B.3

Question 1

Agents used in anemias

Answer 1

Iron hydroxide polymaltose,
Folic acid,
Vitamin B12,
Epoetin-alfa,
Filgrastim

Question 2

Iron hydroxide polymaltose

Answer 2

MOA: supplement of Fe2+ form of iron that can be absorbed;
Pharmacokinetics: can be adm. p.o
(Ionic form: ferrous-sulfate / ferrous-fumarate OR in complex form: Iron hydroxide polymaltose), i.v (only complex form, but rarely given i.v. b/c it can cause anaphylaxis and acute iron poisoning);
IND: iron deficiency anemias;
SEs: oral iron supplementation SEs- GI disturbances (abdominal pain, constipation, nausea, diarrhea), dark stool. P.E iron supplementation SEs- fatal HST, anaphylactoid reactions, acute iron poisoning;
-Diagnostic importance: dark stool can lead to misdiagnosed occult bleeding

Question 3

Epoietin α

Answer 3

MOA: recombinant EPO, stimulates proliferation and differentiation of erythrocytes;
IND: anemia caused by end-stage renal disease, AIDS-related anemia, BM disorders, preventing anemia in premature infants, alleviate anemias caused by anticancer drugs;
Pharmacokinetics: i.v (in renal dialysis patients) or s.c injection;
SEs: BP↑, arthralgia, GIT disturbances;
Extra: iron supplementation may be required

Question 4

Folic acid

Answer 4

MOA: Folic acid is essential in DNA synthesis and cell proliferation (in the FH4 form it acts as cofactor of purines and pyrimidines synthesis);
Pharmacokinetics: p.o adm., absorbed in the jejunum, non-toxic at high doses, excess vitamin is excreted in the urine;
IND: Pregnancy, treatment of megaloblastic anemia cause by folate deficiency, to treat toxicity caused by Methotrexate/Trimethoprim/Zidovudine;
SEs: rare, occasionally GIT disturbances, HST reactions when given P.E;
Special point: shouldn’t be used in undiagnosed megaloblastic anemia b/c if the anemia is due to Vit.B12 deficiency the anemia may improve but the neurological lesions can get worse

Question 5

Vitamin B12

Answer 5

MOA: It is necessary for the conversion of methyl-FH4 to FH4 which is essential for DNA synthesis
(→restores the blood picture in megaloblastic anemias (e.g. pernicious anemia) and results in partial to full recovery of the neurological syndrome); Pharmacokinetics: i.v. infusion or i.m injection;
IND: pernicious anemia treatment and other causes of Vit. B12 deficiency;
SEs: nausea, dizziness, headache, HST reactions, hypokalemia in the beginning of the treatment

Question 6

Filgrastim

Answer 6

MOA: recombinant human G-CSF (granulocyte colony-stimulating factors)→ stimulate granulocyte production in the BM to ↑neutrophil count;
Pharmacokinetics: s.c injection/infusion or i.v injection (x1/day beginning 24-72h after chemotherapy);
IND: Neutropenia associated with cytotoxic cancer chemotherapy, BM transplantation (for donor and acceptor), HIV infection;
SEs: GIT disturbances, bone pain, muscle pain, fever, rash, alopecia
Note: BM transplantation: before the donation the donor gets filgrastim and after the donation the acceptor gets filgrastim so BM recovery will be faster

Question 7

Megaloblastic anemia

Answer 7

type of anemia characterized by very large RBCs, in addition their inner content of the cell is not completely developed. Mostly caused by vitamin deficiency: B12 and folatecan also be caused due to Copper deficiency and SEs of drugs

Question 8

Pernicious anemia

Answer 8

An autoimmune condition that affects the stomach causing weakened stomach lining, the body’s immune system attacks the actual intrinsic factor (IF) protein or the cells in the lining of the stomach that produce IF. IF is required for absorption of B12 from the intestines

Question 9

Hemostatic agents can be divided to

Answer 9

Physical agents and biological agents

Question 10

Hemostatic physical agents

Answer 10

Soaked bandages→ ORC (oxidated regenerated cellulose)- used as sterile net which can be used on abdominal wounds and will be absorbed in 14 days; Gelatin matrix; Kaoline, chitosan→only in military bandages

Question 11

Drug matrix agents

Answer 11

lead to thrombocyte activation & activation of extrinsic pathway
Able to soak up water in the blood (→the factors will be more concentrated near the bleedings)

Question 12

Vitamin B12 deficiency

Answer 12

not consuming enough in nutrition (e.g. problems with intrinsic factor), improper absorption (e.g. old patient taking PPI and his gastric pH increases)

Question 13

Vitamin B12 deficiency lead to

Answer 13

Neurological deficits, anemia

Question 14

Iron deficiency anemia

Answer 14

malabsorption (e.g. celiac disease), bleeding (e.g. menstruation / occult GI bleeding)