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Heme II > Anemia drugs > Flashcards

Anemia drugs Flashcards

1
Q

Oral Fe

A

ferrous

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2
Q

parenteral Fe

A

Iron-dextran
Iron-sucrose complex
Na ferric gluconate complex

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3
Q

Fe chelators

A

deferoxamine

deferasirox

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4
Q

Vit B12 prprs

A

cyanocobalamin

hydroxocobalamin

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5
Q

Erythroctye-stimulating agents

A

epoetin alpha

darbepoetin

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6
Q

G-CSF

A

granulocyte stimulating factor
filgrastim
pegfilgrastim

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7
Q

GM-CSF

A

granulocyte-macrophage stimulating factor

sargramostim

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8
Q

megakaryocyte growth factos

A

oprelvekin, IL11

romiplostim

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9
Q

Fe deficiency anemia

A

microcytic, hypochromic

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10
Q

Fe absorption

A

primarily in duodenum and jejunum
heme Fe can be absorbed intact
nonheme must be reduced by ferroreductase to ferrous (Fe2+)

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11
Q

Fe transport

A

transferrin binds 2 ferric (Fe3+)
endocytosis into RBC
DMTI into cells

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12
Q

increased number of transferrin Rs on RBCs

A

during erythropoiesis

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13
Q

increased serum transferrin

A

Fe store depletion and Fe deficiency anemia

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14
Q

Fe storage

A

as ferritin, in GI, liver, spleen, bone

high levels of Fe stimulate apoferritin to reduce toxicity

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15
Q

Oral Fe adverse effects

A 
nausea
epigastric discomfort
abdominal cramps
constipation
black stools
diarrhea
switching to a different oral option may help
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16
Q

Parenteral Fe

A

reserved for Fe deficiency with intolerance for oral or for extensive chronic anemia (hemodialysis, small bowel resection, inflammatory bowl disease)

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17
Q

parenteral formulated

A

as colloid containing particles w/a core of Fe oxyhydroxide surrounded by carbs -> slow release

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18
Q

Iron dextran

A 
deep IM injection or IV
HA
light-headedness
fever
arthraligas
nausea
vomiting
back pain
flushing
urticaria
bronchospasm
anaphylaxis
death (rare)
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19
Q

Na ferric gluconate complex

A

only IV

less likely to cause hypersensitivity rxns

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20
Q

Fe sucrose complex

A

IV

less likely to cause hypersensitivity rxns

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21
Q

acute iron toxicity

A

seen almost exclusively in young children who ingest Fe tablets (as few as 10 can be lethal)
necrotizing gastroenteritis
vomiting
ab pain
bloody diarrhea
shock, lethargy, dyspnea
can improve only to be follwed by metabolic acidosis, coma, death

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22
Q

Tx acute Fe toxicity

A

urgent whole bowel irrigation and parenteral deferoxamine

charcoal does NOT bind Fe

23
Q

chronic Fe toxicity

A

aka hemochromatosis

excess Fe deposits in heart, liver, pancreas -> organ failure -> death

24
Q

chronic Fe toxicity Tx

A

intermittent phlebotomy

deferasirox helps liver, but not heart

25
Q

synthesis of methionine

A

-methylcobalamin serves as intermediate in transfer of methyl group
during transfer
-methyltetrahydrofolate is converted to tetrahydrofolate

26
Q

B12 deficiency causes

A

depletion of tetrahydrofolate accumulation of homoocysteine

methymalonic acid and methymalonyl-CoA accumulations

27
Q

common characteristics of B12 deficiency

A 
megaloblastic macrocytic anemia
mild or moderate leukopenia
or thrombocytopenia
hypercellular bone marrow w/accumulation of megaloblastic erythroid and other precursor cells
neurological
28
Q

cause of B12 deficiency

A

almost all due to malabsorption

therefore parenteral injections

29
Q

folic acid

A

for synthesis of aa, purines, and DNA

30
Q

folic acid defiency

A

anemia
congenital malformations
vascular disease
relatively low stores, symptoms in 1-6 months

31
Q

folic acid deficiency anemia

A

megaloblastic that is indistinguishable from vit B12 deficiency
does not cause neuro issues
often dietary cuase

32
Q

drugs that cause folic acid deficiency

A

methotrexate, trimethoprim, pyrimethamine

long term Tx w/phenytoin

33
Q

erythropoietin drugs MOA

A

increase reticulocytes in 10days

rise in hematocrit and hemoglobin in 2-6wks

34
Q

erythropoietin uses

A

chronic kidney disease anemia
myelosuppressive chemo
HIV anemia
reduction of allogneic RBC transfusion

35
Q

ESAs not indicated for

A
  • CA receiving concurrent hormonal therapy, therapeutic biological products, radiation, unless concurrent w/chemo
  • myelosuppressive chemo if expected outcome is curative
  • surgery patients who are willing to donate blood
  • surgery patients undergoing cardiac or vascular surgery
  • as substitute for acute RBC transfusion
36
Q

off label use for ESAs

A

Tx of symptomatic anemia in MDS

37
Q

ESA toxicity

A

HTN and thrombotic complications

aggressive use in chronic renal failure or CA has been linked to increased mortality and CV events

38
Q

ESA CI

A

patients w/uncontrolled HTN

39
Q

filgrastim

A

recombinant G-CSF

IV or SubQ

40
Q

Pegfilgrastim

A

covalent conjugation product of filgrastim and PEG

once per myelosuprressive chemo cycle

41
Q

sargramostim

A

recombinant GM-CSF

IV or SubQ

42
Q

G-CSF MOA

A
  • stimulates proliferation and differentiation of progenitors -already committed to neutrophil lineages
  • activates phagocytic activity of mature neutrophils and prolongs survival
  • increases concentration of HSC in peripheral blood
43
Q

GM-CSF MOA

A

broader biological actions than G-CSF
primary therapeutic effect is to stimulate myelopoiesis
simulates fnx of mature neutrophils
stimulates Tcell proliferaion
increased concentration of HSC less then G-CSF

44
Q

Filgrastim and Pegfilgrastim toxcicity

A

used more frequently then GM-CSF b/c better tolerated

can cause bone pain

45
Q

GM-CSF adverse effects

A 
fever
malaise
arthralgias
myalgias
capillary leak syndrome
46
Q

megakaryocyte GFs

A

patinets w/thrombocytopenia have high risk of hemorrhage

thrombopoietin and IL-11 are endogenous regulators of platelet production

47
Q

IL-11

A

oprelvekin

recombinatn form produced from E.coli

48
Q

oprelvekin MOA

A

activates specific cell surface cytokine Rs to stimulate frowth of lymphoid and myeloid cells
stimulates growth of primitive megakaryocytes

49
Q

romiplostim MOA

A

activates Mpl thrombopoietin R t cause dose dependent increase in platelet count 5 days after SubQ injection

50
Q

uses of IL-11

A

secondary prevention of thrombocytopenis in patients recieving cytotoxic chemo for nonmyeloid CAs

51
Q

romiplostim uses

A

Tx of thrombocytopenis for ITP when corticosteroids did not work

52
Q

IL-11 adverse effects

A 
fatigue
HA
dizziness
CV
hypokalemia
all reversible
53
Q

Romiplostim adverse effects

A

well tolerated except for mild HA on day of admission

Heme II (7 decks)

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