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
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
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
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
5
Q
Hemolytic anemia physical sx not associated with normal anemia
A
- yellowing of eyes/skin from bursting RBCs
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
7
Q
Black stool means
A
- Upper GI bleed
2. Iron tablets
8
Q
Iron loss is done how
A
From sloughing of RBCs, more usually though a renal mechanism
9
Q
Iron absorption is regulated by
A
Hepcidin
10
Q
What
- increases
- Decreases
A
- Inflammation, Fe consumption
2. RBC demand, hypoxia
11
Q
How to bypass hepcidin for FE absorption
A
Infuse FE
12
Q
Hb is what
A
4 Hemes (each heme has a FE) Transports 98% of O2 in the blood
13
Q
Causes of microcytic anemia
3 reasons
A
- Low availability: can be from Cu deficiency needed for absorption, inflammation, or malabsorption/intake, blood loss, pregnancy
- Reduced heme synthesis : lead poisoning, sideoblastic anemias
- Reduced globin production : thalassemia, hemoglobinopathies
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
15
Q
2 ways to TX Fe deficiency not including diet
A
- Tablet : (Ferrous sulfate, ferrous gluconate, ferrous fumarate)
- Parenteral IV : (LMW iron dextran** least pricy**, sodium ferric gluconate complex, iron sucrose, ferric carboxymaltose, iron isomaltoside), can very rarely cause anaphylactic shock
16
Q
How fast does FE go back to normal
A
RBC levels in few days, Hgb in 2 weeks
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
18
Q
Acute FE Tocicity TX
A
Deferoxamine
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
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
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
22
Q
X folate causes what 2 things
A
- X thymadylate
- X purine synthesis
HGIH homocysteine
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
VIT B12 comes from what and how much do we need per day
1. Animal products (fish, meat, milk, egg), fortified cereals
2. 2ug/day
Liver stores 2-5mg which can last a very long time
26
VIT B12 deficiency SX
Rapid CNS dysfunction (weakness, paresthesia, spasticity) that may not come back
27
What can deplete all VIT B12 in body fast
Nitrous oxide : inhaled during dental surgeries ——I cyanocobalamin (form of vitB12)
28
VIT B12 in stomach and then what happens
Binds to R- factor
Replaced by IF in duodenum
Binds to cumulonimbus in ileum to be absorbed with ATP needed
29
Chronic Atrophic gastritis
Auto-abs against H-K-ATPase of the parietal cells
| = causes no acid production and no IF
30
VIT B12 SX
- vitiligo
- hyperpigmentation
- jaundice
- glossitis
- megaloblastic anemia
- thrombocytopenia
- neutropenia
- CNS weakness, irritability, cognition, numbness
31
VIT B12 TX
- oral tablet independent of IF (500X normal amount needed)
| - parenteral therapy : CNS problems then this is the way
32
Where does Folate comes from
How much do we need
Absorbed where
Excreted where and how
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
Common reasons folate Deficiency
- inadequate intake
| - alcoholism
34
Folate Deficiency SX
- jaundice
- mouth ulcers
- megaloblastic anemia
- neutropenia, thrombocytopenia
- depression rare, controversial
35
Folate TX
1mg/day for 4mos
| Extreme high dose can cause hypoglycemia and hypotension
36
TX of megaloblastic anemia how fast does Hct, Hgb, and RBC levels return
RBC : few days
Hct : 2 weeks
Hgb : 1-2 months
37
What organ senses RBC levels and O2 availability
Kidney
38
EPO is made by what
Renal cortical fibroblasts
39
Epoetin alfa
What
And used when
EPO manufactured drug with the Darbepoetin Alfa having 3X longer half life = stimulate RBC production
- CKD
- Cancer chemotherapy
- HIV Zidovudine mx
40
Hydroxyurea is used for what
SC, some cancers
= —I ribonucleotide Reductase so X s-phase in cell cycle = higher HbF made****
(Orally)
41
Eculizumab used for what and does what
| Side effects
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
Neutropenia SX
```
Low grade fever
Sore mouth
Odynophagia
Gingival pain
Skin abscess
Recurrent sinusitis/otitis
Perirectal pain and irritation
```
43
Sargramostim does what
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
Filgrastim does what
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
What drug should I use to TX neutropenic fever
Filgrastim/ pegfilgrastim (only effective with febrile neutropenia)
46
Plerixafor
```
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
Thrombopoietin drug
Used to make plt, however not used because it causes severe Auto-AB thrombocytopenia
48
Stem-cell factor (C-Kit)
Drug used because it increased plt progenitor cells
| However also removed due to stimulating mast cells = allergic reactions
49
Oprevekin
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
Romiplostim
```
Peptibody
Binding to the TPO receptor
= increased plt counts
= used for ITP (idiopathic thrombocytopenia purpura)
= at times some allergic reaction
```
51
Eltrombopeg
```
Non-peptide TPO receptor agonist
= increase plt
= for ITP, + Hep C cirrhosis
= orally given once a day
= hepatoxicity
```
52
How to TX (ITP)
| Order of how to treat
1. glucocorticoids + immune globin (to inhibit immune system from destroying Plts)
2. Rituximab + splenectomy (prevent plt destruction)
3. romiplostim/eltrombopag
53
Drugs causing hemolytic anemia (not testable)
```
Cephalosporins (ceftriaxone, cefotetan)
Piperacillin
Quinidine
NSAIDs
Levodopa
Phenazopyridine (relive UTI pain)
```
54
Drugs causes thrombocytopenia
- heparin
- quinidine
- penicillin
- NSAIDs
- Gold (RA)
- sulfonsmides
55
What drugs can cause aplastic anemia
Benzene
Chloramphenicol (can also cause grey baby syndrome)
Cancer chemotherapeutics
