Anemia Flashcards
HPI: SK is a 21 y/o female who presents to her PCP complaining of fatigue and weakness. She also states that she’s having trouble keeping up with the swim team, being unable to swim the distances and speeds she normally does, and getting dizzy during training.
Allergies: NKDA
PMH: Acne, occasional heartburn
Meds: MInocycline 100 mg PO Q12H, Tums 1-2 tabs Q6H PRN
8/4 General Appearance: Thin, pale, young Caucasian female in no apparent distress
5/9 Abnormal Labs:
SCr = 0.6 (0.7-1.3)
Glucose = 90 (100-125)
8/4 Abnormal Labs:
Hgb = 9.4 (women: 12-16, men: 13.5-18)
RBC = 3.8 (women: 4.1-4.9, men: 4.5-5.5)
MCV = 74 (80-100)
Fe = 44 (65-150)
TSAT = 8% (women: 12-45, men: 15-50)
TIBC = 480 (250-400)
Ferritin = 9 (11-300)
Additional Notes:
- 5/9 - Annual physical - healthy, vegetarian female in good health. Immunizations UTD. Has been feeling fatigued but has been studying for final exams at school. Sexually active with 1 partner; uses barrier methods for contraception. Minocycline refilled.
8/4: Regular menses with light bleeding 2-3 days per month. Follows vegetarian diet.
Orders:
8/4: Start ferrous sulfate 325 mg PO BID
What is the most likely cause of iron deficiency anemia in SK?
a. Use of Tums
b. Vegetarian diet
c. Heavy menses
d. Pregnancy
e. Celiac disease
b
An iron-poor (e.g., vegetarian, vegan) is a common cause of iron deficiency.
HPI: SK is a 21 y/o female who presents to her PCP complaining of fatigue and weakness. She also states that she’s having trouble keeping up with the swim team, being unable to swim the distances and speeds she normally does, and getting dizzy during training.
Allergies: NKDA
PMH: Acne, occasional heartburn
Meds: MInocycline 100 mg PO Q12H, Tums 1-2 tabs Q6H PRN
8/4 General Appearance: Thin, pale, young Caucasian female in no apparent distress
5/9 Abnormal Labs:
SCr = 0.6 (0.7-1.3)
Glucose = 90 (100-125)
8/4 Abnormal Labs:
Hgb = 9.4 (women: 12-16, men: 13.5-18)
RBC = 3.8 (women: 4.1-4.9, men: 4.5-5.5)
MCV = 74 (80-100)
Fe = 44 (65-150)
TSAT = 8% (women: 12-45, men: 15-50)
TIBC = 480 (250-400)
Ferritin = 9 (11-300)
Additional Notes:
- 5/9 - Annual physical - healthy, vegetarian female in good health. Immunizations UTD. Has been feeling fatigued but has been studying for final exams at school. Sexually active with 1 partner; uses barrier methods for contraception. Minocycline refilled.
8/4: Regular menses with light bleeding 2-3 days per month. Follows vegetarian diet.
Orders:
8/4: Start ferrous sulfate 325 mg PO BID
SK has which of the following classic symptoms of anemia?
a. Fatigue
b. Heartburn
c. Acne
d. Pallor
e. Exercise intolerance
a, d, e
In anemia, the tissues aren’t getting enough oxygen-rich blood. This results in the classic anemia symptoms of fatigue, weakness, SOB, exercise intolerance, headache, dizziness, anorexia, and pallor (pale skin).
HPI: SK is a 21 y/o female who presents to her PCP complaining of fatigue and weakness. She also states that she’s having trouble keeping up with the swim team, being unable to swim the distances and speeds she normally does, and getting dizzy during training.
Allergies: NKDA
PMH: Acne, occasional heartburn
Meds: MInocycline 100 mg PO Q12H, Tums 1-2 tabs Q6H PRN
8/4 General Appearance: Thin, pale, young Caucasian female in no apparent distress
5/9 Abnormal Labs:
SCr = 0.6 (0.7-1.3)
Glucose = 90 (100-125)
8/4 Abnormal Labs:
Hgb = 9.4 (women: 12-16, men: 13.5-18)
RBC = 3.8 (women: 4.1-4.9, men: 4.5-5.5)
MCV = 74 (80-100)
Fe = 44 (65-150)
TSAT = 8% (women: 12-45, men: 15-50)
TIBC = 480 (250-400)
Ferritin = 9 (11-300)
Additional Notes:
- 5/9 - Annual physical - healthy, vegetarian female in good health. Immunizations UTD. Has been feeling fatigued but has been studying for final exams at school. Sexually active with 1 partner; uses barrier methods for contraception. Minocycline refilled.
8/4: Regular menses with light bleeding 2-3 days per month. Follows vegetarian diet.
Orders:
8/4: Start ferrous sulfate 325 mg PO BID
What counseling should the pharmacist provide for SK’s new med?
a. Take on an empty stomach
b. Use loperamide if she experiences diarrhea
c. Take 2 hours before or 4 hours after taking any Tums
d. Expect stools to get dark and tarry-looking
e. Take with milk to increase absorption
a, c, d
-It’s best absorbed on an empty stomach, but it can be taken with food if stomach upset occurs. Certain foods (including milk) should be avoided as they decrease the absorption of iron.
-Iron is a polyvalent cation and should be separated from certain drugs, including antacids and tetracycline antibiotics.
AP has ESRD and is on 3x weekly hemodialysis. Lab values today include Hgb 11.4 g/dL, Hct 34.2 g/dL, and LDL 146 mg/dL. Her BP averages 156/92 mmHg. It’s most appropriate to initiate an erythropoiesis-stimulating agent for AP when Hgb is less than:
a. 10 g/dL
b. 11 g/dL
c. 12 g/dL
d. 13 g/dL
e. 14 g/dL
a
For chronic renal failure, start ESA therapy when Hgb is less than 10 g/dL and reduce or stop when > 10 g/dL (not on hemodialysis) or > 11 g/dL (if on hemodialysis). Use the lowest possible dose and don’t give more than necessary d/t the risk of serious AEs.
What is pica?
a. Craving and eating substances with poor nutritional value, such as ice, clay, or paper
b. Consuming excessive amounts of fluids and constantly eating without the ability to stop
c. An inflamed, sore tongue
d. Painful muscle spasms in the lower extremities, making it difficult to walk
e. Thin, concave, spoon-shaped nails
a
Pica is sometimes present in pts with iron deficiency anemia. Other symptoms may include a sore, inflamed tongue (glossitis) and thin, concave, spoon-shaped nails (koilonychia).
A child finds her mom’s iron supplements and swallows a few tablets. What action should the mom take?
a. Take the child to the nearest ER immediately
b. No action is needed because iron supplementation for children is safe
c. Watch for symptoms and seek medical attention if needed
d. Treat with calcium carbonate if she develops N/V
e. Give the child ipecac syrup immediately to induce vomiting
a
-Iron poisoning is a leading cause of poisoning deaths among young children. The pills can look like candy, and a small amount can cause severe organ damage in a small child.
-Ipecac syrup is no longer commercially available or recommended.
Which of the following IV iron preparations has the highest risk for anaphylaxis and requires a test dose prior to administration?
a. Iron sucrose (Venofer)
b. Sodium ferric gluconate (Ferrlecit)
c. Ferumoxytol (Feraheme)
d. Iron dextran (INFeD)
e. Ferric carboxymaltose (Injectafer)
d
Ferumoxytol and iron dextran both have a BBW for anaphylaxis, but iron dextran has the highest risk.
KD presents to the pharmacy complaining of constipation over the past couple of weeks. He started taking ferrous sulfate 325 mg PO TID approximately 4 weeks ago. What drug/s are appropriate for the pharmacist to recommend?
a. Bisacodyl
b. Bismuth subsalicylate
c. Miralax
d. Loperamide
e. Docusate
a, c, e
Bismuth subsalicylate (Pepto-Bismol) and loperamide (Imodium) are used to treat diarrhea, not constipation.
AJ is a 35 y/o female with curable breast cancer. Lab values today include Hgb 9.1 g/dL, Hct 28 g/dL, and SCr 1.2 mg/dL. Her BP averages 110/66 mmHg. ESAs should be avoided in AJ at this time because:
a. She doesn’t have CKD
b. She isn’t receiving hemodialysis
c. The Hgb level isn’t < 8 g/dL
d. The average BP is too low
e. There’s a risk of tumor progression
e
ESAs are contraindicated in curable cancer (e.g., breast, non-small cell lung, cervical) d/t the risk of tumor progression and shortened survival.
MP is a female pt who has been told to take ferrous sulfate 325 mg PO TID by her physician. How much elemental iron will MP receive daily?
a. 65 mg
b. 100 mg
c. 195 mg
d. 325 mg
e. 975 mg
c
Ferrous sulfate: 325 mg = 65 mg elemental iron
Dried ferrous sulfate: 160 mg = 50 mg elemental iron
65 x 3 = 195 mg elemental iron
Which lab value is used to distinguish between microcytic and macrocytic anemia?
a. Mean corpuscular volume (MCV)
b. Mean corpuscular hemoglobin concentration (MCHC)
c. Total iron-binding capacity (TIBC)
d. Serum ferritin
e. Total reticulocyte count
a
A pt comes to the pharmacy counter and tells the pharmacist that her doctor wants her to take about 200 mg of elemental iron daily. He recommended ferrous fumarate, but she can only find bottles that have 324 mg per tablet and doesn’t know how many to take. Which instructions are appropriate for this pt?
a. Take 1 tab daily
b. Take 1 tab BID
c. Take 1 tab TID
d. Take 2 tabs BID
e. Take 2 tabs TID
b
324 mg ferrous fumarate = 106 mg elemental iron
(324 mg FF) / (106 mg EI) = (x mg FF) / (200 mg EI) –> x = 611.3 mg
(611.3 mg) / (324 mg) = 1.9 tablets = 2 tablets per day
Which of the following are potential side effects of Aranesp?
a. Arthralgia
b. Constipation
c. HTN
d. Myocardial infarction
e. Stroke
f. Hyperkalemia
a, c, d, e
-Darbepoetin is an ESA.
-Bone pain can occur from the increased production of RBCs occurring in the bone marrow.
Pts with CKD develop anemia because the kidneys can’t produce which hormone?
a. Triiodothyronine
b. Calcitonin
c. Erythropoietin
d. Aldosterone
e. Prolactin
c
What is the antidote for iron overdose?
a. Ferumoxytol
b. Physostigmine
c. Protamine
d. Deferoxamine
e. Dexrazoxane
d
