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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
Folic acid MOA
Stimulates the production of protein synthesis necessary for RBCs, WBCs, and platelet formation
26
Folic acid use
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
27
Folic acid SE
CV: Flushing CNS: Malaise DERM: Rashes
28
Folic acid can decrease the concentration of this drug?
Phenytoin
29
Which drugs are associated w/ folate deficiency?
Drugs associated with folate deficiency: sulfasalazine, phenytoin, and other anticonvulsants, MTX
30
What should be checked in pt's w/ macrocytic anemia w/ a folate deficiency?
In patients with macrocytic anemia due to folate deficiency, be sure that there is not also a simultaneous vitamin B12 deficiency
31
Where is Vit B12 stored in the body?
Liver
32
What is a diagnostic B12 deficiency?
Less than 100 pg/mL
33
Vit B12 MOA
Acts as a coenzyme for many metabolic processes, including fat and carbohydrate metabolism and protein synthesis
34
Vit B12 SE
Headache
35
Which meds decrease B12 absorption?
Oral absorption of B12 is decreased with neomycin, colchicine, anticonvulsants, metformin, and heavy alcohol use.
36
When given B12, what happens to pt's w/ Leber's dz?
Patients with Leber’s optic nerve atrophy may suffer rapid progression of their eye disease when treated with vitamin B12
37
In which diseases should Vit B12 deficiency be considered?
dementia, peripheral neuropathy, or macrocytic anemias
38
How long do B12 stores last?
Several months to years
39
What is the best route to administer Vit B12?
PO, IV is NOT recommended
40
What is the job of glycoprotein?
Major regulator of RBC synthesis by the bone marrow
41
How is erythropoietin measured?
Levels of erythropoietin can be detected by serum assays (serum EPO level)
42
Before starting EPO, what should be checked?
Review the drug list and consider checking iron, folate, B12, fecal occult blood, and serum creatinine
43
Erythropoietin/Epoetin MOA
Induces RBC production by stimulating division and differentiation of erythroid precursor cells in the bone marrow
44
EPO dosing is determined by?
Hb - SHOULD NOT EXCEED 11-13
45
What needs to be available for EPO tx to work?
If there are inadequate iron stores in the bone marrow, treatment of erythropoietin will be ineffective
46
Pts on chemo can receive EPO when their level is?
<200 mU/mL
47
Pts on zidovudine-associated anemia will not respond to EPO when their levels are?
>500 mU/mL
48
Erythropoietin/Epoetin use
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
Erythropoietin/Epoetin SE
hypertensive crisis, MI, vascular thrombosis Nausea, vomiting Thromboembolism (especially w/ hx of prior)
50
Black box warning for EPO
In the setting of renal fx, pts are at increased risk of death or serious cardiovascular events
51
What allergy prevents someone from taking EPO?
Albumin allergy
52
In pts w/ hx of HTN, what should be done prior to starting EPO?
Patients with uncontrolled HTN should have their BP condition controlled before using erythropoietin, and BP should be carefully monitored while on this treatment.
53
In pt's w/ severe anemia, what should be done?
Transfusion
54
How do anticoagulants work?
Preventing blood from clotting through antagonizing clotting factors
55
How is heparin activity monitored?
activated partial thromboplastin time (aPTT) or the anti-Xa level
56
Heparin MOA
Acts on thrombin Factor 2 and 10A in order to prevent fibrinogen from becoming fibrin LMWH only works on Factor 2
57
How long does it take for IV Heparin to work?
Heparin has an immediate onset of action when given intravenously
58
Heparin use
To prevent venous thromboembolism (VTE) To treat either venous or arterial thromboembolism (DVT/PE/MI)
59
Heparin SE
Bleeding, thrombocytopenia
59
Heparin SE
Bleeding, thrombocytopenia
60
What is HIT?
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
What can HIT cause?
This antibody activates platelets and can cause catastrophic arterial and venous thrombosis
62
HIT thrombocytopenia points
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
What things are included in the 4Ts score?
Thrombocytopenia, timing of platelet count fall, Thrombosis or other sequelae, Other causes for thrombocytopenia
64
Interpretation of the 4Ts score?
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
Interpretation of the 4Ts score?
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
In which pts should Heparin be used in w/ caution?
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
Which OTC products be avoided in pts on Heparin?
NSAID, gingko, garlic, ginseng, vitamin E, and fish oil supplementation

Pharm 2 Exam 2 (8 decks)

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