Anemia Drugs Flashcards
Dietary iron supplementation
Fe2+ (ferrous is two-plus): beef, chicken, pork, lamb, liver
Fe3+ (ferric): not absorbed as readily – leafy green veg, potato skins, tomatoes, dry beans, whole grains
Acidic things (ex: orange juice) help convert Fe3+ to 2+
Types of Oral Iron supplementation
Ferrous sulfate, ferrous fumarate, ferrous gluconate, carbonyl iron, Niferex
Oral Iron Toxicity
constipation, GI upset/cramping, black tarry stools, heartburn
Iron Absorption
duodenum + proximal jejunum, DMT1 transporter
Iron Storage in Liver
Ferritin
Iron Transport in Plasma
Transferrin
Iron Transport from Enterocyte to Blood
Ferroportin
Iron Storage in Bone Marrow
Reticulocyte uptake
Iron Absorption Promoters
Fe2+, Vit C, Acid, Fe deficiency, pregnancy, anoxia, increased erythropoiesis
Iron Absorption Reducers
Fe3+, Bases (pancreas) and acid reducers (PPIs), antibiotics (tetracyclines, fluoroquinolones), fiber supplements, diarrhea, decreased erythropoiesis, inflammation, dairy, grains/cereals, coffee, tea, soy,
Types of Parenteral Iron Supplementation
Iron dextran, Iron sucrose, Ferric gluconate
Effects of oral iron supplementation
7 days: reticulocytosis (modest); 3 weeks: 2 gm/dL rise in Hb
When is parenteral iron appropriate?
Intolerance of or noncompliance w/ oral therapy; Abnormal absorption 2/2 GI problem; Blood loss; Prep for EPO therapy
Parenteral Iron Toxicity
Injection site reactions, Diarrhea, Nausea, Anaphylactoid rxn
B12 deficiency causes
Loss of IF (ex: pernicious anemia) Ileum malabsorption Dietary deficiency (rare b/c large stores) PPIs Metformin EtOH
Types of B12 Supplementation
Oral (1-10mcg/d for dietary def, 1000mcg/d for absorption problem), Intranasal (Nasocobal), Parenteral
Folate deficiency causes
Malnutrition, Alcoholism, Pregnancy, Malabsorption, Metformin, Anticonvulsants, Methotrexate
Types of Folate Supplementation
Oral, Parenteral
Erythropoeitin
synthesized by kidney; necessary for erythropoiesis; lost in chronic renal disease (normocytic anemia)
Rx for Erythropoietin Deficiency
Epoetin alfa – recombinant, 2-3x/wk for dialysis pts
Darbepoetin alfa – longer half-life, give 1x/wk
Risks of EPO drugs
CKD pts: Death and CV complications if Hb > 11 g/dL
Cancer pts: Tumor progression, Thromboembolic complications, death if Hb > 12 g/dL
EPO abuse
EPO enhances endurance: “blood doping” – Banned by athletic organizations
Increases RBC concentration –> increased chance for spontaneous coagulation
Colony Stimulating Factors (CSF)
Essential for differentiation and maturation of marrow cell lines; Treats neutropenia secondary to chemotherapy and bone marrow transplant
Granulocyte CSF (G-CSF)
Stimulates neutrophils: Filgrastim, Pegfilgrastim
Granulocyte-macrophage CSF (GM-CSF)
stimulates neutrophils and macrophages: Sargramostim
Whole blood
Provides O2 carrying capacity, volume expansion
Uses: Acute hemorrhage, anemia, exchange transfusions in neonates, surgery
Packed RBCs
Uses: Anemia (wide variety of types), Hypovolemia
Fresh frozen plasma (FFP)
Uses: Coagulation factor deficiencies, ATIII deficiency, Immunodeficiencies (supplies Ig), Warfarin reversal, Massive blood transfusion (+Packed RBC), TTP
Platelet transfusions
Uses: Thrombocytopenia (reduces bleeding risk), Prophylaxis in acute leukemia, Open heart Sx, DIC
Cryoprecipitate Antihemophilic factor (AHF)
From FFP; Contains F8, 9, 13, fibrinogen, vWF
Uses: DIC, depleted fibrinogen (Not hemophilia)
Iron Chelating Agent
Deferoxamine
Iron Overdose
Vomiting, constipation, abdominal pain, bloody stools – Common in children b/c iron tablets usually taste sweet
Antacids w/calcium (like tums) help decrease absorption, but must treat w/chelator
