Parenteral defroxamine

Oral defriprone

Oral iron chelator defasirox

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29
Q

Which iron antidote causes thrombocytopenia

A

Deferiprone

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30
Q

Which iron antidote causes hepatic and renal toxicity

A

Deferasirox

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31
Q

What is the role of B12 and what cofactor is needed

A

DNA synthesis

Folic acid

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32
Q

B12 or folic deficiency will manifest as? Why?

A

Anemia

RBC is synthesized continuously

33
Q

What produces B12

34
Q

What is required for B12 absorption in the intestine

A

Intrinsic factor

35
Q

Where is intrinsic factor made

A

Parietal cells

36
Q

What are the two forms of B12

A

Cyanocobalamin

Hydroxycobalamin (longer circulating half life)

37
Q

Transcobalamin

A

B12 transport protein in plasma

38
Q

Where is B12 stored

39
Q

What two reactions requires B12?

A

Conversion of methmalonyl-CoA to Succinyl-CoA

Conversion of homocysteine to methionine

40
Q

What reaction is linked to folic acid and synthesis of dTMP

A

Conversion of homocysteine to methionine

41
Q

What is dTMP

A

Precursor for DNA synthesis

42
Q

What happens to folate in B12 deficiency and with what results?

A

Folate accumulate as N-methyltetrahydrofolate

Depleting tetrahydrofolate supply

Reducing RBC production

43
Q

What is the benefit of exogenous folate and what can it not help with

A

Helps refill tetrhydrofolate pool in patient with B12 deficiency

Cannot help with neurological defects associated with B12 anemia

44
Q

How is B12 anemia via ineadequate absorption dealt with

A

Parenteral B12

45
Q

Deficiency in folate leads to what type of anemia and why?

A

Megaloblastic anemia because it helps in DNA synthesis

46
Q

Deficiency of folate during pregnancy causes

A

Neural birth defects

47
Q

True or false: There is a lot of storage folate in the body

48
Q

Which cells are sensitive to folate deficiency and how is folate used in this regard

A

Rapidly dividing cells

Antifolate used in cancer therapy

49
Q

What is Erythropoietin

A

Protein that activates RBC production and increase release from bone marrow

50
Q

Where is erythropoietin produced

51
Q

When is it routinely used

A

Anemia associated with renal failure

52
Q

What should you know about erythropoietin use as a therapy

A

Administered 2-3 times weekly

Require adequate iron storage

Use in cancer is ineffective

53
Q

What are the toxicity of therapeutic erythropoietin at high doses

A

HTN

Stroke

Heart attack

54
Q

What is the glycosylated form of erythropoietin and frequency of administration

A

Darbepoietin Alfa-sialic acid

Once weekly

55
Q

What is the peg conjugated erythropoietin and frequency of dosing

A

Methoxy-peg-poietin

Once monthly

56
Q

Fusion protein that inhibit SMAD

A

Lupatercept

57
Q

What is SMAD

A

Blocks RBC differentiation and maturation to prevent defective RBC maturing and circulating in Thalassemia

58
Q

What is the benefit of lupatercept

A

Increase serum Hgb levels

Decrease need for transfusion

59
Q

What type of medication is filgrastim

A

G-CSF used to stimulate neutrophil production

60
Q

What is filgrastim dosing frequency

A

Daily injection

61
Q

Which patient is filgristim administered

A

Chemotherapy

Renal transplantation

Collect hemopoietic stem cells from donors

62
Q

What is the dosing frequency of pegfilgrastimn

A

Once per chemo cycle

63
Q

Which granulocyte growth promoter is a GM-CSF

A

Sargramostim

64
Q

What is the function off sargramostim

A

Increase granulocyte and macrophage, RBC and platelet precursor

65
Q

What toxicity are associated with sargramostim

A

Joint and capillary damage with edema

Fever

66
Q

Which platelet growth promoter is an IL-11

A

Oprelvekin

67
Q

What is the function of oprelvekin

A

Increase platelet activity in thrombocytopenia patients

68
Q

What is the toxicity of oprelvekin

A

Fluid accumulation in lungs

69
Q

Which platelet growth promoter is a peptide hooked to the fc portion of IgG

A

Romiplostim

70
Q

What is the benefit of the IgG attachment by romiplostin

A

Extends half of life IgG to 3 days

71
Q

True/False: The peptide romiplostim has homology to natural human Thrombopoietin

72
Q

What is the pharmacological benefit of romiplostim

A

Decrease bleeding events in patients with thrombocytopenia purpura.

Less toxicity than agent in this class

73
Q

Which platelet growth promoter is an oral agent that binds to thrombopoietin receptor

A

Eltrombopag / avatrombopag

74
Q

What is the pharmacology function of eltrombopag

A

Increase number and maturation o platelets

75
Q

Which has liver toxicity and which was developed for liver disease patient

A

Eltrombopag

Avatrombopag

76
Q

Which drug is a tyrosine kinase inhibitor

A

Fostaminib

77
Q

What is the pharmacology function of fosataminib

A

Decrease macrophage destruction of platelet in spleen which is enhanced in patient with idiopathic thrombocytopenia purpura

78
Q

Hydroxyurea in sickle cell anemia

A

Increase fetal hemoglobin synthesis

Less RBC malformation

Increasing RBC oxygen delivery

79
Q

Voxelotor in sickle cell anemia

A

Binds to globin and increase affinity of altered hemoglobin for oxygen

Reduces globin polymerization and increase semm serum hemoglobin levels

Pharmacology (4 decks)

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