Anemia

Question 1

Epoetin alfa, Darbepoetin alfa

Answer 1

Anemia
Erythropoiesis Stimulating Agents (ESA)
Therapeutic Use
- secondary anemia due to chronic renal disease (Renal Failure)
─ *primary bone marrow disorders (select patients)
─ prevents Transfusion for PTs w/:
a) ↓Preop [Hgb]
b) ↓Retic count
─ HIV PT, CA PT with Myelosuppressive Chemo, PT preop for Elective, Noncardiac, Nonvasc Sx.
MOA
• ↑EPO when ↓Hct
• a TYR-Kinase (in a JAK-STAT Pathway) ⇒⇒changes in Gene Expression.
ADE
─ HTN
─ BLACK BOX1: Thrombotic complications (MI, Stroke, DVT,
─ BLACK BOX2:
CA PT’s: ↑Tumor progression/Recurrance & ↓Survival.

Question 2

Ferrous sulfate, IV iron

Answer 2

Anemia
Iron
Theraputic
─ Iron deficiency
─ Insufficient hemoglobin
Oral iron therapy
─ *Ferrous sulfate
─ *Ferrous gluconate
─ *Ferrous fumerate
Parenteral iron therapy (for PT unable to tolerate/absorb oral Fe (ex: Anemic due to Chronic Kidney Disease (CKD))
─ *Iron dextran
─ *Sodium, ferric gluconate complex (only IV)  
─ *Iron sucrose complex (only IV)
ADE

─ Toxic/Death to PEDS: Store in child proof lid
─ Nausea
─ Epigastric discomfort
─ Abdominal cramps
─ Constipation
─ Diarrhea
─ *black stools
A/E (Parenteral iron therapy)
─ *Always give test dose of IV to check Hypersensitivity
A/E (iron dextran)
─ Headache
─ Light-headedness
─ Fever
─ Arthralgias (joint pain)
─ Nausea/Vomiting 
─ Anaphylaxis (more likely) – high-MW iron dextran
A/E (Iron overload = excess Fe)
─ Iron in heart, liver, pancreas, and other organs

Question 3

Deferoxamine

Answer 3

Anemia
Iron
─ Potent iron-chelating drug
─ Chelation removal of metal from body
─ Test dose given to check for reaction
**~“Antidote” for Fe-Overload
ADE 
─ *orange and red urine (during therapy)
─ skin Irritation around needle
Rare
─ Headache
─ Upset stomach
─ Nausea & diarrhea
─ Dizziness

Question 4

Vitamin B12 (aka) Cyanocobalamin

Answer 4

Anemia
Therapeutic Use
─ *megaloblastic, macrocytic anemia (due to Vit B12 Deficiency)
─ *Correction of B12 deficiency arrests but may not restore neurologic symptoms that have been present for several months
─ *Pernicious anemia
MOA
• Impt Role in DNA Synthesis:
─ Vitamin B12 Deficiency
─ Deficiency of B12 leads to megaloblastic, macrocytic anemia often associated with Mild or moderate leukopenia or thrombocytopenia

Question 5

Folic acid

Answer 5

Anemia
Therapeutic Use
─ *Megaloblastic anemia
─ can restore anemia due to B12 but will not help neurological syndromes due to B12 deficiency
MOA
• Impt Role in DNA Synthesis:
─ Folic Acid: Essential biochemical reactions of amino acids, purines, and DNA
• Folate Deficiency results in megaloblastic, macrocytic anemia
─ Also Neural Tube Defects i.e. Spina bifida