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Pharm 2 Exam 2 > Blood disorders 1 > Flashcards

Blood disorders 1 Flashcards

1
Q

What makes ingested iron more readily absorbed?

A

Ingested iron is converted to its ferrous state by gastric juices, making it more readily absorbed

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2
Q

When are iron stores depleted in infants?

A

first 6 months of life, after which iron requirements decrease

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3
Q

How is iron lost?

A

through bleeding or loss of cells

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4
Q

Sxs of iron deficiency?

A

fatigue, lethargy, dyspnea on exertion

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5
Q

What is the MC iron supplement rx?

A

Oral ferrous sulfate

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6
Q

Iron MOA

A

Iron is an essential ingredient in the production of hemoglobin

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7
Q

How is non-heme iron absorbed?

A

non-heme iron is absorbed better in the presence of vitamin C and worse in the presence of calcium, fiber, tea, coffee, or wine

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8
Q

Which is absorbed better, ferrous or ferric iron?

A

Ferrous iron (Fe3+) is better absorbed than is the ferric (Fe2+) form

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9
Q

Iron SE

A

constipation, darkening of the stools

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10
Q

Which foods reduce iron absorption?

A

Iron absorption is also reduced in the presence of coffee, tea, and fiber/bran products.

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11
Q

Iron supplements decrease the concentration of these abx?

A

tetracyclines, fluoroquinolones, and penicillamine

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12
Q

In which diseases should iron supplementation be avoided?

A

hemosiderosis or hemochromatosis

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13
Q

When do high risk infants receive iron?

A

High-risk infants should receive routine iron supplementation between ages 6 and 12 months

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14
Q

Pts over the age of 50 yrs w/ iron deficiency anemia should be evaluated for?

A

GI malignancy

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15
Q

How soon after supplementation should iron deficiency anemia resolve?

A

Hemoglobin should be normal by 2 months after oral replacement begins

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16
Q

Possible SE of iron elixirs or syrups used in kids?

A

Stained teeth

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17
Q

What should be done when administering IV iron?

A

Due to the anaphylactic risk a test dose of 25 mg has to be given, if no rxn, proceed w/ entire replacement dose

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18
Q

Most accurate iron lab?

A

serum ferritin test

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19
Q

Which diseases may have elevated serum ferritin test?

A

Patients with chronic inflammatory disease (rheumatoid arthritis or chronic liver disease) may have higher ferritin levels because ferritin is an acute phase reactant

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20
Q

What enhances iron absorption?

A

Ingesting iron with ascorbic acid (500 mg) will keep the iron in the ferrous state and enhance absorption

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21
Q

How long should iron supplementation last?

A

Adults should receive at least 3-6 months of oral therapy to replace depleted stores

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22
Q

What should pts on iron be reminded regarding their stools?

A

Iron will turn stools black or dark green, which is a harmless coloration.

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23
Q

What kind of anemia does folate deficiency cause?

A

Folate deficiency causes a macrocytic anemia

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24
Q

What causes folate deficiency?

A

Causes include dietary insufficiency, malabsorption, alcohol use, inborn errors of metabolism, and increased folate demand

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25
Q

Folic acid MOA

A

Stimulates the production of protein synthesis necessary for RBCs, WBCs, and platelet formation

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26
Q

Folic acid use

A

Used to treat folate deficiency
Used to prevent folate deficiency in certain situations (inhibition drugs or SCA)
Pregnancy - reduces the incidence of neural tube defects in offspring

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27
Q

Folic acid SE

A

CV: Flushing
CNS: Malaise
DERM: Rashes

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28
Q

Folic acid can decrease the concentration of this drug?

A

Phenytoin

29
Q

Which drugs are associated w/ folate deficiency?

A

Drugs associated with folate deficiency: sulfasalazine, phenytoin, and other anticonvulsants, MTX

30
Q

What should be checked in pt’s w/ macrocytic anemia w/ a folate deficiency?

A

In patients with macrocytic anemia due to folate deficiency, be sure that there is not also a simultaneous vitamin B12 deficiency

31
Q

Where is Vit B12 stored in the body?

A

Liver

32
Q

What is a diagnostic B12 deficiency?

A

Less than 100 pg/mL

33
Q

Vit B12 MOA

A

Acts as a coenzyme for many metabolic processes, including fat and carbohydrate metabolism and protein synthesis

34
Q

Vit B12 SE

A

Headache

35
Q

Which meds decrease B12 absorption?

A

Oral absorption of B12 is decreased with neomycin, colchicine, anticonvulsants, metformin, and heavy alcohol use.

36
Q

When given B12, what happens to pt’s w/ Leber’s dz?

A

Patients with Leber’s optic nerve atrophy may suffer rapid progression of their eye disease when treated with vitamin B12

37
Q

In which diseases should Vit B12 deficiency be considered?

A

dementia, peripheral neuropathy, or macrocytic anemias

38
Q

How long do B12 stores last?

A

Several months to years

39
Q

What is the best route to administer Vit B12?

A

PO, IV is NOT recommended

40
Q

What is the job of glycoprotein?

A

Major regulator of RBC synthesis by the bone marrow

41
Q

How is erythropoietin measured?

A

Levels of erythropoietin can be detected by serum assays (serum EPO level)

42
Q

Before starting EPO, what should be checked?

A

Review the drug list and consider checking iron, folate, B12, fecal occult blood, and serum creatinine

43
Q

Erythropoietin/Epoetin MOA

A

Induces RBC production by stimulating division and differentiation of erythroid precursor cells in the bone marrow

44
Q

EPO dosing is determined by?

A

Hb - SHOULD NOT EXCEED 11-13

45
Q

What needs to be available for EPO tx to work?

A

If there are inadequate iron stores in the bone marrow, treatment of erythropoietin will be ineffective

46
Q

Pts on chemo can receive EPO when their level is?

A

<200 mU/mL

47
Q

Pts on zidovudine-associated anemia will not respond to EPO when their levels are?

A

> 500 mU/mL

48
Q

Erythropoietin/Epoetin use

A

Primarily to treat anemia associated with renal failure
Those with mild anemia (Hg 10-13 g/dL) who are scheduled to undergo elective, noncardiac, nonvascular surgery to reduce the need for RBC transfusions
Chemo induced anemia

49
Q

Erythropoietin/Epoetin SE

A

hypertensive crisis, MI, vascular thrombosis
Nausea, vomiting
Thromboembolism (especially w/ hx of prior)

50
Q

Black box warning for EPO

A

In the setting of renal fx, pts are at increased risk of death or serious cardiovascular events

51
Q

What allergy prevents someone from taking EPO?

A

Albumin allergy

52
Q

In pts w/ hx of HTN, what should be done prior to starting EPO?

A

Patients with uncontrolled HTN should have their BP condition controlled before using erythropoietin, and BP should be carefully monitored while on this treatment.

53
Q

In pt’s w/ severe anemia, what should be done?

A

Transfusion

54
Q

How do anticoagulants work?

A

Preventing blood from clotting through antagonizing clotting factors

55
Q

How is heparin activity monitored?

A

activated partial thromboplastin time (aPTT) or the anti-Xa level

56
Q

Heparin MOA

A

Acts on thrombin Factor 2 and 10A in order to prevent fibrinogen from becoming fibrin
LMWH only works on Factor 2

57
Q

How long does it take for IV Heparin to work?

A

Heparin has an immediate onset of action when given intravenously

58
Q

Heparin use

A

To prevent venous thromboembolism (VTE)
To treat either venous or arterial thromboembolism (DVT/PE/MI)

59
Q

Heparin SE

A

Bleeding, thrombocytopenia

59
Q

Heparin SE

A

Bleeding, thrombocytopenia

60
Q

What is HIT?

A

Heparin Induced Thrombocytopenia (HIT)
Life-threatening complication of exposure to heparin that occurs in a small percentage of patients exposed, regardless of the dose, schedule, or route of administration

61
Q

What can HIT cause?

A

This antibody activates platelets and can cause catastrophic arterial and venous thrombosis

62
Q

HIT thrombocytopenia points

A

Platelet count fall >50 percent and nadir ≥20,000/microL – 2 points
Platelet count fall 30 to 50 percent or nadir 10 to 19,000/microL – 1 point
Platelet count fall <30 percent or nadir <10,000/microL – 0 points

63
Q

What things are included in the 4Ts score?

A

Thrombocytopenia, timing of platelet count fall, Thrombosis or other sequelae, Other causes for thrombocytopenia

64
Q

Interpretation of the 4Ts score?

A

Interpretation—The sum of the point values gives a total from 0 to 8:
0 to 3 points – Low probability (risk of HIT <1 percent)
4 to 5 points – Intermediate probability (risk of HIT approximately 10 percent)
6 to 8 points – High probability (risk of HIT approximately 50 percent)

65
Q

Interpretation of the 4Ts score?

A

Interpretation—The sum of the point values gives a total from 0 to 8:
0 to 3 points – Low probability (risk of HIT <1 percent)
4 to 5 points – Intermediate probability (risk of HIT approximately 10 percent)
6 to 8 points – High probability (risk of HIT approximately 50 percent)

66
Q

In which pts should Heparin be used in w/ caution?

A

Use heparin with caution in patients with a history of peptic ulceration or GI angiodysplasia, patients with poorly controlled HTN, or those with diabetic retinopathy.

67
Q

Which OTC products be avoided in pts on Heparin?

A

NSAID, gingko, garlic, ginseng, vitamin E, and fish oil supplementation

Pharm 2 Exam 2 (8 decks)

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