Anemia Pharmacology

Question 1

Pharmacotherapy of Iron Deficiency Anemia

Answer 1

Iron preparations

Iron is needed for hematopoietic of RBC’s
-Heme: Contains IRON
-Globulin: Protein that bind heme group together
-Hemoglobin necessary for RBC’s to carry oxygen to the body

Supplemental Iron comes in oral form including liquid formulations and parenteral forms for IM and IV use

Question 2

Iron Deficiency Drugs

Answer 2

Ferrous sulfate, ferrous gluconate (oral)

Iron dextran (IV form)

Question 3

Iron durg indications

Answer 3

treat and prevent iron deficiency anemia. Treat blood loss

Question 4

Iron supplementation: Interactions

Answer 4

-Decrease absorption with antacids

-Increased absorption with Vitamin C

Question 5

Iron Supplements: Adverse Effects

Answer 5

Nausea, Heartburn, Constipations

Metallic taste

Staining teeth

Fatal iron toxicity (OD in children causing liver failure)

Question 6

Iron Supplementation: Chelating agent

Answer 6

Deferoxamine/Desferal is drug given to treat iron toxicity

Works by binding or chelating the iron causing it form insoluble complex that is excreted in the stool

Question 7

Administration of IRON

Answer 7

Oral: Best absorbed on empty stomach. Do not crush or chew. Take at night to help minimize effects. Do not give iron to antacids or calcium supplements (calcium supplements)

Parental: Give test dose. BBW:

Question 8

Iron Therapy Dosage Issues

Answer 8

Ferrous sulfate only contains 20% elemental iron by weight

Elemental iron - available for absorption

Question 9

Iron Therapy Interactions

Answer 9

Antacids reduce absorption

Food help prevent GI effects

Food decreases absorption by 50-70%

Question 10

Iron Therapy Toxicity

Answer 10

Risk of OD

Stomach pain and GI problems

Fatal in kids

Question 11

Treatment of B12 deficeincy: injection

Answer 11

cyanocobalamin

Question 12

B12 deficiency: Diet

Answer 12

Meat, Salmon, Cod, Milk, Dairy, and Eggs

Question 13

Treatment of folate deficiency: Diet

Answer 13

Increase consumption of leafy greens, legumes, and organ meats

Multivitamin supplements

Question 14

cyanocobalamin: Indicaitions

Answer 14

Low b12 levels

Pernicious Anemia

Bariatric surgery patients need 1 mg daily indefinitely

Surgeries where all or part of the stomach is removed

Question 15

Folic Acid Supplements: Indications

Answer 15

To treat folic acid anemia, in pregnant women to prevent neural tube defects

Question 16

Folic Acid: Available

Answer 16

Prescription strength = tablets or liquid; usual dose 1-5 mg daily

OTC; recommended dose is 400 mcg/day

Well tolerated

Question 17

Erythropoiesis stimulating agent

Answer 17

epoetin alfa

Question 18

Epoetin alfa: MOA

Answer 18

Stimulates erythropoiesis; increases hemoglobin and reticulocyte counts. Only indicated when hemoglobin is less than 10g/dL UNLESS on dialysis

IV and Subcutaneously

Just for people who kidneys on not functioning and they are not releasing erythropoietin

Question 19

Epoetin alfa: Indications

Answer 19

Treatment of anemia due to chronic kidney disease

Question 20

Epoetin alfa: Monitoring

Answer 20

Blood test weekly to monitor hemoglobin with goal of less than 11 g/dL to decrease risk for clotting

Evaluate iron status before and during treatment - usually need iron supplementation

Question 21

Epoetin alfa: Side Effects

Answer 21

Hypertension and serious CV events (Increased hematocrit = increase risk)

Progression of certain cancers

Injection site problems, bone pain, headache

Question 22

Epoetin alfa: NSG considerations

Answer 22

-Do not given that has been shaken or frozen

-Protect from light

-Do not dilute or mix

-Is contraindicated in patients with uncontrolled hypertension as epogen my worsen high BP

-May be given IV push

-Levels of Hgb typically begin to rise in about 2 weeks

Question 23

Epogen alfa: BBW

Answer 23

Patients experienced greater risks for death, serious adverse CV reactions, and stroke when administered ESA to target hemoglobin >11 g/dL

Question 24

Iron dextran BBW

Answer 24

Have epi available for possible allergic reaction. IM use Z track to avoid staining skin and use 1.5 inch needle