Anemia Drugs

Question 1

Iron oral therapy

Answer 1

o Ferrous sulfate
o Ferrous gluconate
o Ferrous fumarate

Question 2

Parenteral iron therapy

Answer 2

Iron dextran (risk of type I hypersensitivity )
Sodium ferric gluconate complex
Iron sucrose

Question 3

Acute iron toxicity presentation

Answer 3

Iron is a direct GI tract irritant which causes acute vomiting, diarrhea, abdominal pain, mucosal ulceration, and bleeding.

As the regulatory enterocyte barrier is compromised, free iron passes unimpeded into the blood.

Metabolic acidosis

Question 4

Treatment for acute iron toxicity

Answer 4

Deferoxamine

• given IV
• promote excretion

Deferasirox

• oral
• reduces iron absorption if given within one hour of iron ingestion.

Question 5

Chronic iron toxicity presentation

Answer 5

• in inherited hemochromatosis and patients who need frequent blood transfusions
• cardiomyopathy, cirrhosis and “bronze diabetes”.

Question 6

Chronic iron toxicity treatment

Answer 6

Deferasirox

Question 7

Vitamin b12 therapy

Answer 7

Parental administration

• hydroxycobalamin
• cyanocobalamin

Question 8

Drugs which impair folate metabolism

Answer 8

Methotrexate
Phenytoin
Pyrimethamine
Trimethoprim

Question 9

Why should folic acid supplementation not be given alone in a person with macrocytic megaloblastic anemia?

Answer 9

Folic acid alone will greatly correct hematological signs of vitamin B12 deficiency without correcting neurological dysfunction

patient is at ever increasing risk of PERMANENT NEUROLOGICAL DISABILITY.

Question 10

serum findings for B12 deficiency

Answer 10

Macrocytic megaloblastic anemia

Increased Homocysteine, Methylmalonate and Methylmalonyl CoA

Question 11

Serum findings for Folate deficiency

Answer 11

Macrocytic megaloblastic anemia
Increased homocysteine
Normal methylmalonate

Question 12

Example of erythrocyte growth factors

Answer 12

Recombinant human erythropoietin (epoetin alfa) is a glycoprotein given IV, with a half life of 4- 13 hours. It must be administered three times a week.

Darbepoetin alfa has a twofold to threefold longer half life than epoetin alfa. It may be administered once weekly.

Exogenous erythropoietin
Chronic renal failure, hiv patients using zidovudine etc

Question 13

How does erythropoietin work

Answer 13

Erythropoietin binds JAK/STAT receptors on red cell progenitors and causes

o Stimulation of erythroid proliferation and differentiation.
o Induction of reticulocyte release from bone marrow.

Question 14

Who are the myeloid growth factors and winch receptors do they act through

Answer 14

Filgrastim and sargramostin ; together they are used reverse neutropenia
They act via JAK/STAT receptors

Question 15

Filgrastim

Answer 15

Filgrastim (G-CSF) stimulates the production and function of neutrophils.

Question 16

Sargramostim

Answer 16

Sargramostim (GM-CSF) stimulates all myeloid lines including megakaryocyte progenitors.

Question 17

Megakaryocyte growth factors

Answer 17

Interleukin 11

• stimulate the growth of primitive megakaryocytic progenitors and increase the count of peripheral platelets and neutrophils.
• reverses thrombocytopenia

Question 18

prophylaxis against painful crisis in moderate to severe sickle cell disease

Answer 18

Hydroxyurea

Question 19

Function of hydroxyurea

Question 20

PK and adverse effects of hydroxyurea

Answer 20

Hydroxyurea is well absorbed orally.

The major toxicities are leukopenia, the induction of megaloblastic changes, maculopapular skin rash and painful leg ulcers.