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Lippincotts pharmacology 6th edition > Ch. 33 Drugs for Anemia > Flashcards

Ch. 33 Drugs for Anemia Flashcards

1
Q 
Cyanocobalamin (B12)
Darbepoetin
epoetin alfa 
folic acid
iron
A

treatment of anemia

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2
Q

filgrastim
pegfilgastim
sargramostim
tbo-filgrastim

A

treatment of neutropenia

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3
Q

hydroxyurea

pentoxifylline

A

treatment of sickle cell anemia

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4
Q

below normal plasma hemoglobin concentration restulting from a decreased number of circulating red blood cells or an abnormally low total hemoglobin content per unit of blood volume?

A

definition of anemia

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5
Q

signs and symptoms of anemia

A 
fatigue 
rapid heart rate/beat
shortness of breath 
pale skin
dizziness 
insomnia
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6
Q

nutritional anemia

- substances necessary for normal erythropoiesis

A

deficiency of iron, folic acid, and Vitamin B12 (cyanocobalamin)

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7
Q

anemia via genetic basis

A

sickle cell disease

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8
Q

iron storage in the body

A 
-stored as FERRITIN (iron-protein complex)
intestinal mucosal cells
liver 
spleen
bone marrow
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9
Q

iron deficiency results from

A

blood loss, insufficient intake, heavily menstruating and pregnant women

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10
Q

hypochromic microcytic anemia results from

A

low iron and small sized red blood cells

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11
Q

Koilonychias

A

upward curvature of the finger and toe nails

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12
Q

iron deficient anemias cause

A

pica, koilonychias, soreness and cracking at the corners of the mouth.

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13
Q

patients with iron defiency anemia dosis

A

supplemental iron of 150-180mg/days 2-3 times per day

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14
Q

reduced ferrous form , which is more soluble form is thanks to

A

acidic conditions in the stomach

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15
Q

extended release iron is dosed how many times a day

A

once daily

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16
Q

out of these oral preparations which is most commonly used due to its high content of elemental iron and relatively low cost?

ferrous sulfate, ferrrous fumerate, ferrous gulconate, polysaccharide iron complex, and carbonyl iron

A

FERROUS SULFATE

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17
Q

parental iron

A

iron dextran
sodium ferric gluconate complex
iron sucrose

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18
Q

whats special about iron sucrose?

A

it’s used for specific exchange mechanisims transfer iron to transferrin

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19
Q

purified iron

A

carbonyl iron

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20
Q

no taste compared to other iron salts

A

ferrous fumarate

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21
Q

GI disturbances and dark stools

A

most common adverse effects of oral iron supplements

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22
Q

what are the severe adverse effects of parental iron adminstration?

-a test dose should be administered prior to iron dextran

A

fatal hypersensitivity and anaphylactoid reactions

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23
Q

in case of excessive iron toxicity patient should be administered?

A

deferoxamine

-chelator that reverses the toxicity

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24
Q

used in treating deficiency states that arise from inadequate levels of the vitamin?

A

folic acid

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25
Q

what are the 4 causes of folate defiiciency?

A

increased demand (pregnancy, lactation)
pathology of small intestine (poor absorption)
alcoholism
dihydrofolate inhibitors

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26
Q

dihydrofolate inhibitors cause folate deficiency, what are they?

A

they are: methotrexate, pyrimethamine, and trimethoprim!!!

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27
Q

leucovorin calcium

A

folic acid

-available in oral or parental form

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28
Q

megaloblastic anemia

large-sized RBCs caused by

A

diminished synthesis of purines and pyrimidines due to deficiency of folic acid
- inability of erythropoietic tissue to make DNA and thereby, proliferate

29
Q

excess amounts of folic acid are

A

excreted in urine/feces

nontoxic

30
Q

failure of gastric parietal cells to produce intrinsic factor

A

pernicious anemia

-vit b12 deficiency

31
Q

loss of activity of the receptor needed for intestinal uptake of the vitamin

A

vit b12 deficiency

32
Q

glycoprotein produced by parietal cells of the stomach required for vit b12 absorption

A

intrinsic factor

33
Q

bariatric surgery (surgical treatment for obesity) requires

A

vit b12 supplementation of cyancobalamin in large oral doses, sublingually or once a month by parental route

34
Q

hydroxocobalamin is no preferrred for

A

bariatric surgery

35
Q

causes tingling (pins and needles) in the hands and feet, difficulty walking , dementia

-extreme cases: hallucinations , paranoia, or schizophrenia

A

vit b12 deficiency anemia

36
Q

deep subcutaneous administration of vit b12 for

A

pernicious anemia

37
Q

administration of folic acid alone can cause

A

masking of vitamin b12 deficiency thus resulting in severe neruologic dysfucntion and disease

-revereses the hematologic abnnormality

38
Q

treatment for megaloblastic anemia must have

A

folic acid and vitamin b 12

39
Q

amount of time of treatment required for patients suffering with pernicious anemia?

A

LIFE!

40
Q

non toxic even in large doses

A

vit b12

41
Q

a glycoprotein

A

erythropoietin (EPO)

42
Q

works as sensors that respond to hypoxia and mediate synthesis and release of erythropoietin

A

peritubular cells in the kidneys

43
Q

process of hemoglobin formation

A

EPO stimulates stem cells to differentiate into proerythroblasts and promotes release of reticulocytes from the marrow and initiation of hemoglobin formation

44
Q

actions of EPO

A

regulates RBC proliferation and differentiation in bone marrow

45
Q

effective in the treatment of anemia caused by

-end-staged renal disease, anemia associated with HIV , bone marrow disorders, prematurity, cancer patients

A

epoetin alfa

-recombinant DNA technology

46
Q

protein administered in renal dialysis

A

epoetin alfa

  • iv
  • subcutaneous route preferred
47
Q

is a long-acting version of erythropoietin that differes from erythropoietin by the addition of 2 carbohydrate chains

A

darbepoetin

-improved biological activity

48
Q

has decreased clearance and has a half-life 3 times that of epoetin alfa

A

darbepoetin

49
Q

recommendations of epoetin alfa or darbepoetin

A

should NOT exceed a hemoglobin level of 12 g/dL

hemoglobin should not rise more than 1g/dL over a
2-week period

50
Q

cardiovascular events (thrombosis, severe hypertension) , increased risk of death

A

hemoglobin level higher than 11g/dL

51
Q

if the hemoglobin level exceeds 10g/dL, doses of epoetin alfa or darbepoetin should be

A

reduced or treatment should be discontinued

52
Q

stimulate granulocyte production in the marrow to increase the neutrophil counts and reduce the duration of severe neutropenia

A

Myeloid growth factors:
filgrastim, tbo-filgastim, and pegfilgrastim
G-CSF
GM-CSF (sargramostim)

53
Q

G-CSF

GM-CSF

A

granulocyte colony -stimulating factors (G-CSF)
granulocyte macrophage colony-stimulating factors
-(GM-CSF )

54
Q

used prophylactically to reduce risk of neutropenia following chemotherapy and bone marrow transplantation

A

myeloid growth factors

55
Q

dosed either subcutaneously or intravenously in the case of neutorpenia?

A

filgrastim and sargramostim (GM-CSF)

56
Q

dosed subcutaneously only

A

tbo-filgastrim and pegfilgrastim

57
Q

dosed once a day beginning 24-72 hours after chemotherapy ?

neutrophil count?

A

filgrastim, tbo-filgrastim, and sargramostim

absolute neutrophil count (ANC) reaches 5000-10,000/uL

58
Q

pegylated form of G-CSF, much longer 1/2 L when compared to other agents to treat neutropenia

whats the dosage?

A

pegfilgrastim

single dose 24 hours after chemotherapy, rather than once daily

59
Q

monitoring ANC is typically not necessary for :

A

pegfilgrastim

60
Q

Bone pain is the most common side effect for

A

Neutropenia treatment agents

61
Q

reduces the frequency of painful sickle cell disease

A

hydroxyurea

62
Q

used off label to treat myelogenous leukemia and polycythemia vera

A

hydroxyurea

63
Q

increases HbF and thus dilutes HbS

-minimizes tissue anoxia

A

hydroxyurea

64
Q

side effects of hydroxyurea

A

bone marrow suppression and cutaneous vasculitis

65
Q

methylxanthine derivative that has been called a “rheologic modifier”

A

pentoxifylline

-used to treat sickle cell disease

66
Q

increases the deformability of red blood cells (improves erythrocyte flexibility) and reduces the viscosity of blood

A

pentoxifyline

-used to treat sickle cell disease

67
Q

decreases total systemic vascular resistane. improves blood flow, and enhances tissue oxygenation in pts with peripheral vascular disease. treats intermittent cluadication .

A

pentoxifyline

-used to treat sickle cell disease

68
Q

unlabeled uses of pentoxifyline

A

improve psychopathological symptoms in patients with cerebrovascular insufficiency

  • diabetic angiopathies
  • transient ischemic attacks, leg ulcers, strokes, and Raynaud’s phenomenon
69
Q

adverse reactions of pentyoxifyllline

A

GI in nature and lessened by administration with food

Lippincotts pharmacology 6th edition (6 decks)

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