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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
synthesis of methionine
-methylcobalamin serves as intermediate in transfer of methyl group during transfer -methyltetrahydrofolate is converted to tetrahydrofolate
26
B12 deficiency causes
depletion of tetrahydrofolate accumulation of homoocysteine | methymalonic acid and methymalonyl-CoA accumulations
27
common characteristics of B12 deficiency
``` megaloblastic macrocytic anemia mild or moderate leukopenia or thrombocytopenia hypercellular bone marrow w/accumulation of megaloblastic erythroid and other precursor cells neurological ```
28
cause of B12 deficiency
almost all due to malabsorption | therefore parenteral injections
29
folic acid
for synthesis of aa, purines, and DNA
30
folic acid defiency
anemia congenital malformations vascular disease relatively low stores, symptoms in 1-6 months
31
folic acid deficiency anemia
megaloblastic that is indistinguishable from vit B12 deficiency does not cause neuro issues often dietary cuase
32
drugs that cause folic acid deficiency
methotrexate, trimethoprim, pyrimethamine | long term Tx w/phenytoin
33
erythropoietin drugs MOA
increase reticulocytes in 10days | rise in hematocrit and hemoglobin in 2-6wks
34
erythropoietin uses
chronic kidney disease anemia myelosuppressive chemo HIV anemia reduction of allogneic RBC transfusion
35
ESAs not indicated for
- 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
off label use for ESAs
Tx of symptomatic anemia in MDS
37
ESA toxicity
HTN and thrombotic complications | aggressive use in chronic renal failure or CA has been linked to increased mortality and CV events
38
ESA CI
patients w/uncontrolled HTN
39
filgrastim
recombinant G-CSF | IV or SubQ
40
Pegfilgrastim
covalent conjugation product of filgrastim and PEG | once per myelosuprressive chemo cycle
41
sargramostim
recombinant GM-CSF | IV or SubQ
42
G-CSF MOA
- 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
GM-CSF MOA
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
Filgrastim and Pegfilgrastim toxcicity
used more frequently then GM-CSF b/c better tolerated | can cause bone pain
45
GM-CSF adverse effects
``` fever malaise arthralgias myalgias capillary leak syndrome ```
46
megakaryocyte GFs
patinets w/thrombocytopenia have high risk of hemorrhage | thrombopoietin and IL-11 are endogenous regulators of platelet production
47
IL-11
oprelvekin | recombinatn form produced from E.coli
48
oprelvekin MOA
activates specific cell surface cytokine Rs to stimulate frowth of lymphoid and myeloid cells stimulates growth of primitive megakaryocytes
49
romiplostim MOA
activates Mpl thrombopoietin R t cause dose dependent increase in platelet count 5 days after SubQ injection
50
uses of IL-11
secondary prevention of thrombocytopenis in patients recieving cytotoxic chemo for nonmyeloid CAs
51
romiplostim uses
Tx of thrombocytopenis for ITP when corticosteroids did not work
52
IL-11 adverse effects
``` fatigue HA dizziness CV hypokalemia all reversible ```
53
Romiplostim adverse effects
well tolerated except for mild HA on day of admission

Heme II (7 decks)

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