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Year 2 Heme lymph > Exam I, Linger, anemia Tx, lec Part I > Flashcards

Exam I, Linger, anemia Tx, lec Part I Flashcards

1
Q

What are the oral preparations for iron

A

ferrous sulfate
ferrous gluconate
ferrous fumarate

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2
Q

what are the parenteral preparations for iron

A

iron dextran
iron-sucrose complex
sodium ferric gluconate complex

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3
Q

What are the iron chelators

A

deferoxamine

deferasirox

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4
Q

what are the Vit B12 preperations

A

cyanocobalamin

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5
Q

what are the erythrocyte stimulating agents

A

epoetin alpha

darbepoetin alpha

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6
Q

what are the myeloid growth factors that are granulocyte colony stimulating factors

A

filgrastim(neupogen)

pegfilgrastim

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7
Q

what are the myeloid growth factors that are granulocyte macrophage colony stimulating factors

A

sargramostim

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8
Q

what are the megakaryocyte growth factor stimulants

A

oprelevekin (IL-11)

romiplostim

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9
Q

Sx of anemia

A

pallor fatigue, dizziness, exertional dyspnea

tissue hypoxia, tachycardia, increased CO and vasodilation

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10
Q

what do RBC look like in iron deficiency

A

microcytic hypochromic anemia

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11
Q

where does most iron absorption occur

A

duodenum and proximal jejunum

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12
Q

which iron has to be broken down by ferroreductase to be absorbed

A

nonheme iron

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13
Q

what occurs when iron stores are high

A

absorbed iron is diverted into ferritin in the intestinal epithelial mucosal cells for storage

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14
Q

what transports iron into the plasma

A

transferrin, beta globulin

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15
Q

how is ferrous iron transported

A

divalent metal transporter 1 into cell and enteres Hb synthesis pathway or stored as ferritin

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16
Q

how does iron uptake change in situations of increased erythropoiesis

A

increase in # of tranferrin R n developing etythroid cells

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17
Q

where is iron stored

A

intestinal mucosal cells in macrophages in liver, spleen and bone and in the parenchymal liver cells

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18
Q

how does low level of iron change apoferritin levels

A

inhibits its synthesis

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19
Q

What is the ONLY clinical indication for use of iron preparations

A

Tx or prevention of Fe deficient anemia

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20
Q

when giving patient ferrous sulfate or any other iron supp what should you tell them to do when taking the medicine

A

take with water or juice on empty stomach

with food to prevent irritation if need be

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21
Q

adverse effects of oral iron therapy

A

nausea, epigastric discomfort, abdominal cramps, constipation, black stools and diarrhea

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22
Q

when do you use parenteral iron therapy

A

patient cannot tolerate oral iron or patients with advanced chronic renal disease requiring hemodialysis and Tx with erythropoietin, small bowel resection etc

23
Q

how does pareneteral iron avoid severe toxicity from free ferric iron at administration

A

colloid particles with core of oxyhydroxide surrounded by carbohydrate
Fe is released slowly
Need to monitor iron storage levels

24
Q

how is iron dextran administered and side effects?

A

IM or IV (usually IV)
HA, light headedness, fever, arthralgias nausea, vomiting, back pain, flushing, urticaria, bronchospasm, anaphylaxis and death

25
Q

how is sodium ferric gluconate complex administered

A

IV

HS reactions

26
Q

which parenteral iron is less liley to cause HS reacions

A

iron sucrose

IV

27
Q

Sx acute iron toxicity

A

necrotizing gastroenteritis, vomiting and abdominal pain, bloody diarrhea, shock, lethargy and dyspnea

28
Q

what is Tx acute iron toxicity

A

whole bowel irrigation and parenteral deferoxamine

29
Q

what occurs in chronic iron toxicity? who is it seen in

A

Fe deposits in Heart, liver, pancreas
toxicity is most common in patients with inherited hemochromatosis( excessive iron absorption) and patients with many RBC tranfusions

30
Q

Tx for chronic Fe toxicity

A

intermittent phlebotomy

deferasirox reduces liver Fe [ ] but not sure if reduce Fe in heart

31
Q

what is cobalamine

A

B12

32
Q

deficieny in B12 can lead to what

A

megaloblastic anemia, GI Sx and neurologic abnormalities

33
Q

where is B12 found in diet

A

meat, eggs and dairy products

34
Q

where is B12 stored

A

liver

35
Q

what is needed for absorption of B12

A

intrinsic factor

36
Q

where is B12 absorbed

A

distal ileum

37
Q

what cause B12 deficiencys

A

lack of IF

loss or malfunction of absorptive mech in distal ileum

38
Q

how is B12 transported in body

A

glycoproteins transcobalamin I II and III

39
Q

what reactions in human body require B12

A

synthesis of methionin and synthesis of succinyl CoA

40
Q

why does folic acid help with B12 deficinecy

A

because B12 deficinecy causes accumulation of N5 methyltetrahydrofolate and depletion tetrahydrofolate

41
Q

folic acid does not prevent what Sx of B12 deficiency

A

neurologic

42
Q

accumulation of homocysteine is characteristic of what deficiency

A

Vit B12

43
Q

What are Dx for B12 defieicny

A

increased serum lvels homocysteine

increased serum and urine levels methylmalonic acid

44
Q

common causes Vit B12 deficiency

A

pernicious anemia, partial or total gastrectomy and conditions that affect distal ileum

45
Q

what are the common clinical manifestations of B12 deficiency

A

megaloblastic macrocytic anemia
mild or moderate leukopenia or thrombocytopenia
hypercellular bone marrow with accumulation of megaloblastic erythroid and other precursor cells

46
Q

what are the neuro Sx B12 deficiency

A

paresthesias in peripheral nerves and weakness and progresses to spaxticity ataxia and other CNS dysfunctions

47
Q

Tx B12 deficiency

A

parenteral injections

48
Q

what are the richest dietary sources of folic acid

A

yeast, liver, kidney and green vegetables

49
Q

where is folic acid abosrbed

A

proximal jejunum

50
Q

what type of anemia is caused by folic acid deficiency

A

megaloblastic anemia that looks like B12 deficiency anemia

51
Q

what can cause folic acid deficiency

A

inadequate intake of folates like alcoholics with porr diet and pregnant women and patients with hemolytic anemia with icnreased folate requirements

52
Q

what drugs can cause folic acid deficiency

A

methotrexate, trimethoprim and pyrimethamine

long term therapy with phenytoin

53
Q

how much folic acid is given to resverse megaloblastic anemia

A

1 mg/day

Year 2 Heme lymph (28 decks)

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