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Therapeutics IV Final Subjects > Anemia > Flashcards

Anemia Flashcards

1
Q

What cell is a biconclave disc with no nucleus and contains hemoglobin which colors the cell red?

A

The Red blood Cell

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2
Q

Anemia is just a ________, the way you get anemia is the diagnosis.

A

Symptom

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3
Q

What is the definition of anemia?

A

blood oxygen levels are too low to support normal metabolism; lower than normal oxygen-carrying capacity

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4
Q

icrocytic

A

small cells

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5
Q

macrocytic

A

where the cells are too big

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6
Q

deficiency related anemia

A

from lower than needed levels of something (ie. bleeding may cause iron deficecny anemia)

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7
Q

Congenital anemia

A

Born with it (sickle cell)

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8
Q

hypochromic

A

less than pale red blood cell

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9
Q

production releated anemia

A

inability to produce cells, low in EPO

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10
Q

destruction related anemia

A

hemolytic anemia the cells lyse

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11
Q

What is the normal cycle of Erythropoiesis from the stimulus of Dec blood oxygen?

A

When the kidneys sense low blood oxygen it inc the production of erythropoietin (EPO) which travels to the bone to inc the production of red blood cells, which contain hemoglobin to carry more oxygen

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12
Q

What are the 7 factors needed for erythropoiesis?

A

EPO, Iron, Vit B12, Folic Acid, Ascorbic Acid, Pyridoxine, Amino Acids

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13
Q

What is normal hematocrit?

A

Just the Red blood cells, not the plasma or WBC or platelets; it normally around 50 for males and 45 for females

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14
Q

When diagnosis anemia you should first take labs and then ask about symptoms because the symptoms can be very general

A

True

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15
Q

What are some clinical symptoms of iron deficiency?

A

pallor of the face, lips, and tongue; atrophic glossitis and angular stomatitis

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16
Q

Iron deficiency anemia results from 3 things, list them.

A

1) a secondary result of bleeding
2) inadequate intake of iron-containing foods
3) Impaired iron absorption

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17
Q

What is pernicious anemia and what does it result from? What type of diet can contribute to this type of anemia?

A

a deficiency of vit B12 in the serum;
Results from: 1) deficiency of vit B12
2) lack of intrinsic factor needed for absorption of B12

Vegan diets

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18
Q

How can you get folic acid deficiency anemia?

A

From dec intake or absorption

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19
Q

What two types of anemia cause abnormal hemoglobin?

A

Thalassemias and Sickle-cell anemia

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20
Q

What causes Thalassemias?

A

absent or faulty globin chain in hemoglobin

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21
Q

What do the RBCs in thalassemias look like?

A

thin, delicate, and deficient in hemoglobin

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22
Q

What is skickle cell anemia and what causes it?

A

RBCs are sickle shaped in low oxygen conditions because it has a defective gene coding for an abnormal hemoglobin called hemoglobin S (HbS) that is a since amino acid subsitiution in the beta chain

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23
Q

What is polycythemia?

A

excess RBCs which cause viscosity

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24
Q

What are some risk factors of iron deficiency anemia?

A

age, sex, reporduction, renal fialure, GI tract issues, apsiran and NSAIDs, diet (vegetarians), pregnancy, infancy, breast feeding

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25
Q

Does iron def anemia affect: males or females more; young or old more; accompanies cancer or CDK?

A

females>males
old>young
Cancer and CDK

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26
Q

When iron intake is low, where does the body get the neccessary iron first?

A

The iron stores, then the circulating iron, then the red blood cell iron.

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27
Q

What happens to the serum ferritin as you begin to lose all your iron stores?

A

it begins to go down

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28
Q

What happens to the total iron binding capacity as you lose iron?

A

it begines to go up

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29
Q

In what order is iron restored to the body?

A

The RBCs first, then the serum ferritin, then the bone marrow stores.

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30
Q

What happens if you get too much iron in your system?

A

You begin to overflow your stores and you being to have symptoms of anemia but your arent anemic

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31
Q

Too much iron is called ____________-

A

hematochromotosis

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32
Q

What is normal Hgb?

A

13-14

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33
Q

What is normal MCV?

A

80-100

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34
Q

If someone is low MCV what is the next thing that needs to be done?

A

Check for ferritin stores

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35
Q

What could cause iron deficiency anemia?

A

blood loss

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36
Q

What does RDW tell us?

A

Variation of size of cells this can tell us that regular cells are mixedi n with abnormal cells and can tell if the anemia is early on

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37
Q

What is normal hemoglobin for males?

A

15.2 +/- 2 mg/dl

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38
Q

What is normal hemoglobin for females?

A

13.5 +/- 2 mg/dl

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39
Q

Low HgB indicateds ______ while high HgB indicates ________.

A

1) anemia

2) polycythemia

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40
Q

WHat is the normal hematocrit for males an females?

A

males: 46 +/- 6%
females: 41.0 +/- 6%

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41
Q

What is the normal RBC for females and males?

A

males: 4.3-5.9 million/uL
females: 4.0-5.2 million/uL

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42
Q

What is the normal MCV for makes and females?

A

Males: 80-96
females: 82-98

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43
Q

Large cells are caused by _______ and small cells are caused by _______.

A

B-12 or folate deficiecny

Fe deficiency

44
Q

If you have microcytic you could have _______ deficiency or _______ or _________

A

iron; thalassemias, underlying chronic disease

45
Q

What is MCH?

A

mean Cell hemoglobin

46
Q

Iron deficiecny has low MCH and low MCHC. TRUE or FALSE?

A

TRUE

47
Q

In folate decificecy is MCH inc or dec?

A

increased

48
Q

What are reticulocytes?; take about 1 day to mature. Under the influcence of EOP take 2-3 days longer because of early release

A

young RBC that still conatins a small amount of RNA

49
Q

The retic count should be ____ of total RBC count.

A

1/120th

50
Q

What is normal ferritin levels? This is the most sensitive lab test for iron

A

30-400ng/ml for males

13-150ng/ml

51
Q

What is Total iron binding capactiy (TIBC)?

A

shows if there is too much or too little iron in the blood.

52
Q

What is the normal TIBC?

A

240-450 mcg/dL

53
Q

Iron is carried in the blood attached ot the protein ________.

A

transferrin

54
Q

High values of TIBC mean what?

A

Fe deficiency, pregnancy

55
Q

What are the normal values of Serum Iron?

A

60-170mcg/dL

56
Q

When are serum iron levels the highest?

A

In the morning

57
Q

80% of normal bilirubin production is a result of the degradation of ________.

A

hemoglobin

58
Q

In the absence of liver disease, indirect bilirubin is an ecellent indicator of RBc destruction. T or F?

A

True

59
Q

What is the normal Serum Iron?

A

115 ug/dL

60
Q

What is the normal Total iron binding capacity?

A

330

61
Q

What is the normal Transferrin satuation %?

A

35

62
Q

What is normal Serum Ferritin?

A

100

63
Q

Erythrocytes

A

Normal

64
Q

Stainable marrow Iron

A

2+

65
Q

For oral replacement, ___ mg elemental Iron/day is best because only 5-20% is absorbed in the iron-deficient state.

A

200mg

66
Q

Ferrous fumarate has how much ferrous iorn?

A

200mg (65 elemental)

67
Q

Ferrous gluconate has how much Iron?

A

300mg (35mg)

68
Q

If nausea, with iron how do you aleviate it?

A

Give with food

69
Q

How much Iron is in the following:
Ferrous Sulfate
Ferrous gluconate
Ferrous fumarate

A

65mg
39mg
33mg

70
Q

What are the oral Iron products ADRs?

A 
Abdominal pain
Nausea
Heartburn
Constipation
Dark stools
71
Q

Should u use child-proof caps for pts taking iron?

A

Yes, 8 caps to a child is leathal

72
Q

How long is therapy for Iron therapy?

A

4-6 months

73
Q

How long can it take for iron therapy to respond?

A

7-14 days; Anemia begins to correct after 3wks; Hg correction takes about 2 months

74
Q

What are some causes of tx failure with oral iron?

A

poor compliance
poor absorption or oral iron
wrong diagnosis

75
Q

What are some IV options for Iron?

A

Ferrus Dextan
Iron Saccharate
Ferric Gluconate

76
Q

When are IV doses of Iron used?

A

When pt doesnt respond to Oral doses or can’t tolerate oral products

77
Q

What are the dosses of Iron Dextran, Iron sucrose and ferric gluconate?

A

Iron Dextran: InFED: 50mg/ml
Iron sucrose: Venofer: 20mg/ml
Ferric gluconate: Ferrlecit: 62.5mg/5mL

78
Q

For chronic kidney disease, which IV formulations are approved?

A

Dextran
iron sucrose
ferric gluconate

79
Q

For Iron deficiency which IV iron product is approved? How long is it infused over? Is a test dose required and what do you monitor for?

A

Iron Dextran; 4-6 hours

Yes 0.5mL of iron dextran test dose is needed an you monitor for anaphylaxis for 1 hour

80
Q

What three values will really let you know if it is Iron Deficeecy Anemia or Anemia of Chronic Disease?

A

Serum Ferritin
Serum Iron
TIBC
MCV?

81
Q

What are the two main types of megaloblastic anemia?

A 
Folate
Vit B12 (pernicious, deficient)
82
Q

What are some symptoms of megaloblastic anemia?

A 
LARGE CELLS
Low retic count
bilirubin is inc
Fatigue
sore pale
constipation
diarrhea
anorexia
edema
urticaria
worsening of pulmonary or cardiac conditions
 smooth tongue
83
Q

Lack of ____ or _____ prevents formation of DNA so RBC production does not occur or occurs abnormally

A

Folate or Vit B12

84
Q

What is pernicious anemia?

A

anemia caused by an autoimmune disease that destroys the parietal cells of the stomach that then doesn’t product intrinsic factor to help absorb vit B12

85
Q

How do your test if its B-12 or folic acid anemia?

A

Serum B12 levels
or
Serum Folate levels
Red Cell folate

86
Q

What is big beefy tongue a side effect of?

A

Vit B12 or folic acid

87
Q

How do you tx Pernicious Anemia?

A

replace B12 stores with 30-100mcg of cyanocobalamin IM or SQ daily for 2-3 weeks

Long term replacement therapy with IM cyanocobalamin every 2-4 weeks (dose is 100-200mcg)

Oral B12 is not available in US

88
Q

What is prevention of pernicious anemia?

A

post-gastrectomy pts should be given replacement therapy to prevent deficiency

89
Q

What are some medications that alter B12?

A 
Colchincine
KCl
PPIs
Anticonvulsants
neomycin
90
Q

What causes Folic acid macrocytic anemia?

A 
inadequate folate intake
alcoholics
teenagers
some infants
malabsorption
impaired metabolism
91
Q

What drugs cause malabsorption of folic acid?

A

barbituarates
phenytoin
oral contraceptives

92
Q

What drugs cause impaired metabolism of oflic acid?

A

methotrexate

93
Q

Do you need folate during pregnancy?

A

yes

94
Q

How do you increase your folate consumption?

A

Green leafy veggies

95
Q

How do you replace Folic acid deficiency?

A

You need 5-10mg of folic acid

Oral folic acid 1mg PO QD for 2-3 weeks will replace stores

96
Q

how long does it take to inc retic and Hct?

A

retic - 5-10 days

Hct - 2-4 weeks

97
Q

What drugs cause a dec in absorption of folate?

A 
PEP BIC
Phenytoin
Ethanol
Primadone
Barbiturates
INH
COC with mestranol
98
Q

What drugs antagoize folate?

A 
PPTTM
Pyrimethamine
Pentamidine
Triamterene
Trimethoprim
Methotrexate
99
Q

What is a common cause of microcytic anemia?

A

Thalassemai and iron deficiency

100
Q

Is thalassemia deadly?

A

if homozygous, yes

101
Q

How do you tell the difference between IDA and Thalassemia?

A

Iron in marrow

and low iron levels (iron is normal for Thalassemia)

102
Q

What are some adverse effects of Epogen?

A

HTN,Seizures,Allergic reactions, thrombosis

103
Q

how fast should your Hgb inc when on EPOGEn?

A

1g/dL ever 2 weeks

104
Q

If GFR declines does the dose requirement for EPOGEn increase?

A

yes (kidney produces EPO)

105
Q

What do you monitor when on EPO?

A

HTN, Hgb, Iron

Therapeutics IV Final Subjects (10 decks)

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