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Pharmacology 2 > Anemia Exam 4 > Flashcards

Anemia Exam 4 Flashcards

1
Q

What is iron deficiency anemia?

A

insufficient hemoglobin in RBCs due to lack of iron

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2
Q

What is Megaloblastic anemia?

A

Impaired loss of B12 from loss of IF
OR
Deficiency in B12 diet (rare) OR Folate acid (common)

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3
Q

What are the two forms of Hemolytic anemia?

A

Acquired and genetic

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4
Q

What is genetic hemolytic anemia?

A

deficiency in G6PD

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5
Q

What is acquired hemolytic anemia?

A

RBC lysis due to drugs

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6
Q

What is sickle cell anemia?

A

seen in sickle cell disease, short life span of RBC

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7
Q

What are some special conditions caused by abuse in body builders on anabolic steroids?

A

Anemia caused by kidney failure (Nandrolone)
Anemia caused by insufficient RBC production (Oxymetholone)
Anemia caused by CRF, Zidovudine, Chemo (Erythropoetin and darepoetin)

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8
Q

What causes Lack of blood?

A 
decrease RBC
- Decrease in production
-RBC loss (bleeding)
-RBC destruction (hemolysis)
decreased hemoglobin
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9
Q

What decreases RBC production?

A
  • low erythropoietin (drug)

- decreased bone marrow response to erythropoietin

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10
Q

What things can cause Iron deficiency anemia?

A 
Menstruation
GI bleed (PU, L/T NSAIDS)
Inadequate intake
Malabsorption
Pregnancy
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11
Q

What is the best way to treat iron deficiency anemia?

A

treat the underlying disease

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12
Q

What transport iron? What stores iron?

A

Transferritin

Ferritin

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13
Q

What percent of iron is absorbed?

A

10%

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14
Q

What is ferritin stored?

A

liver and heart

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15
Q

What is the most absorbable form of iron?

A

Ferrous (FE2+) (unbound, soluble)

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16
Q

What is recommend iron intake?

A

Oral, elemental Fe2+, FERROUS SULFATE x3-4/d, 100-150mg

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17
Q

What is the best way to take oral iron? and why?

A

on a EMPTY stomach, optimal absorptive

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18
Q

If iron is taken w/ food how much is absorbed?

A

50%

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19
Q

How to combat the sde of oral iron?

A

decreased dose or frequency, rather than change formulation

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20
Q

What are common sde of oral iron?

A

n/v, upper abdominal pain, constipation, melena

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21
Q

What does oral iron have a ddx?

A

FQ and tetracycline (decreasing them)

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22
Q

How long does it take for iron to work?

A

months

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23
Q

Iron bound to transferrin in circulation is in what form?

A

Ferric (oxidized) FE3+

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24
Q

How do you monitor treatment?

A

check reticulocytes count in 1 wk. Hgb in 1 mo. If Hgb is normal, continue txt for 2-6mo, then stop

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25
Q

What is a txt if a pt can’t take/ respond to oral iron therapy?

A

IV/IM Iron Dextran

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26
Q

What iron form is iron dextran?

A

ferric (Fe3+)

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27
Q

Why would iron dextran work better than oral ferrous sulfate?

A

prevents unbound iron toxicity

28
Q

What should ALWAYS be done when prescribing iron dextran?

A

test dose for hypersenstiivity

29
Q

What symptoms of hypersensitivity is seen in iron dextran?

A

Fever, hypotension, rash, arthralgia, anaphylaxis

Lymphadenopathy, splenomegaly

30
Q

What can be done to reduce hypersensitivity of iron dextran?

A

decrease infusion rate

31
Q

What are two alternative therapies to iron dextran?

A

sodium ferric gluconate and iron sucrose

32
Q

How many grams of iron is need for overdose?

A

1 to 2 grams

33
Q

Early changes 1-2 hours of overdose?

A

vomiting, gastric bleeding

34
Q

Intermediate changes 8-12 hrs of overdose?

A

short-lived clinical improvement, followed by shock, CV collapse, pulmonary edema, death (12-24hr)

35
Q

Late stage (1 month) of overdose?

A

intestinal scarring, fatty acid degeneration of liver, cirrhosis and death

36
Q

What is the treatment for iron overdose in the ER?

A

gastric aspiration and lavage

37
Q

What is the anti-dote for iron?

A

Deferoxamine (chelate iron)

  • oral: for whats unabsorbed
  • IV/IM: for whats absorbed
38
Q

What can mess with the gut causing megaloblastic anemia?

A
  • drug induced
  • ETOH, PPIs, H2 receptor antagonist
  • Nitrous oxide
39
Q

What is the role of folic acid?

A

RBC formation and maturation

40
Q

Wha form of Folic acid is needed?

A

“trapped” inactive tetrahydrofolate

41
Q

A deficiency in B12 causes what sde?

A

neurological problems

42
Q

Why you should check and correct B12 first before correcting folate?

A

because its causes neuro problems and folate just wont work if its a B12 problem

43
Q

Folate deficiency mostly comes from?

A

inadequate diet intake

44
Q

Impaired absorption of B12 resulting from loss of function of ???? that produces ???

A

gastric parietal cells, intrinsic factor (IF)

45
Q

What is the role of IF and B12?

A

binds to B12 protects it form degradation in gut, complex absorbed in ileum

46
Q

What can cause loss of parietal cells?

A
  • gastric surgery

- autoimmune condition (pernicious anemia)

47
Q

What is the treatment of B12?

A

IM- Hydroxy-cobolamin

PO- Cyanocobalamin

48
Q

Which B12 is usually used in a EMERGENCY?

A

Hydroxy-cobolamin - IM

49
Q

T/F a allergy is reported with B12 treatment?

A

YES- but no like dextran

50
Q

What common cause of folate anemia?

A

ETOH, drug induced

51
Q

What anticonvulsant drugs cause folate deficiency?

A

3 P’s: Phenytoin, Phenobarbital, Primidone

52
Q

What drugs can are folate antagonists:

A 
methotrexate
trimethoprim
flucytosine
pyrimethamine
zidovudine
53
Q

What is the treatment for folate deficiency?

A

oral folate

54
Q

Before treating folate what must be done?

A

check B12 first to r/o B12 deficiency

55
Q

What is a ddx with folate?

A

phenytoin (decreases)

56
Q

What is a good thing about G6PD deficiency?

A

protects against malaria

57
Q

What is a bad thing about G6PD deficiency

A

drugs can increase sensitivity to oxidation, causing drug induced hemolysis

58
Q

What are oxidant drugs?

A

Sulfonamides, PrimaQUINE, Quinine, dapsone, nitrofurantoin aspirin
Raw broad beans (FAVA BEANS)

59
Q

What causes acquired hemolytic anemia?

A

Methyldopa, hydralazine, procainamide (SLE)

60
Q

What is the correlation of acquired/genetic hemolytic anemia drugs?

A

SHIP drugs

61
Q

What is used to treat sickle cell pain?

A

IV opioids (pt controlled), and regular opioids

62
Q

What is sickle cell?

A

vessel occlusion with painful crises, due to inherited blood disorder, stretching and distorting Hgb

63
Q

What is the cell life in sickle cell anemia?

A

short life span of RBC

64
Q

What is the treatment for sickle cell anemia?

A
  • daily folic acid (produce RBC)
  • Hydroxyurea (increase fetal Hgb production)
  • Stem cell transplantation
65
Q

What enhances the absorption of iron?

A

Vitamin C

66
Q

What reduces absorption of ferrous iron?

A

antacids

Pharmacology 2 (9 decks)

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