Drugs to treat anemia and sickle cell disease, and hematopoietic GF

Question 1

Iron is stored in intestinal mucosal cells as…

Answer 1

Ferritin

Question 2

Reasons to iron deficiency

Answer 2

• Chronic blood loss
• Insufficient intake during periods of growth
• Vegetarian diet
• Heavily menstruation
• Pregnancy

Question 3

Iron deficiency cause what type of anemia?

Answer 3

Microcytic hypochromic anemia

Question 4

Iron is transported as…

Answer 4

Transferrin

Question 5

Iron is absorbed as…

Answer 5

• Ferrous iron (Fe2+)

- It is oxidized in the mucosal cell to the ferric form (Fe3+)

Question 6

Excess overload of iron is stored in…

Answer 6

• Reticuloendothelial system

- In case of gross overload, iron is stored in parenchymal cells of the skin, liver and other organs

Question 7

Iron deficiency anemia treatment

Answer 7

• Dietary ferrous iron supplementation (ferrous sulfate)
• May be in special cases given parenteral (Iron Dextran)
• Toxicity in children: necrotizing gastroenteritis, shock, metabolic acidosis, coma, and death

Question 8

Iron deficiency causes what type of anemia?

Answer 8

Microcytic hypochromic anemia

Question 9

Vitamine B12 storage

Answer 9

Stored in the liver in large amounts (5 years)

Question 10

Vitamine B12 transportation form

Answer 10

Bound to transcobalamin II

Question 11

Vitamin B12 deficiency causes what type of anemia?

Answer 11

Pernicious anemia - caused by decreased intrinsic factors

Megaloblastic anemia

Question 12

Vitamine B12 is essential in..

Answer 12

1. Conversion of methylmalonyl-coenzyme A (CoA) to succinyl-CoA
2. Conversion of homocysteine to methionine –> a step in the folic acid metabolism (dTMP)
   In vitB12 deficiency, folates accumulate as N5-methyltetrahydrofolate

Question 13

Vitamine B12 are available as two forms, which?

Answer 13

• Hydroxocobalamin

- Cyanocobalamin

Question 14

Causes of folate deficiency

Answer 14

• Increased demand (pregnancy, lactation)
• Poor absorption
• Alcholism
• Treatment with drugs that are dihydrofolate reductase inhibitors

Question 15

Folate deficiency cause what type of anemia?

Answer 15

Megaloblastic anemia

Caused by diminished synthesis of purines and pyrimidines

Question 16

Folic acid is essential in…

Answer 16

• dTMP cycle

- Folic acid is converted to tetrahydrofolate by dihydrofolate reductuase

Question 17

Erythropoietin deficiency

Answer 17

• Caused by end-stage renal disease, HIV virus, or in cancer patients
• Treated by IV infusion or subcutaneously by erythropoietin or Darbepoetin (longer half-life)

Question 18

Myeloid growth factors

Answer 18

• Filigrastim (G-CSF) –> used to mobilize peripheral blood stem cells in preparation for auto and allo transplantation
• Sargramostim (GM-CSF)
• Stimulates production of neutrophils

Question 19

Megakaryocyte growth factors

Answer 19

• Oprelvekin (IL-11)
• Stimulates the growth of primitive megakaryocytic progenitors and increases the number of peripheral platelets
• Used in patients who have had thrombocytopenia after chemotherapy
• Reduces the need for platelet transplantation

Question 20

Hydroxyurea

Answer 20

• Relieve painful clinical course of sickle cell disease
• Increase fetal hemoglobin levels, thus diluting the abnormal hemoglobin (HbS)
• May also be used to treat chronic myelogenous leukemia and polycythemia vera

Question 21

Pentoxifylline

Answer 21

• Increase the deformability of RBC and reduce the viscosity of blood
• Decrease systemic vascular resistance, improves blood flow, and enhances tissue oxygenation
• Studied in diabetic angiopathy, TIA, leg ulcers, sickle cell disease, strokes and Raynaud syndrome