Anemia part 1

Question 1

Iron Treatment Targets

Oral Iron Target:
150-200 mg per day of elemental iron (Approximately 2 to 5 mg of iron per kilogram of body weight per day)
Typically trialed for _________

Answer 1

1-3 months

Question 2

IV Iron Target
Initial course of IV iron amounting to approximately 1000 mg; this may be repeated
if an initial dose fails to increase Hb level
Repeat labs in ___________

Answer 2

1 week

Question 3

Should be testing iron status at least every __________

Answer 3

3 months

Question 4

When prescribing iron therapy, balance the potential beneift of avoiding or minimizing _________ transfusions, ______ therapy and anemia related symptoms against the risk of harm in individual patients

Answer 4

blood transfusions

ESA

Question 5

For adults CKD patients w/anemia not on iron or ESA theray we suggest a __________of IV iron (or in CKD ND pts alternatively a 1-3 month trial of oral iron therapy if
an increase in Hb concentration without starting ESA treatment is desired and TSAT is more than or equal to 30% and ferritin is more than or equal to 500ng/ml

Answer 5

trial

Question 6

For CKD ND patients who require iron supplementation, select the route of iron administration based on the oral or IV iron therapy, availability of venous access, response to prior oral iron therapy, side effects with prior oral or IV iron therapy, patient compliance, and cost

Question 7

ESAs are used in chronic kidney disease but also used in what other type of pts?

Answer 7

cancer pts and oncology pts

Question 8

Erythropoietic-Stimulating Agents (ESAs)
Glycoproteins that have the same biologic activity as endogenous erythropoietin

Binds to and activates the erythropoietin receptor to stimulate erythropoiesis

Used to maintain _________ levels often after receiving iron therapy

Prevent _________ transfusions

Often increase iron demands for CKD patients

Answer 8

hemoglobin

prevent blood transfusions

Question 9

ESAs are given Subcutaneous and given in the abdomen

Question 10

Darbepoetin alfa is used in oncology pts

Question 11

Epoetin alfa-epbx(Retacrit) is a biosimilar and its cheaper than Epoetin alfa (Procrit)

Question 12

ESAs like epoetin alfa (procrit), Epoetin ala-epbx (Retacrit), Darbepoetin alfa (Aranesp), and Methoxy polyethylene glycol-epoetin beta (Miracera) are **weight based doing, administerded subcutaneous or IV

Question 13

Epoetin alfa-epbx (Retacrit) is a biosimilar

minimal availability of multi use vials

availability in our clinic is only single use vials

insurances may begin to push to utilize this biosimilar to decrease costs

Question 14

There’s a black box warning for Epooetin alpha (procrit) that increases risk of death, myocardial infarction, stroke, venous thromboembolism, thrombosis of vascular access

Question 15

Thrombosis of vascular access means what? At IV access you can develop blood clotting, port that patient has, dialysis access sites,fistulas or cracks

Question 16

In the use of epopoetin alfa (procrit) use the lowest dose effective dose is important and we should be look at a hemoglobin target under 11

any pt with that has chronic kidney disease has increased risk of cardiovascular complications

With this medication we are not going to get somebody who has chronic kidney disease to a level of hemoglobin that is on par with the general population we are never correcting their anemia from like a lab based perspective with these agent and the intent is to get their hemoglobin level up high enough so they feel better but its never going to be perfect because of the risk associated with the black box warning

Don’t overshoot a target because of the black box warning

Question 17

What is the normal hemoglobin value for pts w/o anemia? it

Question 18

If pt is less than 13 then pt has anemia especially our male pts

Question 19

If you give pt more procrit their hemoglobin level is going to go higher so its dose-related response