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Pharm III - Exam 3 > Anemia > Flashcards

Anemia Flashcards

1
Q

Treatment options of Fe deficiency anemia

A
  • Oral iron supplements (approx. 200 mg/day elemental iron)
  • Diet (meat, fish, poultry)
  • Parenteral iron
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2
Q

When is parenteral iron used in treatment of Fe deficiency anemia?

A
  • Iron malabsorption
  • Intolerance of oral therapy
  • Chronic non-compliance
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3
Q

Types of oral iron supplements and how much is elemental

A
  • Ferrous gluconate 300 mg (12% elemental)
  • Ferrous sulfate 300 mg (20%)
  • Ferrous fumarate 100 mg (33%)
  • Polysacch iron complex 150 mg (100%)
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4
Q

Types of parenteral iron

A
  • Iron dextran
  • Sodium ferric gluconate
  • Iron sucrose
  • Ferumoxytol
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5
Q

Which parenteral iron is more likely to cause anaphylaxis?

A

Iron dextran

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6
Q

Approximately how much elemental iron should be given each day in Fe deficiency anemia?

A

200 mg/day

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7
Q

1st line treatment of Vit B12 deficiency anemia?

A

PO cyanocobalamin (B12)

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8
Q

2nd line treatment of Vit B12 deficiency anemia?

A
  • IM/SC Canocobalamin DAILY until acute symptoms reside
  • Then weekly until Hgb/HCT normal
  • Then monthly indefinitely
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9
Q

What is Nascobal?

A
  • Nasal spray of B12
  • MAINTENANCE treatment of Vit B12 deficiency anemia
  • Expensive
  • 1 hr before or after ingestion of hot foods or beverages
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10
Q

Rare ADRs of Vit B12 therapy

A
  • Hyperuricemia
  • Hypokalemia
  • Sodium retention
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11
Q

Treatment of folic acid anemia

A
  • Oral folic acid IV/PO daily for about 4 months
  • Long term therapy sometimes indicated
  • Maintenance dose used in some patients
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12
Q

How is Nascobal dosed?

A
  • 1 spray in 1 nostril weekly
  • 1 hr before or after ingestion of hot foods or beverages
  • Each spray is 500 mcg
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13
Q

Treatment options for anemia of chronic disease?

A
  • RBC transfusions

- Erythropoiesis stimulating agents

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14
Q

When are RBC transfusions typically considered in pts with anemia from chronic disease?

A

Hgb 8-10 g/dL (or less)

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15
Q

Drawbacks of RBC transfusions in chronic anemia

A
  • Limited, expensive
  • Short term (doesn’t fix cause)
  • Infection risk
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16
Q

Describe erythropoiesis stimulating agents

A

Mimic body’s own EPO produced by kidneys

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17
Q

What agents are erythropoiesis stimulating agents?

A

Darbepoetin (Aranesp)
Epoetin alfa (Epogen, Procrit)
*Recombinant DNA available IV or SC (preferred)

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18
Q

What route is preferred when using erythropoiesis stimulating agents?

A

SC (but they are available IV too)

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19
Q

When are erythropoiesis stimulating agents indicated? What are the preferred agents for each indication?

A

Anemia secondary to:

  • Cancer (APE: Aranesp, Procrit, Epogen)
  • Renal disease (AEP)
  • Drug induced (AEP)
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20
Q

What should be given along with erythropoiesis stimulating agents?

A

Iron supplements to prevent deficiency (ESAs trigger rapid use of iron stores)

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21
Q

MOA of ESAs

A
  • Mimic EPO, circulate through vasculature and into BM
  • In BM, bind receptors on hematopoietic stem cells
  • Stimulus results in increased erythrogenesis
22
Q

Efficacy difference between Darbepoetin (Aranesp) and Epoetin alfa (Epogen, Procrit)?

A

NONE

23
Q

How does dosing of Darbepoetin (Aranesp) compare to Epoetin alfa?

A

Darbepoetin: longer half life allows less frequent dosing (once a week or less)

24
Q

How should ESAs be dosed in chemo patients?

A

Lowest effective dose to maintain lowest Hgb to prevent RBC transfusion (and don’t exceed Hgb of 11)

25
Q

How should ESAs be dose adjusted in chemo pts if Hgb response is less than 1 and remains under 10 after 4 weeks?

A
  • Epoetin: INCREASE to 60,000 units

- Darbepoetin: STAY at 500 mcg

26
Q

How should ESAs be dose adjusted in chemo pts if Hgb increases by more than 1 within 2 weeks?

A
  • Epoetin: reduce by 25% to 30,000 units

- Darbepoetin: reduce by 40% to 300 mcg

27
Q

When should ESAs be d/c in chemo pts?

A

No response in Hgb or still requiring RBC transfusion after:

  • 8 weeks of epoetin
  • 9 weeks of darbepoetin
28
Q

Max epoetin dose in renal patients?

A

Up to 20,000 units tiw

29
Q

Max epoetin dose in oncology pts?

A

60,000 units q week

30
Q

Max darbepoetin dose in oncology pts?

A

500 mcg q 3 weeks

31
Q

Warnings a/w ESA use

A
  • Increased mortality
  • Serious CV and thromboembolic events
  • Increased risk of tumor progression or recurrence
32
Q

In general, how should ESAs be dosed?

A

Individualized - use LOWEST dose to avoid RBC transfusion

33
Q

When are ESAs contraindicated?

A

Patients receiving myelosuppressive therapy when the anticipated outcome is CURE (bc ESAs may shorten overall survival and increase risk of tumor progression/recurrence)

34
Q

What is the ESA Apprise program?

A
  • Assisting Providers and cancer Patients with Risk Information for Safe use of ESAs
  • Prescribers/hospital designees must enroll to dispense Aranesp or Procrit to oncology pts
35
Q

Who needs to be enrolled in the ESA Apprise program?

A

Prescribers/hospital designees

Patients do NOT need to enroll

36
Q

In oncology patients, what are ESAs used for?

A

ONLY treatment of anemia due to concomitant myelosuppressive chemo (discontinue after completion of the chemo)

37
Q

What should be monitored routinely during ESA treatment?

A

Iron (monthly)

38
Q

How long could it take renal pts to see ESA treatment response in HCT/Hgb?

A

2-6 weeks

39
Q

How long could it take oncology pts to see ESA treatment response in HCT/Hgb?

A

4-8 weeks

40
Q

Response rate of oncology pts to ESAs?

A

Only about 60% oncology pts respond to ESA therapy

41
Q

Types of sickle cell crises

A
  • Vaso-occlusive (MC)
  • Aplastic
  • Hemolytic
  • Splenic sequestration (significant cause of mortality)
42
Q

Supportive and preventive treatment of sickle cell disease

A
  • Folic acid (prevents deficiency due to hyper-erythropoiesis)
  • Vaccines (HIB, pneumococcal)
  • Proph penicillin up to 5 yo
  • Hydroxyurea (increases Hgb-F)
43
Q

Treatment of sickle cell complications

A
  • RBC transfusions (in life threatening situations)

- HSCT

44
Q

What is the only potentially curative treatment of sickle cell disease?

A

HSCT (limited success, risk of treatment related toxicity, limited by availability of donors)

45
Q

Drawbacks of HSCT for sickle cell disease

A
  • Limited success
  • Risk of treatment related toxicity
  • Limited by availability of donors
46
Q

Drawbacks of RBC transfusions in sickle cell disease

A

May increase risk of transfusion reactions and iron overload

47
Q

Management of sickle cell crisis

A
  • Hydration w/saline based fluid (3-4 L/day, avoid overhydration)
  • Pain management (individualized)
48
Q

How do RBC transfusions work in sickle cell disease?

A

Dilutes concentration of RBCs containing Hgb-S

49
Q

When is splenectomy recommended in sickle cell disease?

A

Cases of severe splenic sequestration

50
Q

What should patients on hydroxyurea be monitored for?

A

Myelosuppression

Pharm III - Exam 3 (2 decks)

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