Drugs Acting On The Blood Flashcards
Epoetin alfa indications
Anemia of chronic renal failure; in AIDS patient cancer related (epo should be <100u/l) Surgery Premature Zidovudine treatment
Most important regulator of the proliferation of committed progenitors and their immediate progeny
Erythropoetin
Epoetin alfa monitoring
Hiv & cancer patients: Hct 1x/week
Renal failure: 2x/week
Decrease dose if Hct inc >4pts
Epoetin alfa AE
Absolute or fxnal iron deficiency
Thromboembolic events
Cardio:inc bp, hypertensive encephalopathy, seizures
Myeloid growth factors
Gcsf gmcsf
By fibroblasts, endothelial cells, macrophages, T-cells
Gcsf used more since less toxic
Gm csf
Myelopoeisis,shorten neutropenia
Sq or iv, leukocyte count return to baseline 2-10 days
Low-neutrophilic, high-monocytosis and eosinophilia
Capillary leak syndrome with prolonged admin
G csf
Inc neutrophil by stimulating cfu g
Reduce episodes of febrile neutropenia
Ae produces marked granulocytosid and splenomegaly
Interleukin 11
For under chemo for nonmyeloid malignancies
Intestinal epithelial cell growth, osteoclastogenesis, inhibit adipogenesis
Ae:may require diuretics; blurred vision
Thrombopoetin
Recombinant human megakaryocyte growth and devt factor
PRIMARY regulator of platelet production
Produced by liver, marrow, stromal cells
Most common nutri disorder
Iron deficiency
Largest amt of dietary iron ingested by underprivileged
Nonheme iron
New erythrocytes
catabolized by RES
Sites of iron storage
Res, spleen, bone, intestinal mucosa cells, hepatocytes
Acts as natural ceiling and regulates absorption of iron
Small intestine
INDICATION of effectiveness of iron therapy
Inc reticulocyte count 4-7 days after
Inc hb/hct 3-4 weeks after treatment
Iron absorption is decreased by
Food and antacids
Oral iron ae
Nausea and abs pain
Constipation >diarrhea
TEMP staining of teeth
WOF hemochromatosis
Treatment for od of oral iron
Induce vomiting
Colortest
Deferoxamine
Activated charcoal cant be used for iron poisoning
Parenteral iron
Iron malabsorption
Intolerance of metal iron
Create iron stores in pregnant women
Ferritin levels=?
Total iron binding capacity
Warning for parenteral iron
Can cause anaphylaxis, usewhen indicated
Preparation for parenteral irons
Ferric gluconate complex
Iron sucrose
Iron dextran- iv route, use z track when IM(buttocks)
Copper deficiency
Leukopenia(granulocytopenia, anemia)
Menke’s disease
Treatment-cupric sulfate
Pyridoxine
For sideroblastic anemia
Isoniazid and pyrazinamide
Levodopa
Chloramphenicol
Vit b12
If inadequate, becomes trapped as methyltetrahydrofolate
Methylcobalamin
Homocysteine to methionine
5deoxyadenosylcobalamin
Isomerization of LmethylmalonylCoa to succinylcoa
Vitb12 deficiency
Pt with gastric atrophy, surgery, antibodies top arietal cells Assoc with neurologic abnormalities Megaloblastic erythropoiesis Pancytopenia Schilling test
Requirements for ileal transport of vit b12 include
Intrinsic factor
Bile
Sodium bicarbonate
Folic acid metabolic functions
Homocysteine to methionine Serine to glycine Thymidylate Histidine metabolism Purines
Daily requirements of folic acid
Green vegetables, liver, yeast, some fruits
Folate deficiency
By diseases of the small intestine
MOST COMMON cause of folate deficienct megaloblastic erythropoiesis
Lead to megaloblastic anemia
Drugs that inhibit dihydrofolate reductase
MTX
TMP
Drugs that interfere with absorption and storage of folate
Some AEDs and OCP
folic acid therapy
Do not treat patients with vit b12 deficiency with folic acid
Absorption requires transport and action of pteroglutamyl carboxypeptidase associated with mucosal cell membranes
Folate is stored within cells as
Polyglutamates
A better measure of folate levels than serum folate
RBC folate
