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Oncology > Anemias > Flashcards

Anemias Flashcards

1
Q

What Hgb level is considered anemia?

A

<11

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2
Q

What patients is anemia more common in?

A
  1. Women during reproductive year
  2. Comorbid conditions (cancer, CKD)
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3
Q

What hormone is RBC production stimulated by?

A

Erythropoietin EPO

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4
Q

Where is erythropoietin produced?

A

Kidneys

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5
Q

What are the symptoms of anemia?

A
  1. fatigue/ lethargy
  2. shortness of breath
  3. headache
  4. edema
  5. tachycardia
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6
Q

What are the complications of anemia?

A
  1. increase in cardiac output due to lack of oxygen
  2. decreased quality of life
  3. influences mortality
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7
Q

What are possible causes of decreased RBC production?

A
  1. hypoproliferative bone marrow (chancer/chemo)
  2. decreased production/ response to EPO (CKD/ inflammatory conditions)
  3. nutritional deficiency (B12, iron)
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8
Q

How does cancer cause anemia?

A
  1. hematologic cancer
  2. bone metastases
  3. cytokines decrease EPO production
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9
Q

When are RBC transfusions appropriate?

A
  1. severe anemia (Hgb <8)
  2. life-threatening anemia (Hgb <6.6)
  3. active bleeding
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10
Q

What are the potential complications with RBC transfusions?

A
  1. infusion reactions
  2. infection transmission
  3. autoantibody development
  4. hemochromatosis
  5. brief effects
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11
Q

What agents are erythropoietin stimulating agents and increase the production of RBCs?

A
  1. Epoetin alfa (PROCRIT)
  2. Darbepoetin alfa (ARANESP)
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12
Q

When are erythropoietin stimulating agents commonly used?

A

treat anemia associated with cancer and chemotherapy

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13
Q

What are adverse effects with erythropoietin stimulating agents?

A
  1. venous thromboembolism
  2. HTN
  3. Cardiovascular events
  4. stroke
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14
Q

What outcomes do recent studies of erythropoietin stimulating agents show?

A

increased mortality

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15
Q

When are erythropoietin stimulating agents NOT recommended?

A
  1. patients receiving myelosuppressive chemo with anticipated cure
  2. treat anemia associated with cancer
  3. hematologic malignancies
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16
Q

When should erythropoietin stimulating therapy begin and be D/C?

A

Hgb <10;
Stop when Hgb= 10

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17
Q

The FDA requires that all prescribed erythropoietin stimulating agents be part of a ____________

A

REMS program

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18
Q

What is the cause of anemia of CKD?

A

reduced EPO production AND reponse

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19
Q

When should evaluation of anemia if CKD begin?

A

stage 3 or higher

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20
Q

What is the target Hgb range for those with CKD?

A

10-12

21
Q

What agents are used to treat anemia of CKD?

A

SQ erythropoietin stimulating agents

22
Q

When are adverse effects of erythropoietin stimulating agents more common is CKD?

A

target Hgb > 13

23
Q

How is anemia due to inflammatory conditions treated?

A

treat underlying condition

24
Q

What is the most common cause of anemia in children and women of childbearing age?

A

iron-deficiency

25
Q

What are the symptoms of iron deficiency anemia?

A
  1. hair loss
  2. pica
  3. koilonychia (spoon nails)
  4. angular stomatitis (crusty around the mouth)
26
Q

Is dietary supplementation of iron adequate to treat anemia?

A

no

27
Q

What are the 3 different iron salts available?

A

sulfate, gluconate, fumarate

28
Q

How much elemental iron is needed per day for replacement?

A

200 mg

29
Q

What can enhance the absorption of iron supplements?

A

Vitamin C

30
Q

What can reduce the absorption of iron therapy?

A

alkaline environment

31
Q

What are adverse effects of iron replacement?

A
  1. constipation
  2. N/V
  3. discoloration of feces
  4. heartburn
32
Q

When should iron replacement be taken for the best absorption?

A

1 hour before meals

33
Q

What drugs can decrease iron absorption?

A
  1. Al, Mg, Ca containing products
  2. tetracyclines
  3. H2 antagonist
  4. PPIs
  5. cholestyramine
  6. fluoroquinolones
  7. mycophenolate
  8. penicillamine
  9. levodopa
34
Q

When is parenteral iron used?

A
  1. intolerance to oral therapy
  2. malabsorption
  3. CKD
  4. excess continuous blood loss
  5. chemo/ ESAs
35
Q

What is the standard dose of parenteral iron?

A

1000mg

36
Q

What parenteral iron needs to be tested for hypersensitivity?

A
  1. iron dextran
  2. ferric gluconate
  3. iron sucrose
37
Q

What are adverse affects with IV iron?

A
  1. anaphylaxis
  2. infusion-related reactions
  3. cramps
  4. diarrhea
  5. hypotension
38
Q

What are the causes of B12 deficiency?

A
  1. poor intake
  2. malabsorption
  3. medications
39
Q

What are the causes of B12 malabsorption?

A
  1. advanced liver disease
  2. infections (H.pylori, tapeworms, TB)
  3. GI surgery
40
Q

What medications can cause B12 deficiency?

A
  1. metformin
  2. phenytoin
  3. trimethoprim
41
Q

How is B12 supplemented?

A

Oral 1000-2000 mcg daily
IM/ IV 1000 mcg monthly
both are equivalent

42
Q

What are the causes of inadequate intake of folic acid?

A
  1. alcoholism
  2. chronically ill
  3. demented
  4. economically challenged
  5. fad diets
43
Q

What are the causes of the malabsorption of folic acid?

A
  1. alcohol
  2. drugs
  3. GI surgery
44
Q

What are the reasons for increased requirements of folic acid?

A
  1. burn patients
  2. chronic inflammatory conditions
  3. growth spurts
  4. malignancy
  5. pregnancy
45
Q

What drugs directly inhibit DNA synthesis causing folic acid deficiency?

A
  1. Azathioprine
  2. 5-FU
46
Q

What drugs act as folate antagonists?

A
  1. MTX
  2. pentamidine
  3. trimethoprim
  4. triamterene
47
Q

What drugs reduce absorption causing folic acid deficiency?

A
  1. phenytoin
  2. phenobarnitol
  3. primidone
48
Q

How much folic acid is needed for replacement?

A

1-5 mg daily

Oncology (22 decks)

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