325 mg (65 elemental iron) - 20% daily to TID

Anemia Flashcards by Crystal Rim

What are abnormal Hgb & hct levels?

Male: <13 Hgb, <38 Hct
Female: <12 Hgb, <36 Hct

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What defines microcytic anemia?

Low hgb, MCV <80, low RBC production (low reticulocyte), low iron/ferritin/TSAT, high TIBC
Iron deficiency

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What defines macrocytic anemia?

Low hgb, MCV >80
Folate or vit b12 deficiency

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Treatment for iron deficiency anemia

100-200 mg elemental iron per day

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Admin instructions for iron

Take on empty stomach, may take WF if GI upset
avoid H2RA/PPI ; separate from antacids
Separate with quinolone/tetracyclines, bisphosphonate, cefdinier, dolutegravir, levothyroxine, levodopa/methyldopa
Vit C 200 mg may enhance absorption

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Ferosul, Fer-In-Sol

325 mg (65 elemental iron) - 20%
daily to TID

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Slow Fe, Slow iron

Ferrous sulfate, dried
ER tab
160 (50 mg elemental) - 30%
daily to TID

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Ferretts, Ferrimin 150, Hemocyte

Ferrous fumarate
324 mg (106 mg elemental) - 33%
daily to TID

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Ferate

Ferrous gluconate
324 mg (38 mg elemental iron) - 10%
daily to TID

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Safety/SE/Notes for iron

BW: accidental OD of iron-containing products/fatal poisoning in children <6, keep away
CI: hemochromatosis, hemolytic anemia, hemosiderosis
SE: constipation (dose-related), dark/tarry stools, nausea, stomach upset
Notes: use stool softener
Antidote for iron OD: deferoxamine (Desferal)

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Who should use IV iron?

CKD on HD, ESA
unable to tolerate PO iron (ex: IBD, celiac, gastric bypass, achlorhydria, H.pylori)
losing iron too fast for PO
alt for blood transfusions

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Safety/SE/Notes for IV iron

BW for iron dextran/ferumoxytol: analyphylactic rxns (fatal) occurred; need test dose prior to full dose. Careful w/pts with hx of drug allergy or multiple drug allergies
ADE: muscle aches, fatgue, hypo/hypertension, tachcardia, CP, peripheral edema
Notes: give by slow IV injection or infusion to decrease hypotension
Stable in NS; Feraheme stable in NS/D5W

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Triferic

ferric pyrophosphate citrate
* indicated only for HD dependent CKD
* added to the bicarb concentrate of hemodialysate in HD

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Venofer

Iron sucrose

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Feraheme

ferumoxytol
stable in NS/D5W

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InFeD

Iron dextran complex

Ferrlecit

sodium ferric gluconate

Injectafer

Ferric carboxymaltose

Monoferric

ferric derisomaltose

Causes of macrocytic anemia

alcoholism
poor nutrition
GI disorders (Crohns, celiac)
Pregnancy
Vit B12 deficiency: long term use of metformin, PPI/H2RA –> serious neurologic dysfunction (CI, peripheral neuropathy)
Folic acid deficiency –> ulceration of the tongue/mouth, changes to skin/hair/nail pigmentation

Treatment of macrocytic anemia

Vit B12 - first parenteral
Folic acid

Nascobal

Nasal vitamin b12
500 mcg in 1 nostril once weekly

Cyanocobalamin

IM or deep SC: 100-1000 mcg daily/weekly/monthly
PO/SL: 1000-2000 mcg daily

Vit B12 Safety/SE/

CI: allergy to cobalt or vit B12
Warning: parenteral products may contain aluminum (cns/bone tox in renal dysfxn) or benzyl alcohol (fatal tox & “gasping syndrone” in neonates
SE: pain with injection; rash, polycythemia vera, pulmonary edema (all rare)

FA-8

Folic acid 0.4-1 mg daily SE: bronchospasm, flushing, rash, pruritis, malaise (all rare)

What can decrease vit B12 efficacy? | Drug interactions

Chloramphenicol (abx) Colchicine (gout)

Which meds can folic acid decrease the concentrations of?

Raltitrexed (chemo) fosphenytoin, phenytoin, primidone, phenobarb

What can decrease concentrations of folic acid?

Green tea, sulfasalazine

Which meds cause G6PD deficiency (hemolytic anemia risk)?

* Abx: cephs, PCN, dapsone, isoniazid, nitrofurantoin, primaquine (malaria), rifampin, sulfonamides * Gout: rasburicase, pegloticase * Levodopa, methyldopa, methylene blue, quinidine, quinine

When to supplement iron before ESA in CKD?

* TSAT <30% FERRITIN <500

Epogen, Procrit, Retacrit

Epoetin alfa * CKD: 50-100 units/kg IV or SC 3x/week Initiate when hgb <10, decrease or d/c when Hgb approaches or exceeds 11 (due to stroke risk) in HD, or >10 in non-HD *Cancer (taking chemo): 150 units/kg SC 3x/week or 40,000 units weekly Initiate when Hgb <10 & at least 2 more months of chemo

Aranesp

Darbepoetin * CKD: weekly or every 2 weeks (longer half-life) * Cancer: weekly or every 3 weeks

ESA boxed warnings, SE, CI, warnings

* BW: increased risk of DEATH, MI, STROKE, VTE, THROMBOSIS * CKD: incr risk of DEATH & stroke when hgb >11 * Cancer: not indicated when CURE is goal * Perisurgery (epogen only): DVT prophy rec CI: uncontrolled HTN, pure red cell aplasia after tx; epogen: multidose vials contain benzyl ETOH (not for pregnant, lactating, infants/neonates) Warnings: HTN, seizure, allergic rxn, SJS/TENS ADE: **arthralgia/bone pain**, fever, HA, pruritis/rash, N/V, cough, dyspnea, edema, dizziness, inj site pain Store in fridge, protect from light. Discard MDV in 21 days. Don't shake