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P3 Therapeutics > Exam 3 - Rogers > Flashcards

Exam 3 - Rogers Flashcards

1
Q

s/sx of anemia

A
  1. exertional dyspnea
  2. angina
  3. tachycardia
  4. fatigue
  5. pallor
    *may be asymptomatic if it develops slowly
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2
Q

normal Hgb (female)

A

12-16 g/dL

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3
Q

normal Hgb (male)

A

13.5-18

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4
Q

normal MCV

A

80-100 mm

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5
Q

normal RDW

A

11.5-14.5%

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6
Q

microcytic MCV

A

< 80

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7
Q

macrocytic MCV

A

> 100

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8
Q

ferritin normal values

A

15-200 ng/mL
(iron deficiency is likely for ferritin < 45 ng/mL)

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9
Q

normal TSAT percentages

A

20-50%

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10
Q

T/F: drugs are likely to cause iron deficiency anemia

A

FALSE

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11
Q

oral iron exceptions:

A
  1. cannot tolerate (side effects)
  2. cannot absorb
  3. ESRD
  4. HF
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12
Q

Why might every other day dosing be better for iron?

A

Hepcidin, a hormone that decreases dietary iron absorption, is increased after a dose of oral iron for 24 hours and normalizes within 48 hours

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13
Q

Oral iron counseling points

A
  1. increased absorption on empty stomach
  2. however, causes stomach upset so can take with food or split up doses
  3. absorption increased by vitamin C
  4. causes constipation - increase fluids, activity, and fiber
  5. causes dark stools
  6. keep in safe place - children can mistake it for candy
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14
Q

IV iron indications

A
  1. ESRD
  2. HF
  3. failed oral iron
  4. malabsorption
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15
Q

IV iron side effects

A

common: hypotension during infusion
rare: skin tattooing

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16
Q

causes of vitamin B12 deficiency

A
  1. diet - vegan/vegetarian
  2. alcoholism
  3. lack of intrinsic factor (pernicious anemia)
  4. decreased absorption
  5. medications - PPIs, metformin
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17
Q

T/F: our bodies can produce vitamin B12

A

FALSE, must absorb it from diet

18
Q

consequences of vitamin B12 deficiency

A

neurologic - weakness, numbness, cognitive dysfunction

19
Q

vitamin B12 deficiency treatment options

A
  1. IM or SC: 100-1000 mcg
  2. oral: 1000-2000 mcg/day
20
Q

folic acid deficiency causes

A
  1. malabsorption
  2. malnutrition - found in greens, orange juice, cereal, flour, milk
  3. alcoholism
  4. medications: methotrexate, phenytoin, SMZ-TMP, sulfasalazine
21
Q

Never replace folic acid without checking ___________ ______

A

vitamin B12

22
Q

folic acid deficiency treatments

A

oral: 1-5 mg daily until Hgb normalizes
(rarely need IV)

23
Q

Which chronic diseases is anemia common in?

A
  1. CKD
  2. CHF
  3. Cancer
  4. HIV/AIDS
24
Q

Mechanism of anemia in CKD

A

erythropoietin is produced in the kidneys and stimulates production of RBCs, so decreased erythropoietin production -> anemia

25
Q

Treatment of anemia in CKD

A

Avoid blood transfusions
1. correct nutritional deficiencies:
folate/B12
iron (oral in stages 3-5, IV in HD)
2. ESAs - only start ESAs after replenishing iron stores

26
Q

T/F: you should target normal Hgb levels when using ESAs for anemia caused by CKD

A

FALSE - use minimum dose to maintain Hgb > 10, there is an increased risk of CV events if targeting higher Hgb

27
Q

T/F: you should use IV iron in hemodialysis patients

A

TRUE

28
Q

T/F: you should use oral iron in HF patients

A

FALSE - oral iron has not showed benefit

29
Q

When are ESAs used in HF?

A

never

30
Q

Sickle cell anemia treatment options:

A
  1. folic acid 1mg/day
  2. blood transfusions
  3. hydroxyurea
  4. immunizations
31
Q

Which anemic patients may require high doses of opioids?

A

patients in sickle cell crisis

32
Q

What is aplastic anemia?

A

Bone marrow failure that causes body to stop producing enough new blood cells

33
Q

What is immune hemolytic anemia?

A

antibodies form against body’s own RBCs and destroy them

34
Q

What is oxidative hemolytic anemia?

A

Medications trigger premature breakdown of RBCs in patients with genetic deficiency of G6PD enzyme

35
Q

In hemolytic anemia, RBCs are destroyed before _______ days

A

120 (normal lifespan of RBC)

36
Q

In blood loss anemia, you should transfuse packed red blood cells when Hgb < _______

A

7

37
Q

When using ESAs for anemia of CKD, you should not titrate the dose up for at least _____ weeks after initiating or increasing dose

A

4

38
Q

Additional s/sx of iron deficiency anemia

A
  1. spoon-shaped nails
  2. inflamed tongue
  3. pica
39
Q

Causes of iron deficiency

A
  1. blood loss (menstruation, donation)
  2. decreased absorption (celiac)
  3. vegetarian diet
  4. increased consumption (pregnancy)
40
Q

Which types of anemia are usually macrocytic?

A

folic acid and B12 deficiency
**not always the case!

41
Q

Which types of anemia are usually microcytic?

A

iron deficiency and sickle cell
**not always the case!

42
Q

Which types of anemia are usually normocytic?

A
  1. Blood loss
  2. Anemia of chronic disease
  3. Hemolytic anemia

P3 Therapeutics (16 decks)

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