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PHARM 243 (Midterm 2) > Anemia > Flashcards

Anemia Flashcards

1
Q

Hypochromic, Microcytic Anemia

A

Small RBC
Low Hemoglobin

  • Caused by chronic blood lose causing iron deficiency
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2
Q

Megaloblastic Anemia

A

Large RBC
RBC are few in number

  • Caused by Vit 12 / Folic Acid Deficiency
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3
Q

Pernicious Anemia

A

Normal RBC
RBC are fewer in number
Normal Hemoglobin

  • Lack of intrinsic factor, can not absorb Vit B12
    = Vitamin B12 Deficiency
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4
Q

Other Blood Cell Deficiencies (Anemia)

A

Erythrocytes
Neutrophils
Platelets

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5
Q

Causes of Anemia

A

Deficiency of Nutrients
- Iron
- Folic Acids and Vitamin B12
- B6 and Vitamin C

Bone Marrow Depression
- Less surface for RBC production
Caused by
- Drug toxicity (Clozapine)
- Exposure to radiation
- Bone Marrow Disease
- Reduced production of erythropoietin

Excessive Destruction of RBC

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6
Q

Drug Classes for Anemia Treatment

A

Hematinic Agent

Hematopoietic Growth Factors

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7
Q

Iron (Anemia)
- MOA

A

Iron is recycled through the body
Used for RBC production and is mostly contained as Hemoglobin

In 1 day about 0.8% of RBCs are broken down and iron is recycled

Senescent (Old) RBCS are taken up by the reticular system (Spleen and Macrophages) where they are relived of their iron

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8
Q

Iron (Anemia)
- Where?

A

Most iron is found in hemoglobin (65%)
Half of the rest is found as ferritin in the liver, spleen, and bone marrow

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9
Q

Iron (Anemia)
- Requirements

A

Men:
- 5 mg
Growing Child and Menstruating Women:
- 15 mg
Pregnant Women
- 2 to 10 times 5mg

Iron can be collected from meat usually present as heme iron (20-40%) for absorption

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10
Q

Iron (Anemia)
- Absorption Process

A
  1. Given as Ferric Sulfate (Fe3+)
  2. Ferric Reductase Enzyme converts it into Ferrous Iron (Fe2+) (GI Tract)
  3. Transported into plasma and stored intracellularly as ferritin (Duodenum and Jejunum)
  4. Any iron needed is transported by transferrin
    - Transported to liver for storage
    - Transported to bone marrow for further hemoglobin and RBC production
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11
Q

Iron (Anemia)
- Absorption Considerations

A

Iron should be taken on an empty stomach as some foods inhibit iron absorption

Ascorbic Acid (Vitamin C) enhances absorption of Iron

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12
Q

Iron (Anemia)
- Animal Foods vs Vegetarian Foods

A

Iron from animals is Ferrous
- Larger percent is available for absorption
Iron from vegetarian foods is Ferric
- Smaller percent is available for absorption

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13
Q

Iron (Anemia)
- Highest Sources of Iron

A

Dry Iron (Desiccated Iron) contains the most. Ex:
- Ferrous Sulfate contains the highest elemental iron
- Ferrous Fumarate contains the 2nd highest elemental iron

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14
Q

Iron (Anemia)
- Clinical Uses

A

Iron Deficiencies caused by:
- Chronic Blood Loss
- Increased Demand (Pregnant and Early Infancy)
- Inadequate Diet
- Inadequate Absorption (Celiac Disease, After Gastrectomy)

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15
Q

Iron (Anemia)
- Side Effects

A

Gastrointestinal Disturbances

If large amounts ingested can cause toxic effects (People with Thalassaemia are especially sensitive)

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16
Q

Folic Acid
- MOA

A

Folic Acid is reduced by Dihydrofolate Reductase
- Yields FH2 and FH4
–> These co-factors transfer methyl groups in several important metabolic pathways
–> FH 4 is essential for DNA synthesis

17
Q

Vitamin B12
- MOA

A

Converts Methyl-FH4 to FH 4

Converts Homocysteine to Methionine

FH 4 is essential for DNA synthesis

18
Q

Vitamin B12
- Indications

A

Megaloblastic and Macrocytic Anemia
- Caused by Vitamin B12 and Folic Acid deficiency

Pernicious Anemia
- Caused by Vitamin B12 deficiency

19
Q

Folic Acid
- Indications

A

Megaloblastic and Macrocytic Anemia
- Caused by Vitamin B12 and Folic Acid deficiency

Pernicious Anemia (Combine with B12)
- Caused by Vitamin B12 deficiency

Prevent Methotrexate Toxicity

20
Q

Erythropoietin
- MOA

A

Epoetin Alfa
Stimulates the production of RBC
- Synthesized in kidneys with small amount coming out of liver
- Released in response to hypoxia

  1. Is released by liver
  2. Binds to receptor on committed erythroid progenitor cells in bone marrow
  3. Binding to receptor on bone marrow induces intracellular effects through tyrosine kinase
  4. Inhibition of Apoptosis of RBC
  5. Also promotes proliferation through Janus Protein Kinase-2 Pathways (JAK2)

Result:
- Inhibits Apoptosis of RBC
- Promotes proliferation of RBC

21
Q

Erythropoietin
- Anemia

A

Renal Failure can cause Erythropoietin to become low which will result in anemia

22
Q

Erythropoietin
- Indication

A

Anemia

Renal Failure

Chemotherapy and AIDS

23
Q

Erythropoietin
- Adverse Effects

A

Iron Deficiency: Iron stores can not keep up with RBC production

Thrombosis: Patients on dialysis are at risk

Hypertension: Erythropoietin interacts with Angiotensin II which is vasoactive

Seizures: Patients on dialysis receiving epoetin Alfa are at risk

24
Q

Granulocyte Colony Stimulating Factors
- MOA

A

Filgrastim

  1. Bind to receptors on myeloid progenitor cells in Bone Marrow
  2. Affecting production of RBCs, Platelets, Granulocytes, and Monocytes
    - Mediated by Janus Protein Kinase/Signal Transducers and Activators of Transcription Pathway (JAK/STAT)

G-CSF:
- Stimulates proliferation and differentiation of progenitors that become neutrophils

25
Q

Granulocyte-Monocyte Colony Stimulating Factors
- MOA

A

Sargramostim

  1. Bind to receptors on myeloid progenitor cells in Bone Marrow
  2. Affecting production of RBCs, Platelets, Granulocytes, and Monocytes
    - Mediated by Janus Protein Kinase/Signal Transducers and Activators of Transcription Pathway (JAK/STAT)

M-CSF
- Stimulates production of neutrophils and monocytes
- Stimulates the actions of neutrophils, monocytes, and eosinophils
–> Actions: Phagocytosis, Superoxide production, and cell-mediated toxicity

26
Q

Granulocyte-Monocyte Colony Stimulating Factors
- Controls what actions?

A
  • Phagocytosis
  • Superoxide production
  • Cell-mediated toxicity
27
Q

Colony Stimulating Factors
- Indications

A

Given with Myelosuppressive Chemotherapy

Severe Chronic Neutropenia

Prevention and Treatment of Neutropenia in HIV Infection

28
Q

Colony Stimulating Factors
- Side Effects

A

Bone Loss: G-CSF increases Osteoclast activity

Joint Pain: G-CSF stimulate cytokine release

Renal Dysfunction: G-CSF cause renal impairment through clumping of leukocytes in kidney

Acute Respiratory Distress: G-CSF can lead to accumulation and activation of neutrophils in lung

Splenomegaly or Splenic Rupture: G-CSF can cause splenic ruptures

Sickle Cell Crises: Fatal in patients with Sickle Cell disorders as their Hemoglobin can not carry oxygen

29
Q

Megakaryocyte (Thrombopoietic) Growth Factors
- MOA

A

Oprelvekin (IL-11)
- Stimulate growth of megakaryocytic progenitors
- Increase number of peripheral platelets

30
Q

Megakaryocyte (Thrombopoietic) Growth Factors
- Indication

A

Treats thrombocytopenia after cancer chemotherapy

PHARM 243 (Midterm 2) (11 decks)

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