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NAPLEX - OUR cards > Anemia > Flashcards

Anemia Flashcards

1
Q

Anemia definition

A

decreased hemoglobin and hematocrit conc below normal levels

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2
Q

Immature RBC’s

A

reticulocytes

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3
Q

mature RBC

A

erythrocytes

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4
Q

lifespan of RBC

A

120 days

Recycled by spleen

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5
Q

Common causes of anemia

A

iron, folate, b12 deficiencies
CKD
Malignancy

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6
Q

Symptoms of anemia

A 
Fatigue 
weakness
SOB
exercise intolerance 
HA 
dizziness
anorexia
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7
Q

Specific symptoms of iron deficiency anemia

A

glossitis (inflamed, sore tonuge)
thin, concaved nails
pica (craving and eating non-foods (ie chalk) WTF

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8
Q

Specific symptoms of B12 anemia

A

neurologic symptoms

psychiatric symptoms

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9
Q

What lab value is used to determine the type of anemia?

A

Mean corpuscular volume (MCV) - size of RBCs
Low MCV - microcytic
High MCV- macrocytic

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10
Q

Normal MCV value

A

80 - 100

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11
Q

Microcytic anemias

A

iron

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12
Q

Macrocytic anemias

A

Folate of Vit B12

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13
Q

Normocytic anemias

A

caused by some comorbid condition

CKD, cancer, etc

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14
Q

recommended dose for iron deficiency anemia

A

100- 200 mg elemental iron per day

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15
Q

Things that decrease iron absoprtion

A

food (take on empty stomach unless GI upset occurs)

acid suppressing agents (PPIs)

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16
Q

% elemental iron of ferrous gluconate

A

12%

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17
Q

% elemental iron of ferrous sulfate

A

20 %

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18
Q

% elemental iron of ferrous fumurate

A

33%

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19
Q

% elemental iron of carbonyl iron/polysaccharide iron complex

A

100 %

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20
Q

Main side effects of oral iron therapy

A

nausea, stomach upset
constipation
Dark and tarry stools

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21
Q

Preferred agent to treat iron-induced constipation

A

docusate

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22
Q

Antidote for iron overdose (common in children)

A

deferoxamine (Desferal)

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23
Q

Coadmin of iron and antacids/PPIs/H2RAs

A

take iron 2 hours before or 4 hours after antacids

24
Q

Drug classes that should be separated from iron

A

quinolones and tetracycline (2 hrs before 4-8 hrs after)
bisphosphonates (take iron 60 mins after)
Levothyroxine (2-4 hrs after)

25
Q

What can increase the absorption of iron?

A

Vit C –> creates more acidic environment in stomach

26
Q

When might IV iron be used?

A

Pts with CKD on hemodialysis

27
Q

Ferrlecit

A

sodium ferric gluconate IV

28
Q

Venofer

A

Iron sucrose IV

29
Q

Feraheme

A

ferumoxytol IV

30
Q

Pernicious anemia definition

A

most common cause of B12 anemia

lack of intrinsic factor – decr absorption of vit b 12

31
Q

Long-term (> 2 yrs) use of which drugs decr B12 absorption?

A

metformin
H2RAs
PPIs

32
Q

Folic acid/B 12 anemias are classified as what type of anemia?

A

Macrocytic anemia

MVC > 100 (large RBCs)

33
Q

Which anemia can lead to serious neurlogic issues if not treated?

A

B 12 deficiency

34
Q

What admin route is first line for treating B 12 anemia with severe deficiency or neurologic symptoms?

A

IM or deep SC injection

Don’t have to worry about variable oral absorption

35
Q

Dose of cyanocobalamin injection

A

1000 mcg

36
Q

dose of oral cyanocobalamin

A

1000- 2000 mcg daily

37
Q

Vit b12 nasal spray

A

Nascobal

500 mcg in one nostril once weekly

38
Q

folic acid dose

A

0.4-1 mg daily

39
Q

Underlying cause of anemia in CKD

A

deficiency of erythropoietin, which is produced by the kidneys and stimulates bone marrow to produce RBCs

40
Q

Epogen

Procrit

A

epoetin alfa

41
Q

When would you initiate Epogen?

A

when HGB is < 10

42
Q

When would you decr or stop dose of Epogen

A

when Hgb > 11 (on HD)

WHen Hgb > 10 (not on HD)

43
Q

How often can you increase the dose of Epogen?

A

Every 4 weeks

44
Q

How often is Epogen dosed?

A

Usually 3X/week

45
Q

Darbepoetin

A

Aranesp

46
Q

How often is Aranesp dosed?

A

once weekly (longer t 1/2)

47
Q

Aranesp and Epogen are classified as….

A

Erythropoiesis-stimualting agents (ESAs)

48
Q

ESAs are still effective if Iron stores are low (t/f)

A

False

most supplement iron too

49
Q

1st line iron treatment for pts on HD?

A

IV iron

50
Q

Aplastic anemia

A

bone marrow does not make enough RBCs, WBCs, platelets

51
Q

What medications can be used to treat aplastic anemia?

A

immunosuppressants
stem cell transplant/ blood transfusion
Eltrombopag (Promacta) - incr platelet coount

52
Q

Hemolytic anemia

A

develops when RBCs are prematurely destroyed

commonly drug-induced or autoimmune

53
Q

Test for hemolytic anemia

A

Coombs test

detects antibodies that bind to RBCs

54
Q

Genetic cause of hemolytic anemia

A

G6PD deficiency

G6PD - protects RBCs from being destroyed by reactive oxygen species and more

55
Q

Various drugs that can cause hemolytic anemia

A 
Beta-lactamase inhibitors 
Cephalosporins
penicllins
rifampin
platinum based chemo
Levodopa
Methyldopa
isoniazid

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