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Pharmacology > Anemia > Flashcards

Anemia Flashcards

1
Q

What is haemoglobin?

A

A protein consisting of four similar polypeptide chains

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2
Q

How does the release of oxygen molecules via haemoglobin occur?

A

Each polypeptide chain has a binding site for molecular oxygen -> partial pressure of oxygen in blood and tissues -> oxygen molecules released

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3
Q

What is haemoglobin level and give the normal ranges?

A

Concentration of haemoglobin per unit volume of blood
14g/dL - 17g/dL (men)
12g/dL - 15g/dL (women)

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4
Q

What is haematocrit and give the normal ranges?

A

% of blood volume composed of erythrocytes
42%-50% (men)
37% - 46% (women)

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5
Q

What is erythropoeitin?

A

Glycosylated protein

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6
Q

Where is EPO produced in the fetus vs the adult?

A 
Fetus = liver
Adult = kidney
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7
Q

Define anemia

A

Below normal

1) plasma haemaglobin [ ] due to decreased no of circulating RBCs
2) total haemoglobin content per unit of blood volume

<13.5 (men)
<11.5 (women)

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8
Q

Name symptoms of anemia

A 
CNS
- fatigue
- dizziness
- fainting
Eyes
- yellowing
Blood vessels
- low BP
Heart
- palpitations
- rapid HR
- chest pain
- angina
- heart attack
- arrythmias
Respiratory
- SOB
Muscular
- weakness
Spleen
- enlargement
Intestinal
- changes in stool colour
Skin
- pale
- cold
- yellowing
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9
Q

Name the categories of size variations of RBCs

A 
Normal
Microcyte
Macrocyte
Oval macrocyte
Hypochromic macrocyte
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10
Q

Name the categories of haemoglobin distribution in RBCs

A

Hypochromia 1+, 2+, 3+, 4+

Polychromia

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11
Q

Name the categories of shape variations of RBCs

A 
Target cell
Sphreocyte
Ovalocyte
Stomatocyte
Sickle cell
Acanthocyte
Helmet cell
Schistocyte
Tear drop
Burr cell
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12
Q

Name the categories of inclusions of RBCs

A

Pappenheimer bodies
Cabot’s ring
Basophilic stippling
Howell-Jolly

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13
Q

Name the categories of red cell distribution of RBCs

A

Agglutination

Rouleaux

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14
Q

Classify anemia by morphology

A
  1. MCV >98
    = Macrocytic
    - megaloblastic
    - non-megaloblastic
  2. Normal MCV
    = Normocytic
  3. MCV <78 / MCH <26
    = Microcytic
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15
Q

Name the most common causes of blood loss

A

Menstruation
Drug treatment eg NSAIDs
Pathology eg colon carcinoma
Parasitic infection

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16
Q

Name causes of bone marrow depression

A 
Drug toxicity (anticancer, clozapine)
Radiation exposure
BM diseases (idiopathic aplastic anemia, leukemia)
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17
Q

Which nutrients are necessary for haemopoeisis?

A 
Iron
Folic acid
Vitamin B12
Pyridoxine
Vitamin C
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18
Q

Name causes of decr production/response to EPO

A

Chronic renal failure
Rheumatoid arthritis
AIDS

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19
Q

Name causes of microcytic anemia

A

Iron deficiency
Thalassemia minor
Sideroblastic anemia
Long standing anemia of chronic disease

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20
Q

Name causes of megaloblastic anemia

A

Vitamin B12 deficiency

Folate deficiency

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21
Q

Name causes of non-megaloblastic anemia

A 
Alcohol
Liver cirrhosis
Reticulocytosis
Hypothyroidism
Marrow infiltration
Myelodysplastic syndrome
Myoproliferative disease
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22
Q

Name causes of vitamin B12 deficiency

A 
Pernicious anemia (lack of IF)
Tropical sprue/bacterial overgrowth
Ileal disease (Chron's)
Fish tapeworm
Diet (vegan)
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23
Q

Name causes of folate deficiency

A 
Diet (alcoholics)
Malabsorption (Coeliac's)
Incr cell turnover 
- pregnancy
- leukemia
- chronic haemolysis
- chronic inflammation
Anti-folate drugs
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24
Q

Name anti-folate drugs

A

Phenytoin

Methotrexate

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25
Q

Name causes of normocytic aenemia

A 
Bone marrow failure
- aplastic anemia
- ineffective erythropoesis
- infiltration
Anemia of chronic disease
Haemolytic anemia
- intracorpuscular
- extracorpuscular
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26
Q

Name causes of aplastic anemia

A 
Drugs (phenytoin, indomethacin, sulfonamides)
Radiation
SLE
Viral hepatitis
Pregnancy
Fanconi's syndrome
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27
Q

Name causes of ineffective erythropoesis

A

Myelodysplastic syndrome

Paroxysmal nocturnal hemoglobinuria

28
Q

Name causes of anemia of chronic disease

A 
Chronic inflammation (abscess, TB, CT disease)
Malignancy
Endocrine (hypothy, hypopit, Addison's)
Liver disease
CKD
Malnutrition
29
Q

Name causes of intracorpuscular haemolytic anemia

A 
Hereditary spherocytosis
Hereditary elliptocytosis
Haemoglobinopathies
- thalassemia
- PNH
- sickle cell disease
30
Q

Name causes of extracorpuscular haemolytic anemia

A 
Autoimmune
Incompatible blood transfusion
Hypersplenism
Trauma (prosthetic heart valves, marathon runner)
Microangiopathys (DIC)
Toxic (malaria)
31
Q

Name causes of bone marrow failure due to infiltration

A 
Leukemia
Lymphoma
Myeloma
Granuloma
Myelofibrosis
32
Q

Name signs of anemia

A 
Pallor
Tachycardia
Wide pulse pressure
Systolic ejection murmurs
- rise in CO and HR
33
Q

How can you treat anemia?

A

Dependent on the cause

34
Q

Name the adverse effects of cyanocobalamin

A 
Injection site pain
Arthralgia
Dizziness
Headache
Nasopharyngitis
Anaphylaxis
35
Q

Name potential drug interactions with cyanobalamin

A

PPIs decrease B12 oral absorption

36
Q

Name the adverse effects of erythropoietin/epoetin alfa

A 
Oedema
Pruritis
N+V
Hyperension
CVA
Thrombosis
37
Q

Name potential drug interactions with erythropoietin/epoetin alfa

A

Darbepoeitin alfa -> incr adverse events

38
Q

Name the adverse effects of darbepoetin alfa

A 
Oedema
Dyspnoea
Hypertension
CVA
Thrombosis
39
Q

Name potential drug interactions with darbapoetin alfa

A

Epoetin alfa => adverse events

40
Q

Name the adverse effects of folic acid

A

Bad taste in mouth
Nausea
Confusion
Irratibility

41
Q

Name potential drug interactions with folic acid

A

Cholestyramine can interfere with its absorption

42
Q

Name the adverse effects of iron

A 
Pruritis
NVD
Constipation
Headache
Anaphylaxis
43
Q

Name potential drug interactions with iron

A

Deferoxamine/dimercaprol

Chelate iron

44
Q

Name treatment options for sickle cell anemia

A

Hydroxyurea

Pentoxifylline

45
Q

Name the adverse effects of hydroxyurea

A

Myelosuppresion
Skin ulcers
Secondary leukemia

46
Q

Name potential drug interactions with hydroxyurea

A 
HIV medications
- decr CD4 count
Salicylates
- incr bleeding risk
Probenecid
- incr uric acid
47
Q

Name the adverse effects of pentoxifylline

A

NV
Thrombocytopenia
Jaundice
Anaphylaxis

48
Q

Name potential drug interactions with pentoxifylline

A

Ketorolac
- incr bleeding risk
Gingko biloba
- incr antiplatelet effect

49
Q

Name the available iron formulations

A 
Ferrous gluconate
Ferric ammonium citrate
Ferrous sulfate
Anhydrous ferrous sulfate
Ferrous fumarate
Carbonyl iron
Polysaccharide-iron complex
50
Q

Give the brand name(s) of ferrous gluconate

A

Fergon

51
Q

Give the brand name(s) of ferric ammonium citrate

A

Iron citrate

52
Q

Give the brand name(s) of ferrous sulfate

A

Fer-in-sol

Feosol

53
Q

Give the brand name(s) of ferrous fumarate

A

Slow-FE

54
Q

Give the brand name(s) of carbonyl iron

A

Ferretts
Ferrimin
Hemocyte

55
Q

Give the brand name(s) of polysaccharide-iron complex

A

Nu-iron 150

Niferex

56
Q

Discuss the use of ferrous gluconate

A

12% elemental iron

Less elemental iron that FS but similar tolerability

57
Q

Discuss the use of ferric ammonium citrate

A

18% elemental iron
Less bioavailable than ferrous salts
Intestine needs to reduce it to ferrous form

58
Q

Discuss the use of ferrous sulfate

A 
20% elemental iron
Most common supplement
Low cost
Good effectiveness
Good tolerability
59
Q

Discuss the use of anhydrous ferrous sulfate

A

30% elemental iron
Extended release formulation
Higher cost

60
Q

Discuss the use of ferrous fumarate

A

33% elemental iron
Similar effectiveness + tolerability to FS
Almost no taste vs other iron salts

61
Q

Discuss the use of carbonyl iron

A

100% elemental iron
Microparticles of purified iron
Dissolves in stomach to form HCl salt -> absorbed
Less toxic than iron salts due to slower absorption rate

62
Q

Discuss the use of polysaccharide-iron complex

A

100% elemental iron
Tasteless
Odourless
Similar bioavailability to FS

63
Q

How can you administer erythropoietin?

A

IV
Subcutaneously
Intraperitoneally

64
Q

Name adverse effects of EPO

A

Transient flu-like symptoms
Hypertension
Iron deficiency
Incr blood viscosity

65
Q

Which drug exacerbates the anemia of AIDS?

A

Zidovudine

Pharmacology (32 decks)

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