Anemic drugs

Question 1

What are the TWO drug types for anemia?

Answer 1

1. vitamin supplements
2. iron salts

Question 2

What are the vitamin supplements you can take?

Answer 2

1. cyanacobalamin (Nascobal)
2. Folic Acid

Question 3

Routes for vitamin supplements

Answer 3

Cyanocobalamin (Nascobal)
IM/ deep subcutaneous
Intranasal

Folic Acid
PO/IM/ Subcutaneous/ IV

Question 4

What are the side effects of taking cyanocobalamin?

Answer 4

athralgia, dizziness, headache, nasopharyngitis, anaphylaxis, hypokalemia

Question 5

What are the side effects of folic acid?

Answer 5

Flushing, rash Hypersensitivity

Question 6

What are the iron supplements one can take?

Answer 6

ORAL (long term, risk of GI issues)
- ferrous sulphate
- ferrous polymaltose

IV (short term, fast increase of Hb levels; risk of anaphylaxis)
- Ferrous Carboxymaltose
- Iron Sucrose
- Iron Dextran (greatest risk of anaphylaxis!!)

Question 7

How do you get a deficiency of Vit B12?

Answer 7

1. Intrinsic factor not produced by the stomach (eg. surgery)
2. Strict vegetarians, since Vit B12 is found in animals

Question 8

How often is parental Vit B12 given and via what route?

Answer 8

weekly, biweekly, or monthly intramuscular (IM) or subcutaneous injections.

Question 9

In what instance do patients not require parental Vit B12?

Answer 9

1. Oral: sufficient amounts of intrinsic factor
2. Intranasal: Used for maintenance therapy after normal vitamin B12 levels have been restored by parenteral preparations. (once a week)

Question 10

Onset + Peak (via different routes) + Duration for Vit B12

Answer 10

Onset: Days to weeks
Peak: 8–12 h PO; 1–2 h intranasal; 1 h IV
Duration: Unknown

Question 11

Potential side effects for Vit B12

Answer 11

Hypokalemia (monitor serum levels)
Small number of patients experience arthralgia, dizziness, or headache
Anaphylaxis is possible, though rare.

Question 12

Contraindicators for Vit B12

Answer 12

Sensitivity to cobalt and folic acid–deficiency anemia.
Severe pulmonary disease and should be used cautiously in patients with heart disease because of the potential for sodium retention caused by the drug.

Question 13

What would decrease absorption of Vit B12?

Answer 13

decrease in absorption when given concurrently with
1. alcohol
2. antibiotics (aminosalicylic acid neomycin, and colchicine)

Question 14

What are the routes for taking iron?
What are the types of iron supplements can one take? What are their elemental iron/ properties?

Answer 14

PO
1. Ferrous sulfate (20-30% elemental iron) MOST EFFECTIVE
2. Ferrous fumerate (33% elemental iron)
3. Ferrous gluconate (12% elemental iron), Mn, Cu, folic aicd, vit c. sorbitol)

Parental
1. Ferrous carboxymaltise (ferinject)

Question 15

Routes for ferrous sulfate?

Answer 15

IM/ IV/ PO

Question 16

What to take note of when taking ferrous sulfate? and why?

Answer 16

1. take on an empty stomach
2. avoid antacids, calcium/ aluminium supplements
3. avoid tea and milk
   they reduce the absorption of iron
4. be careful of taking too much fibre even though patient might be constipated
5. will stain the teeth

Question 17

Common side effects of taking iron

Answer 17

1. constipation
2. dark and dry stools

Question 18

Who should not take iron?

Answer 18

1. Patients with hemolytic anemia that is NOT due to iron (eg. thalassemia, leukemia etc.)
2. Patients with hemochromatosis, peptic ulcer, regional enteritis, or ulcerative colitis. (risk of bleeding)

Question 19

What would help absorption of iron?

Answer 19

Vitamin C!

Question 20

Treatments for overdose of iron + MOA

Answer 20

The antidote for acute iron intoxication is deferoxamine (Desferal). This parenteral agent binds iron, which is subsequently excreted by the kidneys, turning the urine a reddish brown color.

Question 21

What are the side effects of iron overdose?

Answer 21

Diarrhoea, fever, severe stomach pain, nausea, and vomiting (basically all the response u get when u want something out of the body)