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Pharmacology quiz 3 > Anemia > Flashcards

Anemia Flashcards

1
Q

Define anemia

A

a reduction in one of the following components of the CBC: Hgb, Hct, RBC count

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2
Q

what is hematocrit?

A

percent of a sample of whole blood occupied by intact RBCs

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3
Q

What is normal Hgb for men vs. women?

A

(15.7 +/- 1.7) (13.8 +/- 1.5)

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4
Q

What Hgb is sufficient for people to live off of?

A

5

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5
Q

What is the reticulocyte count?

A

reflects rate of RBC production

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6
Q

What are the mean cell volume and RDW used for?

A

classifies the type of anemia

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7
Q

What is the first lab to respond to Tx of anemia?

A

reticulocyte count

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8
Q

True or false: symptoms of anemia are less likely if it evolved over a long period of time

A

TRUE

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9
Q

what are symptoms of anemia?

A

dyspnea at rest, fatigue, bounding pulses, palpitations

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10
Q

What is sxs onset of anemia dependent on?

A

compensatory mechanisms, related to O2 delivery and volume (if marked bleeding)

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11
Q

can anemia cause death?

A

yes, via CKD, malignancy, HF, older adults who are hospitalized

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12
Q

What can cause anemia?

A

decreased RBC rpoduction, increased RBC destruction, blood loss (MCC)

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13
Q

what is the lifespan of a RBC?

A

100 days

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14
Q

what are the morphological causes of anemia?

A

alterations in RBC size (MCV) and reticulocyte response

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15
Q

define macrocytic anemia

A

MCV >100/fL

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16
Q

Define normocytic anemia

A

MCV 81-99fL

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17
Q

Define microcytic anemia

A

MCV <80fL

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18
Q

Causes of microcytic anemia

A

iron deficiency, anemia of chronic disease

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19
Q

Causes of normocytic anemia

A

acute blood loss, hemolytic anemia, anemia of chronic disease

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20
Q

Causes of macrocytic anemia

A

B12 deficiency, folic acid deficiency, drug induced bone marrow toxicity

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21
Q

What is important to ask yourself when evaluating an anemic pt?

A

are they bleeding? Is there evidence of increased RBC destruction? Is the bone marrow suppressed? Is the pt iron deficient or deficient in folat or B12?

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22
Q

causes of iron deficiency anemia

A

diet (children, failure to absorb iron salts), increased utilization (pregnancy, adolescent growth), atransferrinemia, failure to utilize (lead poisoning, chronic disease), blood loss

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23
Q

developmental stages of iron deficiency anemia

A

depletion of iron stores, decreased ferritin, increased transferrin, fall in serum iron, development of normocytic normochromic anemia, development of microcytic hypochromic anemia

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24
Q

What are the lab values of iron deficiency anemia?

A

everything decreased, TIBC increased

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25
Q

How is iron deficiency anemia treated?

A

any iron salt, best place is red meat

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26
Q

what is the recommended daily intake of iron?

A

>200mg of elemental Fe/day

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27
Q

How much Fe is absorbed from iron salts?

A

5-10%, changes with bodily needs

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28
Q

ADR of iron

A

nausea, epigastric discomfort, abdominal cramps, constipation, diarrhea, black stool

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29
Q

what is the #1 drug known for poisoning children

A

iron

30
Q

Why are sub-therapeutic doses of iron given?

A

chronic iron toxicity causes hemochromatosis

31
Q

What is the most common cause of acute iron poisoning?

A

accidental ingestion in pediatrics

32
Q

when is IV iron recommended?

A

pts with documented iron deficiency who are unable to tolerate or absorb oral iron (CKD, malabsorption syndromes, IBD)

33
Q

IV iron drugs

A

iron dextran, ferric gluconate complex, iron sucrose, feraheme, injectafer

34
Q

Which IV iron preparations can be used in CKD?

A

ferric gluconate complex, iron sucrose

35
Q

how much elemental iron is in iron dextran?

A

50mg/ml

36
Q

How much elemental iron is in ferric gluconate complex?

A

12.5mg/ml

37
Q

How much elemental iron is in iron sucrose?

A

20mg/ml

38
Q

What are the available dosage forms of vitamin B12?

A

injection, lozenge, nasal solution, tablet (ER/SL)

39
Q

What are the available dosage forms of folic acid?

A

capsule, injection, tablet

40
Q

How does folic acid work?

A

folic acid + CH3B12 decrease homocysteine, succinyl CoA and increase DNA

41
Q

What should always be done first when prescribing iron dextran?

A

order test dose first and have nurses watch for anaphylaxis

42
Q

what is needed to transport B12?

A

intrinsic factor

43
Q

what labs should be taken in megaloblastic anemia in geriatrics?

A

serum folate/B12

44
Q

what does vitamin B12 deficiency cause?

A

hematopoietic and neurological systems, abnormal DNA replication

45
Q

What labs should be ordered when suspect B12 deficiency?

A

serum B12 and serum methylmalonic acid

46
Q

What is folic acid deficiency linked with?

A

acute/chronic alcoholism (malnourished)

47
Q

Where can B12 be supplied from in your diet?

A

animal byproducts, some legumes

48
Q

What are some dietary sources of folate?

A

green vegetables, liver, some fruit - cooking at length can destroy folate

49
Q

what can low folate cause in pregnancy?

A

neural tube defects

50
Q

What IV should be given to alcoholics?

A

banana bags

51
Q

ADR of B12 injectables

A

itching, dizziness, nausea, anaphylaxis

52
Q

Folic acid ADR

A

none oral, IV has rare injection site reactions

53
Q

What do erythropoeisis stimulating agents do?

A

“Colony stimulating fators”; glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells in the bone marrow

54
Q

What are the erythropoeisis stimulating agents

A

epoetin alfa, darbepoetin alfa

55
Q

where is EPO made?

A

in the kidneys, release stimulated by hypoxia to increase differentiation of stem cells into RBCs

56
Q

what are the effects of EPO?

A

increase RBC production, prevent apoptosis of erythrocytic progentiors, increase RBC viability

57
Q

Which EPO stimulating agent is long-acting?

A

darbepoetin alfa

58
Q

Which EPO drug can be used to treat HIV pts?

A

epoetin alfa

59
Q

What is a therapeutic failure of EPO therapy?

A

no effect after 12 weeks

60
Q

what is considered a positive reaction to EPO stimulating agents?

A

1g/dl of Hgb increase

61
Q

What is always the preparation of EPO stimulating agents in pts on chemo?

A

IV

62
Q

What is the target Hgb level of therapy?

A

10-12 g/dl, could cause HTN, thrombotic events

63
Q

ADR of EPO stimulating drugs

A

HA, HTN, fever, nausea, pruritis, injection site reaction

64
Q

Don’t initiate tx for anemia if Hgb is above…

A

10

65
Q

Why is sickle cell anemia not a true anemia?

A

low Hct, Hgb, elevated reticulocytes

66
Q

What are the reasons to be concerned with a patient who has sickle cell anemia?

A

problems in the microvasculature, veno-occlusive damage, organ damage

67
Q

How are pts with sickle cell anemia treated?

A

analgesics, abx, blood transfusions, pneumococcal vaccine

68
Q

What is the most frequent complication in sickle cell disease?

A

pain - treat with NSAIDs, acetominophen, opioids

69
Q

How do anti-sickling agents work?

A

hydroxyurea increases RBC Hgb F levels, reduce polymerization of Hgb S, reduction of deformed RBCs, increases RBC water, alters RBC adhesion to enothelium

70
Q

ADR of anti-sickling agents?

A

leukopenia, CNS, dizziness, disorientation, hallucinations, hepatotoxicity, hyperuricemia, dysuria

71
Q

What labs should be used to monitor pts taking anti-sickling drugs?

A

renal function, liver function, serum uric acid

72
Q

what should be done if leukopenia occurs with anti-sickling agents?

A

rechallange after labs normalize

Pharmacology quiz 3 (4 decks)

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