DLA(3)- Agents Used in Anemia Flashcards
Fe deficient anemia is treated with:
- (1) what supplements / Fe ion form
- (2) route of administration
- (3) length of therapy
- (4) co-administration
1- (Fe2+, ferrous iron) ferrous sulfate, ferrous gluconate, ferrous fumarate
2- oral
3- 3-6 mos
4- ascorbic acid / vitC
In patients CRF, Fe deficient anemia treatment:
- (1) formulations
- (2) route of administration
1- Fe dextran (highes risk of of Type I hypersensitivity), sodium ferric gluconate complex, Fe sucrose
2- parenteral (also for patients with Fe malabsorption)
Fe adverse effects
(oral preparations)
- n/d, constipation, epigastric discomfort + abdominal cramping
- black stools resembling melena
Acute Iron Toxicity, include Tx
(mostly seen in children via accidental ingestion)
- GI irritant: n/v/d, abdominal pain, mucosal ulceration, bleeding
- damage to GIT => free Fe into blood => metabolic acidosis (–> coma / death)
Tx:
- deferoxamine: IV, binds free Fe –> urinary/fecal excretion
- deferasirox: reduces Fe absorption (w/in 1 hr of ingestion)
Chronic Iron Toxicity, include Tx
(mostly genetic predisposition or patients with frequent transfusions => hemochromatosis)
-excess Fe deposition in major organs => cardiomyopathy, cirrhosis, bronze diabetes
Tx: phlebotomy (w/o anemia), for transfusion Pts use oral chelators / deferasirox
B12 is stored in….
liver, 2-5 yr stores
blood indications for B12 deficieny
- anemia (macrocytic)
- elevated homocysteine
- elevated methyl malonic acid
(possibly: leukopenia, thrombocytopenia, anti-IF Igs)
B12 deficiency therapy (include forms)
IM (parenteral) administration of B12, usually monthly
- hydroxocobalamin
- cyanocobalamin
drug that impair B9/folate metabolism
- trimethoprim
- pyrimethamine
- phenytoin
- MTX
blood indications of B9 deficiency
-macrocytic anemia
-elevated homocystein
(*-normal methyl malonic acid levels)
if macrocytic anemia is evident, what is the immediate treatment protocol
B12/B9 co-therapy until methyl malonic acid levels are tested to distinguish the difference
discuss EPO therapy
- Recombinant form EPO (epoetin alfa) –> glycoprotein given IV 3 times a week (1/2 life = 4-13 hrs)
- Darbepoetic alfa- once a wk (1/2 life x2-3 longer)
EPO:
- binds (1) receptors on (2) cells
- (3) and (4) are the main effects
1- JAK/STAT receptors
2- RBC progenitors
3- stimulates erythroid proliferation / differentiation
4- release of reticulocytes
list the G-CSF type therapies and their effects
(myeloid GFs)
-Filgrastim, G-CSF: neutrophil production
-Sargramostim, GM-CSF: stimulates all myeloid line, including megakaryocyte progenitors
G-CSF therapies are given via (1) route of administration and it activates (2) receptors on (3) cells
1- IV, SQ
2- JAK/STAT receptors
3- myeloid progenitors (specifics depend on GF given)