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Skin, Lymph, Blood > Dr. Wolff - Pharmocology Of Anemia And hematopoietic Growth Factors > Flashcards

Dr. Wolff - Pharmocology Of Anemia And hematopoietic Growth Factors Flashcards

1
Q

anemia sx

A 
Fatigue
Pallor (can sometimes see dark circles under the eyes)
Cold hands and feet
SOB
Irregular heartbeats 
Dizziness
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2
Q

Reason you feel dizzy fatigue with anemia

A

Hgb is low and you have less O2 available to get delivered even with normal 98%O2 saturation

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3
Q

Reason you have low BP during anemia

A
  • less viscous blood from less RBCs
    1. Less resistance and thickness
    2. Vasodilation of organs and vessels since they need O2
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4
Q

Reason you feel CP and angina with anemia

A

Heart is working really hard to deliver O2 and with the less viscous blood

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5
Q

Hemolytic anemia physical sx not associated with normal anemia

A
  • yellowing of eyes/skin from bursting RBCs
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6
Q

Reason you feel cold hands, SOB, muscular weakness with anemia

A

Hands and feet are cold since blood is needed else where

  • SOB from needed more O2 delivered
  • less ATP stored
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7
Q

Black stool means

A
  1. Upper GI bleed

2. Iron tablets

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8
Q

Iron loss is done how

A

From sloughing of RBCs, more usually though a renal mechanism

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9
Q

Iron absorption is regulated by

A

Hepcidin

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10
Q

What

  1. increases
  2. Decreases
A
  1. Inflammation, Fe consumption

2. RBC demand, hypoxia

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11
Q

How to bypass hepcidin for FE absorption

A

Infuse FE

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12
Q

Hb is what

A 
4 Hemes (each heme has a FE)
Transports 98% of O2 in the blood
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13
Q

Causes of microcytic anemia

3 reasons

A
  1. Low availability: can be from Cu deficiency needed for absorption, inflammation, or malabsorption/intake, blood loss, pregnancy
  2. Reduced heme synthesis : lead poisoning, sideoblastic anemias
  3. Reduced globin production : thalassemia, hemoglobinopathies
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14
Q

Fe is best absorbed how

A
  • from meat, fish, poultry (NOT veggies, grain, milk, eggs = needs VIT C)
  • single dose of Fe (not several per day) with water/juice
  • food lowers absorption
  • non-enteric-coated + non-sustain release
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15
Q

2 ways to TX Fe deficiency not including diet

A
  1. Tablet : (Ferrous sulfate, ferrous gluconate, ferrous fumarate)
  2. Parenteral IV : (LMW iron dextran** least pricy**, sodium ferric gluconate complex, iron sucrose, ferric carboxymaltose, iron isomaltoside), can very rarely cause anaphylactic shock
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16
Q

How fast does FE go back to normal

A

RBC levels in few days, Hgb in 2 weeks

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17
Q

Acute Fe Toxicity

What and how and SX

A

Usually in children consuming a 10 or more FE tablets

  • necrotizing gastroenteritis, V, ABD pain, bloody D, shock, dyspnea
  • Sx may improve for a bit and then become severe metabolic acidosis, coma, death
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18
Q

Acute FE Tocicity TX

A

Deferoxamine

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19
Q

Chronic Fe toxicity sx and seen in who usually

A

Fe depositing in various organs (liver, heart, pancreas), organ failure, death

  • hereditary hemochromatosis
  • many RBC transfusions in there life
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20
Q

Reason megaloblastic or macrocytic cells form

A
  • double proteins made for division purposes
  • new DNA is unable to be made (usually from no Folate, B12, or MDS)
  • nucleus is extruded and RBC becomes big and can get cleaved when stuck in vessels
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21
Q

Reason for CNS effects in B12 deficiency

A

VIT B12 makes methionine from Homocysteine

- methionine is needed in the CNS for methylation reactions

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22
Q

X folate causes what 2 things

A
  1. X thymadylate
  2. X purine synthesis
    HGIH homocysteine
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23
Q

Megaloblastic anemia BS

A

All cell lines are big

24
Q

Macrocytic anemia

A

Spherical and hyperchromic cells with highly banded Neutrophils

25
Q

VIT B12 comes from what and how much do we need per day

A
  1. Animal products (fish, meat, milk, egg), fortified cereals
  2. 2ug/day
    Liver stores 2-5mg which can last a very long time
26
Q

VIT B12 deficiency SX

A

Rapid CNS dysfunction (weakness, paresthesia, spasticity) that may not come back

27
Q

What can deplete all VIT B12 in body fast

A

Nitrous oxide : inhaled during dental surgeries ——I cyanocobalamin (form of vitB12)

28
Q

VIT B12 in stomach and then what happens

A

Binds to R- factor
Replaced by IF in duodenum
Binds to cumulonimbus in ileum to be absorbed with ATP needed

29
Q

Chronic Atrophic gastritis

A

Auto-abs against H-K-ATPase of the parietal cells

= causes no acid production and no IF

30
Q

VIT B12 SX

A
  • vitiligo
  • hyperpigmentation
  • jaundice
  • glossitis
  • megaloblastic anemia
  • thrombocytopenia
  • neutropenia
  • CNS weakness, irritability, cognition, numbness
31
Q

VIT B12 TX

A
  • oral tablet independent of IF (500X normal amount needed)

- parenteral therapy : CNS problems then this is the way

32
Q

Where does Folate comes from
How much do we need
Absorbed where
Excreted where and how

A
  1. Yeast, liver, kidney, green easy veggies
  2. 5-50ug/day (recommend 400 adult and 800 pregnant)
  3. Jejunum
  4. Hepatocytes trapping it by polyglutamation (liver stores this for 3 weeks)
33
Q

Common reasons folate Deficiency

A
  • inadequate intake

- alcoholism

34
Q

Folate Deficiency SX

A
  • jaundice
  • mouth ulcers
  • megaloblastic anemia
  • neutropenia, thrombocytopenia
  • depression rare, controversial
35
Q

Folate TX

A

1mg/day for 4mos

Extreme high dose can cause hypoglycemia and hypotension

36
Q

TX of megaloblastic anemia how fast does Hct, Hgb, and RBC levels return

A

RBC : few days
Hct : 2 weeks
Hgb : 1-2 months

37
Q

What organ senses RBC levels and O2 availability

A

Kidney

38
Q

EPO is made by what

A

Renal cortical fibroblasts

39
Q

Epoetin alfa
What
And used when

A

EPO manufactured drug with the Darbepoetin Alfa having 3X longer half life = stimulate RBC production

  • CKD
  • Cancer chemotherapy
  • HIV Zidovudine mx
40
Q

Hydroxyurea is used for what

A

SC, some cancers
= —I ribonucleotide Reductase so X s-phase in cell cycle = higher HbF made**
(Orally)

41
Q

Eculizumab used for what and does what

Side effects

A

Monoclonal Ab that blocks C5–> C5b (NO MAC COMPLEX)
= for Paroxymal nocturnal Hemoglobinuria (pt has low CD59/CD55 which inhibit MAC complexes, so their RBCs burst randomly, blood in urine)
= atypical hemolytic anemia (having thrombotic microangiopathy from MACS)
= viral and bacterial infections

42
Q

Neutropenia SX

A 
Low grade fever 
Sore mouth
Odynophagia 
Gingival pain
Skin abscess
Recurrent sinusitis/otitis
Perirectal pain and irritation
43
Q

Sargramostim does what

A

GM- CSF : for all myeloid cells (plt, B, N, E, Monocytes, RBCs)
= given IV
= when bone marrow transplant
= or in AML tx with no blasts left
= edema, dyspnea, (if taken with benzoyl alcohol = fetal gasping syndrome), can effect liver, kidney, heart are side effects

44
Q

Filgrastim does what

A

G-CSF : for B and N only
= to tx infections from anti cancer drugs or bone marrow transplant, and severe neutropenia
= given IV without any chemotherapy for past 24hrs
= pegfilgrastim (longer half-life*)

45
Q

What drug should I use to TX neutropenic fever

A

Filgrastim/ pegfilgrastim (only effective with febrile neutropenia)

46
Q

Plerixafor

A 
Agonist of (CXCR4 receptor  = homing hematopoietic stem cells to BM), so this drug causes hematopoietic stem cells to stay in plasma and not go to BM
= used when you need to mobilize sufficient stem cells when Filgrastim is not enough
47
Q

Thrombopoietin drug

A

Used to make plt, however not used because it causes severe Auto-AB thrombocytopenia

48
Q

Stem-cell factor (C-Kit)

A

Drug used because it increased plt progenitor cells

However also removed due to stimulating mast cells = allergic reactions

49
Q

Oprevekin

A

IL11
Does not have anything to do with thrombopoietin
= promotes megakaryocytes
= 1st drug to be used
= edema, cardiac problems, allergic reactions (can happen)
(NOT USED SO MCUH)

50
Q

Romiplostim

A 
Peptibody
Binding to the TPO receptor 
= increased plt counts 
= used for ITP (idiopathic thrombocytopenia purpura)
= at times some allergic reaction
51
Q

Eltrombopeg

A 
Non-peptide TPO receptor agonist 
= increase plt
= for ITP, + Hep C cirrhosis 
= orally given once a day
= hepatoxicity
52
Q

How to TX (ITP)

Order of how to treat

A
  1. glucocorticoids + immune globin (to inhibit immune system from destroying Plts)
  2. Rituximab + splenectomy (prevent plt destruction)
  3. romiplostim/eltrombopag
53
Q

Drugs causing hemolytic anemia (not testable)

A 
Cephalosporins (ceftriaxone, cefotetan)
Piperacillin
Quinidine
NSAIDs
Levodopa
Phenazopyridine (relive UTI pain)
54
Q

Drugs causes thrombocytopenia

A
  • heparin
  • quinidine
  • penicillin
  • NSAIDs
  • Gold (RA)
  • sulfonsmides
55
Q

What drugs can cause aplastic anemia

A

Benzene
Chloramphenicol (can also cause grey baby syndrome)
Cancer chemotherapeutics

Skin, Lymph, Blood (9 decks)

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