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Pharmacotherapeutics > Anemias (exam 3) > Flashcards

Anemias (exam 3) Flashcards

1
Q

Anemia

A

Low hemoglobin concentration
reduced oxygen-carrying capacity

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2
Q

Hemoglobin (Hb)

A

Iron rich protein in RBCs that carries oxygen from lungs to tissues

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3
Q

Anemia level in men

A

Hb < 13 g/dl

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4
Q

Anemia level in women

A

Hb < 12 g/dl

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5
Q

Erythropoietin (EPO)

A

hormone released from kidneys that signals bone marrow to make RBCs

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6
Q

Reticulocytes

A

immature RBCs that become erythrocytes

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7
Q

Erythrocytes

A

mature RBCs that mainly consist of Hb

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8
Q

Normal life span of erythrocytes

A

120 days

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9
Q

Erythropoiesis feedback loop leads to

A

increased RBC production
Decreased Hb concentration
increased erythropoietin

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10
Q

Etiology of anemia

A

blood loss
decreased RBC production
increased RBC destruction

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11
Q

Underproduction of RBCs

A

Problem with bone marrow
lack of iron folate b12
Kidney dysfunction of EPO

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12
Q

Destruction of RBCs results in

A

low Hb
high reticuloctye count

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13
Q

Anemia risk factors

A

Women of childbearing age
Blood donors
Advanced age
CKD
Cancer
Poor dietary intake
Malabsorption syndromes
Medications

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14
Q

Chronic anemia symptoms

A

fatigue, lethargy, dyspnea, weakness, headache, pale

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15
Q

Rapid onset anemia symptoms

A

chest pain, palpitations, tachycardia, breathlessness, orthostatic lightheadedness

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16
Q

Anemia Labs

A

CBC with RBC indices
Reticulocyte index
Deficiencies
Stool sample for occult blood
Peripheral blood smear

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17
Q

Microcytic

A

MCV < 80 fL

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18
Q

Macrocytic

A

MCV > 100 fL

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19
Q

Normocytic

A

MCV 80-100 fL

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20
Q

Hyperchromic

A

Pernicious anemia

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21
Q

Hypochromic

A

iron deficiency anemia

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22
Q

Macrocytic Anemias

A

Vitamin B12 deficiency
Folate deficiency

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23
Q

Macrocytic can be broken down into ____ and _____

A

Megaloblastic

Nonmegaloblastic

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24
Q

Megaloblastic

A

Abnormal DNA metabolism

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25
Q

B12 and folate are ____ in DNA synthesis

A

co-enzymes

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26
Q

Vitamin B12

A

water-soluble crucial for neurologic function, RBC production, and DNA/RNA synthesis

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27
Q

Dietary sources of vitamin b12

A

meat, fish, poultry, dairy, fortified cereals

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28
Q

Vitamin B12 depends on ___ and ____ for absorption

A

gastric acid

intrinsic factor

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29
Q

Which deficiency takes several years to develop?

A

B12

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30
Q

Recommended dietary allowance of B12

A

Adults: 2 mcg
Pregnant/breastfeeding: 2.6 mcg

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31
Q

Etiology of B12 anemia

A

Inadequate intake and malabsorption

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32
Q

Malabsorption of B12

A

Decreased ileal absoption
Decreased intrinsic factor
Inadequate gastric acid production

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33
Q

Clinical presentation of b12 anemia

A

fatigue, dyspnea, weakness
NEUROLOGIC - can be irreversible

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34
Q

Lab findings in b12 anemia

A

High MCV > 100 fL
Leukopenia
Thrombocytopenia
B12 normal in early or low (<200)
High homocysteine and MMA

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35
Q

Oral and parenteral vitamin b12 are ____

A

equally efficacious

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36
Q

Oral B12

A

Cyanocobalmin 1000 mcg PO QD
Sublingual for 30 seconds

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37
Q

Cyanocobalmin ADRs

A

Allergic reaction, pruritis, rash, diarrhea

38
Q

Cyanocobalmin interactions

A

omeprazole and ascorbic acid may decrease absorption

39
Q

Parenteral B12 1000mcg/1mL is recommended for

A

neurologic symptoms

40
Q

Parenteral B12 ADRs

A

Injection site pain, allergic reaction, dizziness, fluid retention

41
Q

Nascobal 500 mcg/0.1 mL is recommended for

A

maintenance therapy

42
Q

Nascobal is not recommended for

A

Patients w nasal disease
Nervous system involvement
Using another nasal spray

43
Q

Folate (B9)

A

water-soluble vitamin necessary for RBC production and DNA/RNA synthesis

44
Q

Folate deficiency occurs within

A

3-4 months

45
Q

Recommended daily allowance of folate

A

400 mcg in males and non preg
600 mcg in pregnant
500 mcg for lactating

46
Q

Etiologies of folate deficiency

A

Inadequate intake
Decreased absorption
Medications (methotrexate)
Increased folate requirements

47
Q

Lab findings of folate deficiency

A

low Hb/Hct
leukopenia
thrombocytopenia
high MCV
low serum folate (<3)
High homocysteine
Normal MMA and B12

48
Q

Folic acid supplementation

A

1 mg PO QD

49
Q

Folic acid drug interactions

A

phenytoin
carbamazepine
primidone
valproate

50
Q

Microcytic anemias

A

iron deficiency anemia

51
Q

Most common cause of anemia

A

iron deficiency

52
Q

Risk factors of IDA

A

women
young children
>65 years old
vegetarians
frequent blood donors

53
Q

Recommended daily allowance of iron

A

8 mg adults + postmenopausal
18 mg menstruating

54
Q

Iron absorption depends on

A

Type of iron molecule (heme vs. nonheme)
Others absorbed with it
Gastric pH

55
Q

Iron-transport protein

A

Transferrin

56
Q

Iron is stored as

A

ferritin in liver, bone marrow, spleen
hemosiderin in liver and bone marrow

57
Q

Transferrin ____ available iron from aging RBCs during phagocytosis

58
Q

Hepcidin

A

regulates iron absorption, recycling, and mobilization from storage

59
Q

Etiology of iron deficiency

A

decreased intake
decreased absorption
increased demand
increased loss of iron

60
Q

Stage 1 Iron deficiency

A

requirement > intake
iron stores reduced
normal iron, low ferritin

61
Q

Stage 2 iron deficiency

A

Iron stores depleted
recycled iron maintains Hb synthesis
Hb lower, low TSAT, high TIBC

62
Q

Stage 3 iron deficiency

A

Impairs RBC synthesis
Results in anemia
low Hb

63
Q

Severe iron deficiency symptoms

A

glossal pain
koilonychias
phagophagia
pica

64
Q

Iron panel

A

Serum iron
Serum ferritin
Total iron binding capacity (TIBC)
Transferrin saturation (TSAT)

65
Q

Oral iron max absorption in the ____
Why?

A

Duodenum

Acidic environment

66
Q

Oral iron recommended daily dose

A

150-200 mg elemental iron daily

67
Q

Oral iron products

A

Ferrous sulfate
Ferrous sulfate, anhydrous
Ferrous gluconate
Ferrous fumarate
Polysaccharide-iron complex

68
Q

Ferrous sulfate % elemental

69
Q

Ferrous sulfate, anhydrous % elemental

70
Q

Ferrous gluconate % elemental

71
Q

Ferrous fumarate % elemental

72
Q

Oral iron ADRs

A

dark/discolored stools, constipation, nausea

73
Q

When to take iron?

A

Empty stomach at least 1 hour before or 2 hours after
Can take with meals if GI side effects or take with OJ

74
Q

Use IV iron when

A

Patient is nonadherent
Significant blood loss
Malabsorption syndromes
CKD
Chemo on ESAs

75
Q

Iron Dextran (IV) indication

A

iron deficiency for anyone unable to tolerate oral iron

76
Q

Iron Dextran BBW

A

Anaphylactic type reactions

77
Q

Iron Sucrose (IV) indications

A

IDA with CKD

78
Q

Iron Sucrose ADRs

A

Hypotension
Muscle/leg cramps
anaphylactic reactions

79
Q

Which IV iron has the lowest risks?

A

Iron sucrose

80
Q

Ferumoxytol (IV) indication

A

IDA with CKD

81
Q

Ferumoxytol BBW

A

Anaphylaxis

82
Q

Which IV iron may alter ability of MRI?

A

Ferumoxytol

83
Q

Sodium Ferric Gluconate (IV) indications

A

IDA with CKD on hemodialysis in conjunction with ESA therapy

84
Q

Sodium Ferric Gluconate ADRs

A

Cramps, nausea, vomiting, flushing, hypotension, rash, pruritus

85
Q

_____ has less anaphylaxis compared to iron dextran

A

Sodium Ferric Gluconate

86
Q

Ferric Carboxymaltose (IV) indications

A

IDA who failed oral iron therapy
IDA intolerant to oral therapy
CKD not on dialysis

87
Q

Ferric Carboxymaltose ADRs

A

Flushing, nausea, dizziness, headache, hypertension, decreased phosphate, anaphylaxis

88
Q

Length of iron therapy

A

Response seen in 7-10 days
Continue 3-6 months after anemia is resolved

89
Q

Target of iron therapy

A

increase Hb by 1 g/dL per week

90
Q

Blood transfusion indication

A

Symptomatic patients with Hb < 7 g/dL

91
Q

Risks of blood transfusion

A

Infections
Volume overload
Hyperkalemia
Citrate toxicity
Rejection

Pharmacotherapeutics (24 decks)

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