Drugs Used in Anemias

Question 1

Anemia

Answer 1

A reduction in the ability of the blood to deliver oxygen by:

1. reduction in number of RBCs
2. reduction in hemoglobin content
3. reduction in functionality of hemoglobin

Question 2

Iron Deficiency Anemia (IDA)

1) Best indicator
2) Cause

Answer 2

1) Ferritin

2) Insufficient dietary intake, blood loss, parasitic infection

Question 3

Hemolytic Anemias

Examples of Intrinsic Abnormalities

Answer 3

1) Increased RBC breakdown

2) Premature destruction, genetic disorders (sickle-cell), Non-genetic forms (Paroxysmal Nocturnal Hemoglobinuria - PNH)

Question 4

Hemolytic Anemias

Examples of Extrinsic Abnormalities

Answer 4

1) Increased RBC breakdown

2) Anti-body related (transfusion, Rh disease) and Mechanical trauma (hemodialysis)

Question 5

What are the three causes of anemia?

Answer 5

1. Blood loss, or dilutional
2. Decreased RBC production
3. Increased RBC breakdown

Question 6

What are the two reasons for decreased RBC production? What are examples of each of these reasons?

Answer 6

1. Reduced proliferation of differentiation of stem cells (Pure red cell aplasia or aplastic anemia)
2. Problem with proliferation or maturation of erythroblasts (Megaloblastic anemia, pernicious anemia, iron-deficient anemia)

Question 7

Microcytic Anemias

1) Environmental causes
2) Genetic causes

Answer 7

Anemias with small cells

1) **too little iron, too much lead
2) Thalessemias

Question 8

Macrocytic Anemias

1) Environmental causes

Answer 8

Anemias with large cells

1) **too little Vit B12 or B9, drug side effect

Question 9

Bad Cell Development Anemias

1) Size of cells
2) Environmental causes
3) Genetic causes

Answer 9

1) Normal sized cells
2) **Chronic Disease (CKD, low EPO), aplastic anemia
3) G6PD, Leukemia

Question 10

Poor Cell Survival Anemias

1) Size of cells
2) Environmental causes
3) Genetic causes

Answer 10

1) Normal sized cells
2) Acute hemorrhage
3) Sickle Cells

Question 11

Oral Iron

1) Use
2) What should be avoided when taking?
3) What can facilitate absorption?

Answer 11

1) Mild to moderate iron deficiency
2) Avoid antacids, H2 blockers, and PPIs
3) Vitamin C

Question 12

Which type of iron is absorbed the best?

Answer 12

**Heme iron (animal source) absorbed better than nonhdme iron (plant source) **

Question 13

Parenteral Iron

1) Use
2) Biggest adverse effect

Answer 13

1) Treat situations where oral iron does not work (ex: patient has deficit of >1 gram)
2) Anaphylactic-type reaction

Question 14

1) What is the risk of staying on iron replacement therapy longer than 1-6 months?
2) What should you use to guide iron replacement therapy?

Answer 14

1) Chronic iron overload

2) Ferritin levels

Question 15

Acute Iron Overdose

1) Symptoms
2) Treatment options

Answer 15

1) abdominal pain, blood diarrhea within 30 minutes, hepatic failure, necrotizing gastroenteritis –> coma, death.
2) Gastric aspiration, lavage with precipitating salts, Deferoxamine - iron chelator

Question 16

Chronic Iron Overdose (Hemochromatosis)

1) Symptoms
2) Treatment options

Answer 16

1) Excess iron deposited into heart, liver, pancreas leading to organ failure and death
2) Best treated by intermittent phlebotomy

Question 17

Deferoxamine

1) Use
2) Mechanism of action
3) Side effects

Answer 17

1) Iron overdose
2) Iron chelator
3) Hypotension, neurotoxicity, increased susceptibility to infection

Question 18

Cyanocobalamin (Vit B12)

1) Use
2) Adverse effect

Answer 18

1) B12 deficiency

2) Injection site reactions, **Hypokalemia, and secondary iron deficiency

Question 19

Folic Acid (Vit B9)

1) Use
2) Adverse effects

Answer 19

1) B9 deficiency
2) Reduce some CNS medication efficacy,
* Can mask B12 deficiency*–> cures anemia but not neurotoxicity

Question 20

Blood transfusion

1) Use
2) Notes

Answer 20

1) Only treat very low hemoglobin (<60g/L)

2) do not use whole blood

Question 21

Epoetin Alfa

1) Use
2) Side effects
3) How long for Hgb response?

Answer 21

1) CKD, renal failure, cancer/chemo
2) HTN, thrombotic events, edema, …. many many other USEs.
3) 2-6 weeks

Question 22

Hyperbaric Oxygen

1) Use

Answer 22

1) For use with exceptional blood loss or situations where blood transfusions can not be used due to medical, practical, or religious reasons