Anemia Pharm

Question 1

What molecules make up heme?

Answer 1

protoporphyrin IX and Fe

Question 2

Causes of microcytic anemia

Answer 2

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

Question 3

Foods from which iron is easily absorbed

Answer 3

meat, fish, poultry

Question 4

How does food effect iron absorption?

Answer 4

inhibits absorption

Question 5

Side effects of oral iron tablets

Answer 5

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

Question 6

IV iron complexes

Answer 6

iron dextran, sodium ferric gluconate, iron-sucrose

Question 7

Acute iron toxicity

Answer 7

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

Question 8

Treatment of acute iron toxicity

Answer 8

parenteral deferoxamine, and whole bowel irrigation

Question 9

Chronic iron toxicity

Answer 9

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

Question 10

Sources of vitamin B12

Answer 10

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

Question 11

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

Answer 11

years, liver stores a significant amount

Question 12

Neurological sxs of B12 deficiency

Answer 12

paresthesias, weakness, spasticity

Question 13

How is cobalamin released from food

Answer 13

acid and pepsin

Question 14

Causes of pernicious anemia

Answer 14

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

Question 15

Sxs of B12 deficiency

Answer 15

vitiligo, hyperpigmentation, glossitis, anemia, neutropenia, thrombocytopenia

Question 16

Treatment of vitamin B12 dficiency

Answer 16

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

Question 17

Sources of folate

Answer 17

yeast, liver, kidney, green leafy vegetables

Question 18

Where is folate absorbed in the body?

Answer 18

jejunum

Question 19

How long does it take to develop a folate deficiency?

Answer 19

three weeks without adequate intake

Question 20

Sxs of folate deficiency

Answer 20

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

Question 21

Treatment of folate deficiency

Answer 21

oral folate, 1mg/day for 4 months

Question 22

epoetin alfa MOA

Answer 22

contains a.a. sequence of isolated erythropoeitin

Question 23

epoeitn alfa effects

Answer 23

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

Question 24

Clinical applications epoetin alfa

Answer 24

chronic kidney disease, CA chemo

Question 25

Pharmacokinetics of epoetin alfa

Answer 25

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

Question 26

Epoetin alfa toxicities

Answer 26

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

Question 27

Hydroxyurea MOA

Answer 27

boosts level of hgb

Question 28

Effects of hydroxyurea

Answer 28

lowers concentration of HbS within a cell

Question 29

Clinical applications hydroxyurea

Answer 29

sickle cell

Question 30

Pharmacokinetics hydroxyurea

Answer 30

administered orally, distributed widely

Question 31

Toxicities hydroxyurea

Answer 31

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

Question 32

Eculizumab MOA

Answer 32

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

Question 33

Eculizumab effects

Answer 33

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

Question 34

Clinical applications eculizumab

Answer 34

PNH, atypical HUS

Question 35

Pharmacokinetics eculizumab

Answer 35

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

Question 36

Toxicities of eculizumab

Answer 36

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

Question 37

Causes of neutropenia

Answer 37

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

Question 38

Sxs of neutropenia

Answer 38

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

Question 39

Filgrastim MOA

Answer 39

human G-CSF

Question 40

Filgrastim effects

Answer 40

regulates production of neutrophils within bone marrow

Question 41

Clinical applications filgrastim

Answer 41

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

Question 42

Pharmacokinetics filgrastim

Answer 42

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

Question 43

Filgrastim toxicities

Answer 43

allergic rxn, bone pain

Question 44

sargramostim MOA

Answer 44

recombinant form of GM-CSF

Question 45

Effects sargramostim

Answer 45

increase production neutrophils, eosinophils, monocytes and macrophages

Question 46

Clinical applications sargramostim

Answer 46

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

Question 47

Pharmacokinetics sargramostim

Answer 47

given IV or SC

Question 48

Toxicities sargramostim

Answer 48

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

Question 49

Does filgrastim or sargramostim have fewer side effects?

Answer 49

filgrastim

Question 50

UpToDate recommendations on CSF use in CA

Answer 50

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

Question 51

Plerixafor MOA

Answer 51

partial agonist of CXCR4 receptor, homing to HSC

Question 52

Plerixafor effects

Answer 52

mobilizes HSC to plasma

Question 53

Plerixafor clinical use

Answer 53

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

Question 54

Plerixafor pharmacokinetics

Answer 54

subcutaneous injection, 3-5 hr half life

Question 55

Toxicities plerixafor

Answer 55

hypersensitivity rxn

Question 56

Oprelvekin MOA

Answer 56

IL-11

Question 57

Effects oprelvekin

Answer 57

promote formation and maturation of megakaryocytes

Question 58

Clinical applications oprelvekin

Answer 58

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

Question 59

Pharmacokinetics oprelvekin

Answer 59

given SC once/day, half life 7 hrs

Question 60

Toxicities oprelvekin

Answer 60

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

Question 61

Romiplostim MOA

Answer 61

binds to TPO receptor

Question 62

Romiplostim effects

Answer 62

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

Question 63

Romiplostim clinical applications

Answer 63

ITP, after failure of glucocorticoids

Question 64

Pharmacokinetics romiplostim

Answer 64

administered weekly as a SC injection, half life 3.4 days

Question 65

Toxicity romiplostim

Answer 65

well-tolerated, but may have allergic rxn

Question 66

Eltrombopag MOA

Answer 66

non-peptide TPO receptor agonist

Question 67

Eltrombopag effects

Answer 67

increase plt ct

Question 68

Clinical applications eltrombopag

Answer 68

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

Question 69

Pharmacokinetics eltrombopag

Answer 69

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

Question 70

Toxicity eltrombopag

Answer 70

hepatotoxicity