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PHRM 864 therapeutics > Anemia Therapeutics > Flashcards

Anemia Therapeutics Flashcards

1
Q

What is anemia?

A

Low RBC or hemoglobin

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2
Q

How to diagnose anemia

A

Look at lab values and signs and symptoms

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3
Q

What are the signs and symptoms of anemia

A

Exertional dyspnea
Angina
Tachycardia
Fatigue
Pallor
could be asymptomatic

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4
Q

what is Hgb for men

A

13.5-18

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5
Q

what is Hgb for women

A

12-16

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6
Q

what is MCV normal

A

80-100

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7
Q

what is RDW

A

variation is size of RBCs

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8
Q

What are the 3 main causes of anemia

A

Decreased RBC production (chronic disease or nutritional deficiencies)
Increased RBC destruction (drugs or sickle cell)
Increased RBC loss (acute blood loss or chronic NSAID/ASA use)

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9
Q

What is microcytic anemia

A

MCV < 80
iron deficiency, sickle cell

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10
Q

what is normocytic

A

MCV 80-100
chronic disease, blood loss, hemolysis

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11
Q

what is macrocytic

A

MCV > 100
folic acid and or b12 deficiency

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12
Q

What are the goals of therapy for anemia

A

Increase Hgb
Relieve symptoms
Reduce morbidity
Improve QOL
Reduce mortality
not just normalize the labs!

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13
Q

Labs for iron deficiency anemia

A

dec Hgb
dec MCV
dec ferritin
dec serum iron
dec TSAT

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14
Q

what is the goal ferritin

A

15-200

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15
Q

what is the goal TSAT

A

20-50%

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16
Q

what are causes of iron deficiency

A

-blood loss
-decreased absorption (celiacs or bypass)
-vegetarian diet
-pregnancy

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17
Q

what are additional signs of iron deficient anema

A

spoon shaped nails
inflamed tongue
pica (ice)

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18
Q

how to treat iron deficiency anemia

A

Oral iron
address underlying cause

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19
Q

when is oral iron not preferred

A

cannot tolerate SE
cannot absorb
ESRD
HF

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20
Q

How much oral iron for anemia?

A

65mg elemental iron every day
120-200mg elemental iron bid/tid

21
Q

why is every other day iron better?

A

hepcidin levels will rise and then fall by the time next dose is due

22
Q

how much elemental iron is in 300mg of ferrous fumarate

A

100mg

23
Q

how much elemental iron is in 325mg of ferrous sulfate

A

65mg

24
Q

how much elemental iron is in 300mg of ferrous gluconate

A

30mg

25
Q

what are counseling points for oral iron

A

inc absorption on empty stomach
can cause stomach upset
absorption increased with ascorbic acid
causes constipation
causes dark stools

26
Q

when to use IV iron

A

ESRD
HF
Malabsorption
Failed oral iron

27
Q

side effects of IV iron

A

hypotension during infusion
skin tattooing

28
Q

lab values for B12 deficient anemia

A

dec Hgb
inc MCV
inc RDW
ferritin and TSAT not affected
dec B12
inc methylmalonic acid

29
Q

what are causes of B12 deficiency

A

diet (vege or alcoholism)
Lack of intrinsic factor
dec absorption
meds (PPIs, metformin)

30
Q

How to treat b12 deficient anemia

A

replace b12
IM or deep SC
oral option

31
Q

when to not give oral b12

A

when neuro symptoms are present

32
Q

b12 dosing

A

1000-2000 mcg/day

33
Q

Labs for folic acid iron deficiency

A

dec Hgb
inc MCV
inc RDW
ferritin/TSAT normal
serum folate < 5
inc homocysteine

34
Q

what are the causes of folic acid deficiency

A

malabsorption
malnutrition
alcoholism
medications

35
Q

what medications cause folic acid deficiency

A

methotrexate
phenytoin
sulfasalazine
SMZ-TMP

36
Q

How to treat folic acid deficiency

A

oral folic acid
1-5mg daily until Hgb normalizes
treat underlying cause

37
Q

what should always be checked before replacing folic acid?

A

B12 deficiency

38
Q

what are the common chronic diseases that lead to anemia

A

CKD
CHF
cancer
HIV/AIDs

39
Q

what should be avoided in anemia of CKD

A

blood transfusions

40
Q

what is the treatment for anemia of CKD

A

correct nutritional deficiencies
oral folate/b12
oral iron if not on hemo
iv iron if on hemo

41
Q

what are ESAs place in therapy for anemia of CKD?

A

Prevent blood transfusions
Keep Hgb > 10

42
Q

how to treat anemia in HF

A

IV iron only in class II or III

43
Q

how does iv iron help HF patients according to trials

A

decrease hospitalizations but do not decrease mortality

44
Q

can you use oral iron in HF

A

no

45
Q

what are the types of hemolytic anemia?

A

Intertied: sickle cel, G6PD deficiency
Acquired: drug induced

46
Q

what is sickle cell anemia

A

RBCs are irregular shape
collect in spleen and destroyed faster than they can be produced

47
Q

How to treat sickle cell

A

Folic acid
Blood transfusions
Hydroxyurea
Pain control

48
Q

what should you be cautious of when doing blood transfusions in sickle cell patients

A

iron overload from frequent transfusions

PHRM 864 therapeutics (14 decks)

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