Anemia drugs

Question 1

Underlying cause of anemia

Answer 1

Maturation defects (cytoplasmic or nuclear), Excessive destruction of RBCs (intrinsic RBC abnormalities or extrinsic mechanisms)

Question 2

RBC cytoplasmic maturation defect

Answer 2

Lack of iron causing a decrease of RBC synthesis

Question 3

RBC nuclear maturation defects (megaloblastic anemia)

Answer 3

Folic acid and Vitamin B12 deficiency leading to pernicious anemia (B12) or folic acid deficiency anemia

Question 4

What is Erythropoiesis

Answer 4

The production of RBC

Question 5

Example of Erythropoiesis-Stimulating Agents

Answer 5

Epoetin alfa

Question 6

What is Epoetin alfa used for

Answer 6

• end stage renal disease related anemia,
• chemotherapy induced anemia
• anemia associated with zidovudine therapy

Question 7

When is Epoetin alfa ineffective

Answer 7

Without adequate iron or bone marrow function so iron supplement are often taken

Question 8

Longer acting version of Epoetin alfa

Answer 8

Darbepoetin

Question 9

contraindication of Epoetin alfa

Answer 9

Any scenario where more rbc is bad like…

uncontrolled hypertension; hemoglobin levels that are above 100 mmol/L for cancer patients and 130 mmol/L for patients with kidney disease; head and neck cancers; risk of thrombosis

Question 10

Adverse effects of epoetin alfa

Answer 10

hypertension, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction

Question 11

What is needed to happen before iron can be absorbed

Answer 11

Must be converted by gastric juices

Question 12

Some foods the enhance iron absorption

Answer 12

Orange juice
Veal
Fish
Ascorbic acid

Question 13

Some foods that impair iron absorption

Answer 13

Eggs (but also contain iron)
Corn
Beans (but also contain iron)
Cereal products containing phytates

Question 14

Example of oral iron preparations (ferrous salts)

Answer 14

ferrous fumarate (Femiron®), ferrous gluconate, ferrous sulphate (FeSO4)

Question 15

Examples of parenteral iron preparations

Answer 15

iron dextran (Dexiron®, Infufer®)
iron sucrose (Venofer®)
ferric gluconate (Ferrlecit®)

Question 16

Uses of iron preperation

Answer 16

Prevent/treat iron deficiency but also alleviated the symptoms of iron deficiency anemia. Does not treat the underlying cause and it should be corrected

Question 17

Iron adverse effects

Answer 17

• pediatric poisoning deaths
• nausea, vomiting, diarrhea, constipation, and stomach cramps and pain
• black, tarry stools
• Liquid oral preparations temporarily discolour teeth.
• Injectable forms cause pain upon injection

Question 18

Treatment of iron toxicity (symptomatic and supportive)

Answer 18

Suction and maintenance of airway, correct of acidosis, control of shock and dehydration with IV fluids, blood, oxygen and vasopressors

Question 19

Treatment of severe iron toxicity

Answer 19

Deferoxamine mesylate

Question 20

Iron dextran

Answer 20

Parenteral iron supplement that may cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis

Less frequently used. Ferric gluconate and iron sucrose is used more often

Question 21

How to give iron dextran

Answer 21

Give a test dose of 25 mg then wait an hour to see the reaction. If no reaction, give the remaining dose

Question 22

Ferric gluconate

Answer 22

Given to replanation total iron content to those with iron deficiency anemia undergoing hemodialysis. Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required

Question 23

Doses of Ferric gluconate 125 mg or higher are associated with

Answer 23

increased adverse events, including abdominal pain, dyspnea, cramps, and itching.

Question 24

Uses of folic acid

Answer 24

Folic acid deficiency and during pregnancy to avoid neural tube defects

Question 25

When/how should folic acid be used

Answer 25

Should be used only when actual cause of anemia is determined as it may mask symptoms of pernicious anemia and may lead to it being untreated.

Question 26

What happens if pernicious anemia is untreated

Answer 26

May progress to neurological damage

Question 27

Type of Vitamin B 12 drug

Answer 27

Cyanocobalamin

Question 28

What is Cyanocobalamin used for

Answer 28

to treat pernicious anemia and other metaplastic anemias

Question 29

How is Cyanocobalamin adminstered

Answer 29

Orally or parenterally (Deep intramuscular injection to treat pernicious anemia)

Question 30

When should not give ferrous salts

Answer 30

If they have ulcer colitis, peptic ulcer disease, liver disease and other GI disorders

Question 31

Iron dextran should only treat

Answer 31

Iron deficiency anemias

Question 32

What should oral forms not be given with

Answer 32

milk or antacids, tetracycline and quinolones

Question 33

What should oral forms be given with

Answer 33

juice

Question 34

For IV iron what position should the pt be in

Answer 34

remain in recumbent position for 30 mins after IV admin