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SBL > Anemia Pharm > Flashcards

Anemia Pharm Flashcards

1
Q

What molecules make up heme?

A

protoporphyrin IX and Fe

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2
Q

Causes of microcytic anemia

A

reduced iron availability, reduced heme synthesis, reduced globin production, rare disorders

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3
Q

Foods from which iron is easily absorbed

A

meat, fish, poultry

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4
Q

How does food effect iron absorption?

A

inhibits absorption

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5
Q

Side effects of oral iron tablets

A

nausea, constipation, anorexia, heartburn, vomiting, diarrhea, dark stools

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6
Q

IV iron complexes

A

iron dextran, sodium ferric gluconate, iron-sucrose

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7
Q

Acute iron toxicity

A

lethal in young children; sxs include necrotizing gastroenteritis with vomiting, abd pain, bloody diarrhea

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8
Q

Treatment of acute iron toxicity

A

parenteral deferoxamine, and whole bowel irrigation

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9
Q

Chronic iron toxicity

A

iron deposits in heart, liver, pancreas and causes organ failure and death

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10
Q

Sources of vitamin B12

A

fish, meat, poultry, eggs, milk, milk products, fortified breakfast cereals

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11
Q

How long does it take to develop a vitamin B12 deficiency?

A

years, liver stores a significant amount

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12
Q

Neurological sxs of B12 deficiency

A

paresthesias, weakness, spasticity

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13
Q

How is cobalamin released from food

A

acid and pepsin

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14
Q

Causes of pernicious anemia

A

ab formation blocking IF interaction with cobalamin, chronic atrophic gastritis, gastrectomy, H. pylori infection

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15
Q

Sxs of B12 deficiency

A

vitiligo, hyperpigmentation, glossitis, anemia, neutropenia, thrombocytopenia

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16
Q

Treatment of vitamin B12 dficiency

A

oral B12, initially 1-2mg/day for 2 weeks, then 1mg daily; parental therapy if neuro sxs are present

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17
Q

Sources of folate

A

yeast, liver, kidney, green leafy vegetables

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18
Q

Where is folate absorbed in the body?

A

jejunum

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19
Q

How long does it take to develop a folate deficiency?

A

three weeks without adequate intake

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20
Q

Sxs of folate deficiency

A

neural tube defect in fetus, jaundice, mouth ulcers, anemia, neutropenia, thrombocytopenia, depression

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21
Q

Treatment of folate deficiency

A

oral folate, 1mg/day for 4 months

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22
Q

epoetin alfa MOA

A

contains a.a. sequence of isolated erythropoeitin

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23
Q

epoeitn alfa effects

A

stimulates erythropoiesis, increase rtc in 10 days, increase RBC 2-6 weeks

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24
Q

Clinical applications epoetin alfa

A

chronic kidney disease, CA chemo

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25
Q

Pharmacokinetics of epoetin alfa

A

IV or subcutaneously; t1/2 = 4-13 hrs

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26
Q

Epoetin alfa toxicities

A

increased risk of death, MI, stroke, VTE, tumor progressoin

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27
Q

Hydroxyurea MOA

A

boosts level of hgb

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28
Q

Effects of hydroxyurea

A

lowers concentration of HbS within a cell

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29
Q

Clinical applications hydroxyurea

A

sickle cell

30
Q

Pharmacokinetics hydroxyurea

A

administered orally, distributed widely

31
Q

Toxicities hydroxyurea

A

neutropenia, anemia, oral ulcers, mild GI upset, hyperpigmentation, rash, nail changes

32
Q

Eculizumab MOA

A

mab binds to C5, inhibits cleavage, preventing generation of complement complex

33
Q

Eculizumab effects

A

inhibits terminal complement mediated intravascular hemolysis, inhibits complement mediated thrombotic microangiopathy

34
Q

Clinical applications eculizumab

A

PNH, atypical HUS

35
Q

Pharmacokinetics eculizumab

A

IV over 35 min oncer per week for 4 weeks, maintenance doses given IV every 2 weeks

36
Q

Toxicities of eculizumab

A

viral infections, life-threatening meningococal infections, immunogenic, URI, msk pain, anemia, leukopenia, HTN, HA

37
Q

Causes of neutropenia

A

cancer, congenital disorders, viral infections, autoimmune disorders, overwhelming infections, drugs

38
Q

Sxs of neutropenia

A

low-grade fever, sore mouth, odynophagia, gingival pain and swelling, skin abscesses, recurrent sinusitis and otitis, sxs of pneumonia, perirectal pain and irritation

39
Q

Filgrastim MOA

A

human G-CSF

40
Q

Filgrastim effects

A

regulates production of neutrophils within bone marrow

41
Q

Clinical applications filgrastim

A

decrease incidence of infection in pts with nonmyeloid malignancies receiving myelosuppressive anticancer drugs or those receiving bone marrow transplant, mobilize hematopoietic progenitor cells

42
Q

Pharmacokinetics filgrastim

A

IV infusion or continuous SC infusion, wait 24 hrs after chemo, dividing cells most vulnerable

43
Q

Filgrastim toxicities

A

allergic rxn, bone pain

44
Q

sargramostim MOA

A

recombinant form of GM-CSF

45
Q

Effects sargramostim

A

increase production neutrophils, eosinophils, monocytes and macrophages

46
Q

Clinical applications sargramostim

A

accelerate recovery myeloid cells after autologous bone marrow transplant, mobilize hematopoietic stem cells, used after chemo induction in pts with AML

47
Q

Pharmacokinetics sargramostim

A

given IV or SC

48
Q

Toxicities sargramostim

A

edema, sequestration of granulocytes in pulm circulation causing dyspnea, worsened pre-existing renal and hepatic dysfx, can cause fatal gasping syndrome

49
Q

Does filgrastim or sargramostim have fewer side effects?

A

filgrastim

50
Q

UpToDate recommendations on CSF use in CA

A

no role in afebrile patients, primary prophylaxis if incidence of febrile neutropenia is >20%, secondary prophylaxis if it would reduce efficacy of chemo

51
Q

Plerixafor MOA

A

partial agonist of CXCR4 receptor, homing to HSC

52
Q

Plerixafor effects

A

mobilizes HSC to plasma

53
Q

Plerixafor clinical use

A

used in pts who do not mobilize sufficient stem cells for transplant with just G-CSF

54
Q

Plerixafor pharmacokinetics

A

subcutaneous injection, 3-5 hr half life

55
Q

Toxicities plerixafor

A

hypersensitivity rxn

56
Q

Oprelvekin MOA

A

IL-11

57
Q

Effects oprelvekin

A

promote formation and maturation of megakaryocytes

58
Q

Clinical applications oprelvekin

A

can be used to treat thrombocytopenia in pts undergoing myelosuppressive chemo for non-myeloid CA

59
Q

Pharmacokinetics oprelvekin

A

given SC once/day, half life 7 hrs

60
Q

Toxicities oprelvekin

A

significant edema, cardiac dysrhythmias, severe allergic rxn, bloodshot eyes

61
Q

Romiplostim MOA

A

binds to TPO receptor

62
Q

Romiplostim effects

A

increase plt count in healthy individuals, people with ITP, or those with myelodisplastic syndrome

63
Q

Romiplostim clinical applications

A

ITP, after failure of glucocorticoids

64
Q

Pharmacokinetics romiplostim

A

administered weekly as a SC injection, half life 3.4 days

65
Q

Toxicity romiplostim

A

well-tolerated, but may have allergic rxn

66
Q

Eltrombopag MOA

A

non-peptide TPO receptor agonist

67
Q

Eltrombopag effects

A

increase plt ct

68
Q

Clinical applications eltrombopag

A

excess plt destruction due to ITP, cirrhosis due to hepatitis C

69
Q

Pharmacokinetics eltrombopag

A

orally active, given once/day, half life 21-36 hrs

70
Q

Toxicity eltrombopag

A

hepatotoxicity

SBL (21 decks)

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