Anemia and Clotting Factors Pharm

Question 1

What are the 6 most common symptoms of anemia?

Answer 1

Fatigue, dizziness, pale skin, cold hands and feet, SOB, and irregular heartbeat

Question 2

What is the most common nutritional deficiency of anemia?

Answer 2

Iron deficiency

Question 3

How do we excrete iron from the body and what protein regulates absorption of iron?

Answer 3

The key here is we don’t have a mechanism to excrete it. Blood loss is the big key here or sloughing it off when it is in cells.

Hepcidin

Question 4

Basically, what is the main problem with hypochromic microcytic anemia?

Answer 4

Not enough hemoglobin

Question 5

3 main types of causes of microcytic anemia and give examples of each?

Answer 5

Reduced iron availability, so iron deficiency or inflammation
Reduced heme synthesis, sideroblastic anemia
Reduced globin production, like thalassemia

Question 6

What 3 food groups do we get iron from?

Answer 6

Meat, fish, poultry

Question 7

How do we most commonly administer iron supplement, what is the dose and how often per day, and what should patients usually take the iron with and why?
What are the 3 iron types we give and what 2 features of the iron pill do we want to avoid?

Answer 7

Oral
200-400 mg of 2-3 divided doses a day with water or juice. Food blocks absorption.
Ferrous sulfate, ferrous gluconate, ferrous fumarate not enteric coated and not sustained release

Question 8

What if the patient can’t do oral iron, what do we do and what are the 3 options?

Answer 8

Parenteral iron

Iron dextran, sodium ferric gluconate complex, iron sucrose complex

Question 9

4 adverse effects of iron supplementation?

Answer 9

Gi, heart burn, anorexia, and dark stools

Question 10

Acute iron toxicity is seen almost exclusively in what patient population?
What is the problem it causes and the symptoms that follow?
2 things to treat it?

Answer 10

Young children who accidentally eat iron tablets.
Necrotizing gastroenteritis leading to vomiting, abdominal pain, and bloody diarhrea.
Irrigate the whole bowel and give deferoxamine which is a potent iron cheating agent

Question 11

What is the problem with chronic iron toxicity?

Answer 11

The iron will deposit into organs like the heart, pancreas, liver and cause organ failure and death.

Question 12

3 main functions of vitamin b12 he mentioned?

Answer 12

Metabolism, RBC formation and maintenance of CNS

Question 13

If body stores of b12 are depleted, what is the rapid onset of symptoms that follow?

Answer 13

Neuro dysfunction

Weakness, paresis, spasticity

Question 14

3 different autoantibodies in pernicious anemia?

Answer 14

Autoantibodies against the IF-b12 complex
Autoantibodies against IF-b12 receptors on the ileum
Autoantibodies against sodium potassium atpase pump on parietal cells

Question 15

What is the b12 supplementation of choice for deficiency?

Answer 15

Oral b12, even in pernicious

Question 16

In what setting would we use parenteral therapy of b12?

Answer 16

Neuro symptoms

Question 17

What is the usual cause of folate deficiency?

Answer 17

Poor diet including alcohol

Question 18

What is the treatment of choice for folate deficiency? What are the two adverse effects of high doses of folate?

Answer 18

Oral folate

Hypotension and hypoglycemia

Question 19

What was the point of the article he mentioned about folate supplementation and its effect on b12?

Answer 19

In the elderly, folate can increase the risk of masking megaloblastic anemia caused by b12 deficiency

Question 20

What is the effect of using Epoetin alfa and what are the three clinical scenarios you would use it in?
What is the main difference between darbepoetin and epoetin?

Answer 20

Increase EPO
Chronic kidney disease, cancer chemo, being treated for HIV. Chronic inflammation situations.
Darb has a longer half life.

Question 21

What are the major categories of serious complications of epoetin?

Answer 21

MI, stroke, thrombi, etc.

Question 22

What is the only approved drug for sickle cell anemia? What is the MOA for it?

Answer 22

Hydroxyurea

Targets ribonucleotide reductase which arrests the cell cycle in the s phase

Question 23

4 side effects of hydroxyurea?

Answer 23

Cough/hoarseness
Fever/chills
Back pain
Hurts when you piss

Question 24

What do we use eculizumab for and what is the MOA?

Answer 24

Paroxysmal nocturnal hemoglobinuria

Basically takes out C5 to prevent complement causing intravascular hemolysis

Question 25

Big time adverse effect for using eculizumab?

Answer 25

Life threatening meningococcal infections so give vaccine prior to using

Question 26

6 common symptoms of neutropenia?

Answer 26

Low grade fever, sore mouth, difficulty swallowing, gums swell, skin abscesses, and recurrent infections.

Question 27

Route of administration for epoetin, hydroxyurea, and eculizumab?

Answer 27

IV, oral, and IV

Question 28

What is considered a neutropenic fever and in what patients are these life threading?

Answer 28

One time temp check over 38.3 or 101 for a fever for greater than an hour
Chemo patients

Question 29

What score on the MASCC risk index for febrile neutropenia is high risk?

Answer 29

Less than or equal to 21