Anemia Drugs

Question 1

What are the 2 underlying causes of anemia?

Answer 1

Maturation defects: Cytoplasmic and nuclear
Destruction of RBCs:
Intrinsic and extrinsic

Question 2

Name an erythropoiesis-stimulating agent

Answer 2

Epoetin alfa

Question 3

What is epoetin alfa used for and when is it ineffective?

Answer 3

ID: Treatment of anemia associated with end-stage renal disease, chemo-induced anemia, and anemia associated with zidovudine therapy
Ineffective w/o adequate body iron stores and bone marrow function

Question 4

What is the long-acting form of epoetin called?

Answer 4

Darbepoetin

Question 5

What are the contraindications and most frequent adverse effects of epoetin alfa?

Answer 5

CI: Uncontrolled HTN, Hb levels >100 mmol/L for cancer pts and >130 mmol/L for pts with kidney disease, head and neck cancers; risk of thrombosis
AE: HTN, Fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction.

Question 6

Where is iron stored?

Answer 6

Liver, spleen, and bone marrow

Question 7

What foods can enhance iron absorption?

Answer 7

OJ, veal, fish, ascorbic acid

Question 8

What foods can impair iron absorption?

Answer 8

Eggs, beans, corn, cereal products containing phytates

Question 9

Name 3 ferrous salts

Answer 9

Ferrous fumarate
Ferrous gluconate
Ferrous sulphate

Question 10

Name 3 parenteral iron drugs

Answer 10

Iron dextran
Iron sucrose
Ferric gluconate

Question 11

What are the indications of iron?

Answer 11

Prevention and treatment of iron deficiency syndromes
Alleviates symptoms of iron deficiency anemia

Question 12

What are the adverse effects of iron?

Answer 12

Nausea, vomiting, diarrhea, constipation, stomach cramps and pain
Black, tarry stools
Liquid oral preps temporarily discolour teeth

Question 13

What supportive measures help with iron toxicity?

Answer 13

Suction and maintenance of the airway
Correction of acidosis
Control of shock and dehydration with IV fluids or blood
Oxygen and vasopressors

Question 14

What med is given to pts with severe symptoms of iron intoxication, such as coma, shock, or seizures?

Answer 14

Chelation therapy with deferoxamine mesylate

Question 15

What is a consideration for the administration of iron dextran?

Answer 15

A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of the dose is given after 1 hour.

Question 16

What is the indication for ferric gluconate?

Answer 16

Repletion of total body iron content in pts with iron deficiency anemia who are undergoing hemodialysis

Question 17

Why is a test dose not required for ferric gluconate?

Answer 17

The risk of anaphylaxis is much less than iron dextran

Question 18

What are doses higher than 125 mg of ferric gluconate associated with?

Answer 18

Increased adverse events, including abdominal pain, dyspnea, cramps and itching

Question 19

What are the primary uses of folic acid?

Answer 19

Folic acid deficiency
During pregnancy, to prevent neural tube defects

Question 20

What are the indications and forms for cyanocobalamin (Vitamin B12)?

Answer 20

ID: Pernicious anemia and other megaloblastic anemias
Forms: Orally or parentally

Question 21

What are the contraindications of ferrous salts?

Answer 21

Ulcerative colitis, PUD, Liver disease, and other GI disorders

Question 22

Iron dextran is contraindicated in all anemias except for ___________

Answer 22

Iron-deficiency anemia

Question 23

Oral forms should be given with _______ but not ______________

Answer 23

Juice
Milk or antacids

Question 24

What can be done to avoid esophageal corrosion?

Answer 24

Pts should remain upright for up to 30 minutes after taking oral iron doses