Anemia Rx

Question 1

Erythropoeitin / Darbepoetin

Answer 1

Target: JAK/STAT receptors
MOA: stimulate erythropoetin proliferation and differentiation
Use: parentally given in ESRD and BM suppression
SE: HTN, thrombosis

Question 2

Filgrastim

Answer 2

G-CSF
Target: JAK/STAT receptors
Action: increase production and function of PMNs
Use: chemo induced neutropenia, BM suppression
SE: few (it’s tolerated well)

Question 3

Sargramostin

Answer 3

GM-CSF
Target: JAK/STAT receptors
Action: stimulates all myeloid lines (including megakaryocyte progenitors)
Use: chemo induced neutropenia, BM suppression
SE: bone pain

Question 4

IL-11

Answer 4

Target: cell surface cytokine receptor
MOA: stimulates growth of primitive megakaryocyte progenitors
Action: increases peripheral platelets and PMNs
Use: reduced need for platelet transfusion in chemo pt w/ prior episodes of thrombocytopenia

Question 5

Hydroxyurea

Answer 5

Action: increased HbF concentration reducing sickling, decreases expression of PMN adhesion molecules, increases endothelial production of NO to vasodilate

Question 6

Deferoxamine

Answer 6

DOC for acute iron toxicity

Question 7

Deferasirox

Answer 7

Indicated in pts that are transfusion dependent as prophylactic for acute iron toxicity

Question 8

Ferrous Iron Supplements

Answer 8

Ferrous (Fe2+) is more readily absorbed, adjunct as or ic acid (via. C) for optimal absorption d/t a pH something something
Treat for 3-6mo
SE: black tarry stool (do guiac test to r/o GI bleed), GI upset

Question 9

Iron Dextran

Answer 9

Parenteral iron supplement, high risk of type I HS rxn compared to other forms of IV therapies

Question 10

Acute Iron Toxicity

Answer 10

ROS: GI upset, abd pn, musical ulceration and bleeding, metabolic acidosis, shock/coma/death
X-ray: pills in stomach
Tx: Deferoxamine (iron chelator) promotes iron excretion or Deferaxirox is oral prep (only useful if given w/in 1h of Iron ingestion)

Question 11

Drugs that inhibit absorption of Vit B12 (Cobalamin)

Answer 11

Metformin / Neomycin (alter gut flora), Nitrous oxide anesthesia (convert the Vit to its inactive form), H+ pump inhibitors / H2 receptor antagonists (increase gastric pH)

Question 12

Hydroxocobalamin

Answer 12

Vit B12 deficiency therapy

*DOC bc it is highly protein bound so it remains in circulation for longer period of time

Question 13

Drugs that impair Folate metabolism?

Answer 13

Trimethoprim, Pyrimethamine, Methotrexate
MOA: inhibit DHF reductase
*Phenytoin reduces serum folate levels but we dfk why