Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Quiz 3 > Anemias > Flashcards

Anemias Flashcards

1
Q

Anemia

A

A reduction in one or more of the major red blood cell measurements obtained as a part of the complete blood count: hemoglobin concentration, hematocrit, or RBC count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hemoglobin

A

the major oxygen-carrying pigment in whole blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hematocrit

A

percent of a sample of whole blood occupied by intact red blood cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RBC Count

A

number of red blood cells contained in a specified volume of whole blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal Hemoglobin

A

Men: 15.7
Women: 13.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal Hematocrit

A

Men: 46
Women: 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Normal RBC count

A

Men: 5.2
Women: 4.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Grade 1 (mild) Anemia

A

Hgb g/dL

WHO: 9.5-10.9
NCI: Greater than or equal to 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Grade 2 (moderate) Anemia

A

Hgb g/dL

WHO: 8-9.4
NCI: 8-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Grade 3 (serious/severe) Anemia

A

Hgb g/dL

WHO and NCI: 6.5-7.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Grade 4 (life-threatening) Anemia

A

Hgb g/dL

WHO and NCI: < 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

reticulocyte count

A

reflects rate of red blood cell production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

mean cell volume (MCV):

A

classifies type of anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

red cell distribution width (RDW):

A

classifies type of anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are signs and symptoms dependent on?

A

Dependent on the degree of anemia and the clinical course:
Symptoms less likely if anemia evolved over long time
Compensatory mechanisms
Relate to oxygen delivery and volume (if acute/marked bleeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms

A

Dyspnea at rest
Fatigue
“Bounding” pulses
“Palpitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Development of anemia is a risk factor for

A

Increased mortality:

  • Chronic kidney disease
  • Malignancy
  • Heart failure
  • The older adult patient
  • Hospitalized adult patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why based on kinetics?

A

Address the mechanism responsible for the fall in hemoglobin

  • Decreased red blood cell production
  • Increased red blood cell destruction
  • Blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why based on Morphological?

A

Address anemia based on alterations in RBC size (MCV) and reticulocyte response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Depressed RBC ±

Depressed hemoglobin can cause:

A
  1. MCV > 100/fL
    Macrocytic anemia
  2. MCV 81-99/fL
    Normocytic anemia
  3. MCV less than or equal to
    80/fL
    Microcytic anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MCV > 100/fL

Macrocytic anemia

A

B12 deficiency, folic acid deficiency, drug induced bone marrow toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MCV 81-99/fL

Normocytic anemia

A

Acute blood loss, hemolytic anemia, anemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MCV less than or equal to
80/fL
Microcytic anemia

A

Iron deficiency, anemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Evaluation of the patient

A

Is the patient bleeding (now or in the past)?
Is there evidence for increased RBC destruction?
Is the bone marrow suppressed?
Is the patient iron deficient? If so, why?
Is the patient deficient in folate or vitamin B12? If so, why?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IRON DEFICIENCY ANEMIA Causes

A
  • Diet- uncommon except in children
  • Failure to absorb iron salts
  • Increased utilization: Pregnancy, Adolescent growth
  • Atransferrinemia
  • Failure to utilize: Lead poisoning, Chronic disease
  • Blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Development stages of iron deficiency anemia

A
  • Depletion of iron stores, decreased ferritin levels- no anemia
  • Increased transferrin levels- no anemia
  • Fall in serum iron- no anemia
  • Development of normocytic, normochromic anemia
  • Development of microcytic, hypochromic anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Laboratory values to diagnose iron deficiency anemia

A
  • Hemoglobin, hematocrit and red blood cell count- decreased
  • MCV- decreased
  • MCH- decreased
  • MCHC- decreased
  • Serum iron- decreased
  • TIBC- increased***
  • Transferrin saturation- decreased
  • Ferritin decreased
28
Q

How do the Iron Deficiency Anemia drugs work?

A
  • Intestinal cells absorb iron via the DMT1 and heme via the HCP1
  • Iron is actively transported into the blood by ferroportin or stored as ferritin
  • In the blood, iron is transported by transferrin to erythroid precurors in the bone marrow to make hemoglobin or to hepatocytes to store as ferritin
  • Transferrin-iron complex binds to TfR and is internalized –> take up the iron
29
Q

Kinetics of Iron salts

A

Absorb about 5 to 10% of iron intake

Absorption changes with body needs

30
Q

ADR of Iron salts

A 
Gastrointestinal: 
Nausea
Epigastric discomfort
Abdominal cramps
Constipation
Diarrhea
31
Q

Iron Salts Toxicity?

A

Acute versus chronic iron poisoning
Acute- accidental ingestion in pediatrics
Chronic- hemochromatosis

32
Q

Iron Salts?

A

Ferrous sulfate
Ferrous gluconate
Iron polysacchride complex

33
Q

Ferrous sulfate dose

A

325 mg

One tablet three times a day with or after meals

34
Q

Intravenous iron preparations for iron deficiency anemia

A

patients with documented iron deficiency who are unable to tolerate or absorb oral iron:

  • Chronic kidney disease patients
  • Malabsorption syndromes
  • Inflammatory bowel disease
35
Q

Intravenous iron preparations Toxicity?

A

Dosage form is the “trick”!

Iron dextran (Dexferrum™, Infed™)
Sodium ferric gluconate complex (Ferrlecit™)
Iron sucrose (Venofer™)
Ferumoxytol (Feraheme™)
Ferric carboxymaltose (Injectafer™)
36
Q

Indication for Iron dextran complex

A

Treatment of iron deficiency in patients in whom oral administration is infeasible or ineffective

37
Q

Indication for Ferric gluconate complex

A

Treatment of iron-deficiency anemia in patients undergoing hemodialysis in conjunction with erythropoietin therapy

38
Q

Indication for Iron sucrose

A

Treatment of iron-deficiency anemia in chronic kidney disease (CKD), including nondialysis-dependent and dialysis-dependent patients

39
Q

Dose for for Iron sucrose

A

100 mg intravenously
during dialysis for 10 doses

  • Cumulative total dose of 1 g elemental iron over approximately 10 sequential dialysis treatments to achieve a favorable response
  • May repeat treatment if clinically indicated
40
Q

Megablastic Anemia Drugs

A 
Vitamin B12 (cyanocobalamin)
Folic acid
41
Q

Why do you need Vitamin B12 (cyanocobalamin) and Folic acid?

A

They are used in making succinyl-coa and DNA –> essential!

42
Q

Vitamin B12 deficiency

A

Impacts hematopoietic and neurological systems
Abnormal DNA replication
Lab tests- serum B12 and serum methlymalonic acid

43
Q

Folic acid deficiency

A

Acute/chronic alcoholism –> malnourished

44
Q

Dietary sources of B12

A

animal byproducts, some legumes

45
Q

Dietary sources of Folate

A

fresh green vegetables, liver, some fruit

Cooking at length can destroy folate

46
Q

Adverse drug reactions of Vitamin B12

A

No rates reported

Range from itching, dizziness, nausea and anaphylaxis

47
Q

Adverse drug reactions of Folic acid

A

None with oral

Intravenous has rare injection site reactions

48
Q

erythropoiesis stimulating agents

A

Glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells in the bone marrow

- Red blood cells: 
Epoetin alfa (Procrit™, Epogen™)
Darbepoetin alfa (Aranesp™)
  • White blood cells:
    Sargramostim (Leukine™)
    Filgrastim (Neupogen™)
49
Q

What does is normal erythropoiesis

A
  1. Kidney senses reduced oxygen carrying capacity in the blood
  2. Kidney releases erythropoietin
  3. Erythropoietin stimulates the bone marrow to produce more RBC’s
  4. Blood has increased oxygen carrying capacity
50
Q

Hypoxia in erythropoiesis

A

Kidney produces erythropoietin which stimulates differentiation of stem cells into erythrocytes so the extra erythrocytes can carry more oxygen

  • Chronic kidney disease impairs this system
  • Use of recombinant-based erythropoietin or epoetin alfa
51
Q

Other effects of erythropoiesis stimulating agents

A

Prevent apoptosis of erythrocytic progenitors

Increase viability of erythrocytes

52
Q

Epoetin alfa Indications

A
  • Treatment of anemia due to concurrent myelosuppressive chemotherapy in patients with cancer (nonmyeloid malignancies) receiving chemotherapy (palliative intent) for a planned minimum of 2 additional months of chemotherapy
  • Treatment of anemia due to chronic kidney disease (including patients on dialysis and not on dialysis) to decrease the need for RBC transfusion
  • Treatment of anemia associated with zidovudine therapy when endogenous erythropoietin levels less than or equal to 500 mUnits/mL
  • Reduction of allogeneic RBC transfusion for elective, noncardiac, nonvascular surgery when perioperative hemoglobin is greater than 10 to 13 g/dL or lower and there is a high risk for blood loss
53
Q

Darbepoetin alfa indications

A
  • Treatment of anemia due to concurrent myelosuppressive chemotherapy in patients with cancer (nonmyeloid malignancies) receiving chemotherapy (palliative intent) for a planned minimum of 2 additional months of chemotherapy
  • Treatment of anemia due to chronic kidney disease (including patients on dialysis and not on dialysis)
54
Q

erythropoiesis stimulating agents drugs?

A

Darbepoetin alfa

Epoetin alfa

55
Q

erythropoiesis stimulating agents Works pretty well

A

Look for reticulocyte count and hemoglobin/hematocrit rise

56
Q

erythropoiesis stimulating agents How to properly dose

A
  • Labeled dosing recommendations
  • Assess effect and then you may have to “surrender”
    No effect after 12 weeks? Therapeutic failure
57
Q

erythropoiesis stimulating agents Short-acting versus long-acting

A

Epoetin is short; darbepoetin is long

58
Q

erythropoiesis stimulating agents Too much of a good thing

A

Ceiling target of achieving 10 to 12 g/dL hemoglobin levels:
Hypertension
Thrombotic events

59
Q

erythropoiesis stimulating agents ADR

A

Allergic reactions: Rare

Headache, hypertension, fever, nausea, pruritus, injection site reaction

60
Q

Darbepoetin alfa (Aranesp™) Dose

A

0.75 mcg/kg subcutaneously

once every 2 weeks

61
Q

Sickle cell anemia

A
  • Anemia actually not the major problem:
    Low hematocrit
    Low hemoglobin
    Elevated reticulocyte count

***Problem is in the microvasculature:
Veno-occlusive damage
Organ damage

62
Q

Sickle cell anemia treatment

A

Analgesics
Antibiotics
Blood transfusions
Pneumococcal vaccination

63
Q

Sickle cell anemia’s most frequent complaint

A

PAIN

Appropriate analgesics such as NSAIDs, acetaminophen, opioids

64
Q

How do anti-sickling agents work?

A
  • Increases red blood cell hemoglobin F levels:
    Reduction of polymerization of hemoglobin S
    Reduction of deformed, dense and damaged erythrocytes
  • Increases red blood cell water content
  • Alters adhesion of red blood cells to endothelium
65
Q

What is the anti-sickling agent

A

Hydroxyurea

66
Q

ADR of the anti-sickling agent

A

Central nervous system with dizziness, disorientation, hallucinations
Hepatotoxicity
Hyperuricemia
Dysuria

Leukopenia:
Need to monitor blood work constantly along with renal function, liver function and serum uric acid
Rechallenge

67
Q

Hydroxyurea

(DroxiaTM) Dose

A

500 mg

Take 5 capsules once a day daily

Pharm Quiz 3 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions