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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
Does iron def anemia affect: males or females more; young or old more; accompanies cancer or CDK?
females>males old>young Cancer and CDK
26
When iron intake is low, where does the body get the neccessary iron first?
The iron stores, then the circulating iron, then the red blood cell iron.
27
What happens to the serum ferritin as you begin to lose all your iron stores?
it begins to go down
28
What happens to the total iron binding capacity as you lose iron?
it begines to go up
29
In what order is iron restored to the body?
The RBCs first, then the serum ferritin, then the bone marrow stores.
30
What happens if you get too much iron in your system?
You begin to overflow your stores and you being to have symptoms of anemia but your arent anemic
31
Too much iron is called ____________-
hematochromotosis
32
What is normal Hgb?
13-14
33
What is normal MCV?
80-100
34
If someone is low MCV what is the next thing that needs to be done?
Check for ferritin stores
35
What could cause iron deficiency anemia?
blood loss
36
What does RDW tell us?
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
37
What is normal hemoglobin for males?
15.2 +/- 2 mg/dl
38
What is normal hemoglobin for females?
13.5 +/- 2 mg/dl
39
Low HgB indicateds ______ while high HgB indicates ________.
1) anemia | 2) polycythemia
40
WHat is the normal hematocrit for males an females?
males: 46 +/- 6% females: 41.0 +/- 6%
41
What is the normal RBC for females and males?
males: 4.3-5.9 million/uL females: 4.0-5.2 million/uL
42
What is the normal MCV for makes and females?
Males: 80-96 females: 82-98
43
Large cells are caused by _______ and small cells are caused by _______.
B-12 or folate deficiecny | Fe deficiency
44
If you have microcytic you could have _______ deficiency or _______ or _________
iron; thalassemias, underlying chronic disease
45
What is MCH?
mean Cell hemoglobin
46
Iron deficiecny has low MCH and low MCHC. TRUE or FALSE?
TRUE
47
In folate decificecy is MCH inc or dec?
increased
48
What are reticulocytes?; take about 1 day to mature. Under the influcence of EOP take 2-3 days longer because of early release
young RBC that still conatins a small amount of RNA
49
The retic count should be ____ of total RBC count.
1/120th
50
What is normal ferritin levels? This is the most sensitive lab test for iron
30-400ng/ml for males | 13-150ng/ml
51
What is Total iron binding capactiy (TIBC)?
shows if there is too much or too little iron in the blood.
52
What is the normal TIBC?
240-450 mcg/dL
53
Iron is carried in the blood attached ot the protein ________.
transferrin
54
High values of TIBC mean what?
Fe deficiency, pregnancy
55
What are the normal values of Serum Iron?
60-170mcg/dL
56
When are serum iron levels the highest?
In the morning
57
80% of normal bilirubin production is a result of the degradation of ________.
hemoglobin
58
In the absence of liver disease, indirect bilirubin is an ecellent indicator of RBc destruction. T or F?
True
59
What is the normal Serum Iron?
115 ug/dL
60
What is the normal Total iron binding capacity?
330
61
What is the normal Transferrin satuation %?
35
62
What is normal Serum Ferritin?
100
63
Erythrocytes
Normal
64
Stainable marrow Iron
2+
65
For oral replacement, ___ mg elemental Iron/day is best because only 5-20% is absorbed in the iron-deficient state.
200mg
66
Ferrous fumarate has how much ferrous iorn?
200mg (65 elemental)
67
Ferrous gluconate has how much Iron?
300mg (35mg)
68
If nausea, with iron how do you aleviate it?
Give with food
69
How much Iron is in the following: Ferrous Sulfate Ferrous gluconate Ferrous fumarate
65mg 39mg 33mg
70
What are the oral Iron products ADRs?
``` Abdominal pain Nausea Heartburn Constipation Dark stools ```
71
Should u use child-proof caps for pts taking iron?
Yes, 8 caps to a child is leathal
72
How long is therapy for Iron therapy?
4-6 months
73
How long can it take for iron therapy to respond?
7-14 days; Anemia begins to correct after 3wks; Hg correction takes about 2 months
74
What are some causes of tx failure with oral iron?
poor compliance poor absorption or oral iron wrong diagnosis
75
What are some IV options for Iron?
Ferrus Dextan Iron Saccharate Ferric Gluconate
76
When are IV doses of Iron used?
When pt doesnt respond to Oral doses or can't tolerate oral products
77
What are the dosses of Iron Dextran, Iron sucrose and ferric gluconate?
Iron Dextran: InFED: 50mg/ml Iron sucrose: Venofer: 20mg/ml Ferric gluconate: Ferrlecit: 62.5mg/5mL
78
For chronic kidney disease, which IV formulations are approved?
Dextran iron sucrose ferric gluconate
79
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?
Iron Dextran; 4-6 hours | Yes 0.5mL of iron dextran test dose is needed an you monitor for anaphylaxis for 1 hour
80
What three values will really let you know if it is Iron Deficeecy Anemia or Anemia of Chronic Disease?
Serum Ferritin Serum Iron TIBC MCV?
81
What are the two main types of megaloblastic anemia?
``` Folate Vit B12 (pernicious, deficient) ```
82
What are some symptoms of megaloblastic anemia?
``` 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
Lack of ____ or _____ prevents formation of DNA so RBC production does not occur or occurs abnormally
Folate or Vit B12
84
What is pernicious anemia?
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
How do your test if its B-12 or folic acid anemia?
Serum B12 levels or Serum Folate levels Red Cell folate
86
What is big beefy tongue a side effect of?
Vit B12 or folic acid
87
How do you tx Pernicious Anemia?
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
What is prevention of pernicious anemia?
post-gastrectomy pts should be given replacement therapy to prevent deficiency
89
What are some medications that alter B12?
``` Colchincine KCl PPIs Anticonvulsants neomycin ```
90
What causes Folic acid macrocytic anemia?
``` inadequate folate intake alcoholics teenagers some infants malabsorption impaired metabolism ```
91
What drugs cause malabsorption of folic acid?
barbituarates phenytoin oral contraceptives
92
What drugs cause impaired metabolism of oflic acid?
methotrexate
93
Do you need folate during pregnancy?
yes
94
How do you increase your folate consumption?
Green leafy veggies
95
How do you replace Folic acid deficiency?
You need 5-10mg of folic acid Oral folic acid 1mg PO QD for 2-3 weeks will replace stores
96
how long does it take to inc retic and Hct?
retic - 5-10 days | Hct - 2-4 weeks
97
What drugs cause a dec in absorption of folate?
``` PEP BIC Phenytoin Ethanol Primadone Barbiturates INH COC with mestranol ```
98
What drugs antagoize folate?
``` PPTTM Pyrimethamine Pentamidine Triamterene Trimethoprim Methotrexate ```
99
What is a common cause of microcytic anemia?
Thalassemai and iron deficiency
100
Is thalassemia deadly?
if homozygous, yes
101
How do you tell the difference between IDA and Thalassemia?
Iron in marrow | and low iron levels (iron is normal for Thalassemia)
102
What are some adverse effects of Epogen?
HTN,Seizures,Allergic reactions, thrombosis
103
how fast should your Hgb inc when on EPOGEn?
1g/dL ever 2 weeks
104
If GFR declines does the dose requirement for EPOGEn increase?
yes (kidney produces EPO)
105
What do you monitor when on EPO?
HTN, Hgb, Iron

Therapeutics IV Final Subjects (10 decks)

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