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Pharmacology > Anemia > Flashcards

Anemia Flashcards

1
Q

Anaemia causes?

A
  1. Defective RBC production (nutritional) OR ↑ RBC destruction (hemolysis)
  2. Blood loss (parasites, ulcers, tumors, ↑ menstruation)
  3. BM replacement, abnormal Hb/RBC, chronic systemic diseases
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2
Q

Anaemia signs & symtoms?

A
  1. Palor (skin, mucous membranes, conjunctivae)
  2. Exertional dyspnoea, fatigue, tachycardia
  3. Eyes red in sever anemia
  4. CNS: fainting
  5. Heart: Chest pain, angina & heart attack
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3
Q

Classification of and their subtypes?

A
  1. Microcytic <80 dL:
     -Iron deficiency anaemia
     Anaemia of chronic
    disease
     -Thalassaemia
     -Sideroblastic anaemia
  2. Normocytic anemia 80-90 dL
    -Hemolytic anaemia
    -Aplastic anaemia (bone
    marrow disorders)
  3. Macrocytic >90 dL:
    -Megaloblastic anaemia
    (Vit. B12, folate
    deficiency, drug induced)
    -Non-megaloblastic
    anaemia (alcohol abuse,
    hypothyroidism,
    pregnancy)
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4
Q

Iron Deficiency Anaemia?

A

Iron deficiency the most common cause → hypochromic microcytic RBCs

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5
Q

Iron Deficiency Anaemia Pathogenesis?

A

blood loss (menstruation, GIT, trauma); increased
requirements (pregnancy); decreased absorption (e.g. regional enteritis)
-Most common in children and women of child bearing age
-In pregnancy and nursing females: folate deficiency and/or combined iron/folate
deficiency commo

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6
Q

Symptoms of iron deficiency

A

-pallor
-lethargy
-fatigue

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7
Q

Iron Deficiency Anaemia treatment goals?

A

Normalise Hb and hematocrit (Htc) and replenish body iron stores

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8
Q

Iron Deficiency Anaemia Non-pharmacological treatment:

A
  1. Identify the cause; e.g. chronic blood loss, and remove it if possible
  2. Patient counselling, lifestyle modifications/adjustments
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9
Q

Iron Deficiency Anaemia drug tx?

A

Adm of Iron preparations (necessary for Hb production):

  1. Oral (ferrous salts): ferrous sulphate, ferrous gluconate, ferrous fumarate, ferrous bisglycate (amino acid chelate)
  2. Parenteral : Iron dextran, Iron sucrose
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10
Q

Factors affecting iron absorption that Increasing iron absorption?

A
  1. Vitamin C (ascorbic acid)
  2. Citric acid
  3. Gastric secretions
  4. Hydrochloric acid
  5. Acidic pH
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11
Q

Factors affecting iron absorption that Decreasing iron absorption?

A

 1. Phytate
 2. Phosphate
 3. Tannate
 4. Tetracycline
 5. EDTA
 6. Milk
 7. Alkaline pH

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12
Q

Oral Iron Preparations

  1. Indications(2)
  2. CI(4)
  3. Cautions(2)
  4. DI(7)
  5. A/E(4(
A
  1. Indications:
    Prophylaxis and Tx of iron deficiency anaemia
  2. CI:
    iron overload, chronic alcoholism, liver disease, repeated blood
    transfusion
  3. Cautions:
     -Geriatrics: may cause constipation, faecal impaction, reduced
    absorption may necessitate large doses
    - Paediatrics: accidental poisoning common (use correct doses)
  4. DI:
    Compounds containing Ca, Mg, Al, Bicarbonates, Phosphates
    (decreased absorption); Tetracyclines (↓absorption of both), Vitamin E
    impaired response to iron therapy
  5. A/E:
    nausea
    epigastric pain
    diarrhoea
    constipation
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13
Q

Parenteral Iron Preparations Include?

A
  1. Iron polymaltose (IM)
  2. Iron Sucrose (IV)
  3. Iron dextran ( IM/slow IV) iron
  4. carboxymaltose (IV)
  5. iron isomaltoside (IV)
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14
Q

Why would oral iron therapy fail & what is the solution?

A
  1. Due to non-adherence, inflammation, malabsorption, continuing blood loss

SOLUTION:

(Malabsorption can be evaluated by measuring iron levels every 30 mins
for 2 hrs after admin of 50mg of ferrous sulphate)

2.If plasma iron levels increase by >50%, absorption is adequate

  1. Intolerance to oral therapy
  2. Required antacids therapy
  3. Significant blood loss in pts refusing transfusion
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15
Q

Parenteral Iron Preparations?

A
  1. Iron carboxymaltose
    (I.V
    Iron isomaltoside (I.V)
  2. Iron dextran OR Iron
    sucrose (I.M/ I.V)
  3. Iron isomaltoside (I.V)
  4. Iron polymaltose (I.V)
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16
Q

Iron carboxymaltose
(I.V

  1. Indications
  2. A/E(4)
  3. CI(2)
A
  1. Indications:
    iron deficiency
  2. A/E:
    headache, N, rash,
    phlebitis on injection
    site
  3. CI:
    severe liver damage,
    iron overload, 1st trim.
    of pregnancy
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17
Q

Iron dextran OR Iron
sucrose (I.M/ I.V)

  1. Indications
  2. A/E(4)
  3. CI(5)
A
  1. Indications
    severe iron deficiency
    in adults
  2. A/E(4);
    metallic taste,
    headache,
    hypotension, N&V
  3. CI(2)
    Iron overload,
    concurrent blood
    transfusion, liver
    disease, infection,
    history of allergies
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18
Q

Iron isomaltoside (I.V)

  1. Indications
  2. A/E(5)
  3. CI(5)
A
  1. Indications:
    iron deficiency
  2. A/E(4)
    N, rash, abdominal
    disorders,
    constipation, fever,
    dyspnoea
  3. CI(5)
    severe liver damage,
    iron overload,
    infection, acute renal
    failure, active RA, 1st
    trim. of pregnancy
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19
Q

Iron polymaltose (I.V)

  1. Indications
  2. A/E(4)
  3. CI(3)
A
  1. Indications;
    iron deficiency
  2. A/E(4)
    allergic reactions,
    fever, leukocytosis,
    tachycardia
  3. CI(3)
    haemolytic anaemia,
    severe liver damage,
    bone marrow
    depression
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20
Q

Parenteral Iron Preparations general S/E?(3)

A

 1.Anaphylactic reactions
 2.Urticaria
 3.Lymphadenopathy

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21
Q

Parenteral Iron Preparations allergies?

A

Parenteral iron preparations must be used with caution in
patients with history of asthma or allergies

22
Q

Anaemia of Chronic Disease characteristics ?

A

↓↓↓ RBC count

23
Q

Anaemia of Chronic Disease states?

A
  1. Infections
  2. Malignancy
  3. Diabetes
  4. Autoimmune disorders
24
Q

Anaemia of Chronic Disease Cause?

A

Continuous inflammation by Chronic Disease

-Impairs iron metabolism → ↓RBC production

25
Q

Anaemia of Chronic Disease Tx(3)?

A
  1. Resolve the underlying cause
  2. Blood transfusions for symptomatic anaemia
  3. Recombinant human erythropoietin (EPO); though expensive
26
Q

Erythropoietin (EPO)?

A

Glycosylated protein hormone, haematopoietic growth factor

27
Q

Erythropoietin (EPO) MOA?

A

stimulate erythropoiesis → increase RBC production

28
Q

Recombinant erythropoietins?

A
  1. Epoetin alfa & beta
  2. darbepoetin alfa
29
Q
A
30
Q

Erythropoietin (EPO) A/E?

A

1.Hypertension
2. Headache
3. Seizures
4. Flu-like symptoms
5.Rash
6. pruritus
7. injection site reaction

31
Q

Erythropoietin (EPO) CI(3)?

A

Uncontrolled
hypertension

myeloid
malignancy

known
hypersensitivity,
children <6 years,
untreated iron
deficiency

32
Q

Thalassaemia

A
33
Q

Erythropoietin (EPO) costs?

A

Expensive

34
Q

Sideroblastic Anaemia plasma concentrations ?

A

↑ serum iron, ↓TIBC, ↑ ferritin level

35
Q

Consequences of Immature RBC in bone marrow

A
  1. Can’t utilize iron for haem synthesis → iron accumulation in
    mitochondria
  2. Unused iron builds up in blood → ↓TIBC
36
Q

Sideroblastic Anaemia Dx(2)?

A
  1. Bone marrow biopsy
  2. genetic testing
37
Q

Sideroblastic Anaemia Tx?

A

Alcohol/meds cessation if that’s the cause;
vitamin/mineral supplementation;
bone marrow transplant.

38
Q

Megaloblastic Anaemia

A

Caused by a deficiency of folic acid and/or vitamin B → large, oval
(macrocytic), well haemoglobinised RBCs.

39
Q

Folic Acid Deficiency Anaemia?

A

Folic acid deficiency → insufficient DNA synthesi

40
Q

Folic Acid Deficiency Anaemia causes?

A

Insufficient intake in diet, alcoholism, pregnancy

41
Q

Folic Acid Deficiency Anaemia frequency?

A

Common in pregnancy and in the elderly

42
Q

Why must folate deficiency be differentiated from B deficiency?

A

Folate deficiency must be differentiated from B deficiency because folate
can reverse the haematological but not the neurological damage caused by B deficiency

43
Q

Types of megaloblastic Anaemia?

A
  1. Folic Acid Deficiency Anaemia
  2. Vitamin B Deficiency/ Pernicious
    Anaemia
44
Q

Vitamin B12 importance?

A

Vitamin B is essential for haematopoiesis,
maintenance of myelin and production of
epithelial cells

45
Q

Vitamin B Deficiency/ Pernicious
Anaemia causes?

A

Impaired absorption (lack of intrinsic factor bacterial overgrowth)

46
Q

Reason for admin for vitamin B12?

A

Oral absorption of Vit B is very poor, therefore it should be given parenterally

47
Q

Vit B12 target?

A

Vit B deficiency occurs specifically in adults

48
Q

Non-Pharmacological Treatment of Megaloblastic Anaemia?

A

Dietary modifications to ensure adequate intake of folate and vit B

49
Q

Megaloblastic Anaemia tx goals?

A
  1. Normalise Hb
  2. Identify and treat the underlying cause (e.g. malabsorption)
50
Q

Drug Treatment of megaloblastic anemia?

A

1.Folic acid; 5mg daily until normal Hb/ ↑demand stops (in pregnancy
give with Iron)

  1. Vitamin B 12 (Cyanocobalamin); IM, 1000μg, alternate days for 1
    week, then monthly for life.
51
Q

Aplastic Anaemia?

A

Anaemia caused by destruction or inhibition of red bone marrow

52
Q
A

Drugs (e.g. chloramphenicol), cancer chemotherapeutics, and
insecticides (e.g. DDT)

Pharmacology (44 decks)

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