Exam I, Linger, anemia Tx, lec Part I Flashcards
What are the oral preparations for iron
ferrous sulfate
ferrous gluconate
ferrous fumarate
what are the parenteral preparations for iron
iron dextran
iron-sucrose complex
sodium ferric gluconate complex
What are the iron chelators
deferoxamine
deferasirox
what are the Vit B12 preperations
cyanocobalamin
what are the erythrocyte stimulating agents
epoetin alpha
darbepoetin alpha
what are the myeloid growth factors that are granulocyte colony stimulating factors
filgrastim(neupogen)
pegfilgrastim
what are the myeloid growth factors that are granulocyte macrophage colony stimulating factors
sargramostim
what are the megakaryocyte growth factor stimulants
oprelevekin (IL-11)
romiplostim
Sx of anemia
pallor fatigue, dizziness, exertional dyspnea
tissue hypoxia, tachycardia, increased CO and vasodilation
what do RBC look like in iron deficiency
microcytic hypochromic anemia
where does most iron absorption occur
duodenum and proximal jejunum
which iron has to be broken down by ferroreductase to be absorbed
nonheme iron
what occurs when iron stores are high
absorbed iron is diverted into ferritin in the intestinal epithelial mucosal cells for storage
what transports iron into the plasma
transferrin, beta globulin
how is ferrous iron transported
divalent metal transporter 1 into cell and enteres Hb synthesis pathway or stored as ferritin
how does iron uptake change in situations of increased erythropoiesis
increase in # of tranferrin R n developing etythroid cells
where is iron stored
intestinal mucosal cells in macrophages in liver, spleen and bone and in the parenchymal liver cells
how does low level of iron change apoferritin levels
inhibits its synthesis
What is the ONLY clinical indication for use of iron preparations
Tx or prevention of Fe deficient anemia
when giving patient ferrous sulfate or any other iron supp what should you tell them to do when taking the medicine
take with water or juice on empty stomach
with food to prevent irritation if need be
adverse effects of oral iron therapy
nausea, epigastric discomfort, abdominal cramps, constipation, black stools and diarrhea
when do you use parenteral iron therapy
patient cannot tolerate oral iron or patients with advanced chronic renal disease requiring hemodialysis and Tx with erythropoietin, small bowel resection etc
how does pareneteral iron avoid severe toxicity from free ferric iron at administration
colloid particles with core of oxyhydroxide surrounded by carbohydrate
Fe is released slowly
Need to monitor iron storage levels
how is iron dextran administered and side effects?
IM or IV (usually IV)
HA, light headedness, fever, arthralgias nausea, vomiting, back pain, flushing, urticaria, bronchospasm, anaphylaxis and death
how is sodium ferric gluconate complex administered
IV
HS reactions
which parenteral iron is less liley to cause HS reacions
iron sucrose
IV
Sx acute iron toxicity
necrotizing gastroenteritis, vomiting and abdominal pain, bloody diarrhea, shock, lethargy and dyspnea
what is Tx acute iron toxicity
whole bowel irrigation and parenteral deferoxamine
what occurs in chronic iron toxicity? who is it seen in
Fe deposits in Heart, liver, pancreas
toxicity is most common in patients with inherited hemochromatosis( excessive iron absorption) and patients with many RBC tranfusions
Tx for chronic Fe toxicity
intermittent phlebotomy
deferasirox reduces liver Fe [ ] but not sure if reduce Fe in heart
what is cobalamine
B12
deficieny in B12 can lead to what
megaloblastic anemia, GI Sx and neurologic abnormalities
where is B12 found in diet
meat, eggs and dairy products
where is B12 stored
liver
what is needed for absorption of B12
intrinsic factor
where is B12 absorbed
distal ileum
what cause B12 deficiencys
lack of IF
loss or malfunction of absorptive mech in distal ileum
how is B12 transported in body
glycoproteins transcobalamin I II and III
what reactions in human body require B12
synthesis of methionin and synthesis of succinyl CoA
why does folic acid help with B12 deficinecy
because B12 deficinecy causes accumulation of N5 methyltetrahydrofolate and depletion tetrahydrofolate
folic acid does not prevent what Sx of B12 deficiency
neurologic
accumulation of homocysteine is characteristic of what deficiency
Vit B12
What are Dx for B12 defieicny
increased serum lvels homocysteine
increased serum and urine levels methylmalonic acid
common causes Vit B12 deficiency
pernicious anemia, partial or total gastrectomy and conditions that affect distal ileum
what are the common clinical manifestations of B12 deficiency
megaloblastic macrocytic anemia
mild or moderate leukopenia or thrombocytopenia
hypercellular bone marrow with accumulation of megaloblastic erythroid and other precursor cells
what are the neuro Sx B12 deficiency
paresthesias in peripheral nerves and weakness and progresses to spaxticity ataxia and other CNS dysfunctions
Tx B12 deficiency
parenteral injections
what are the richest dietary sources of folic acid
yeast, liver, kidney and green vegetables
where is folic acid abosrbed
proximal jejunum
what type of anemia is caused by folic acid deficiency
megaloblastic anemia that looks like B12 deficiency anemia
what can cause folic acid deficiency
inadequate intake of folates like alcoholics with porr diet and pregnant women and patients with hemolytic anemia with icnreased folate requirements
what drugs can cause folic acid deficiency
methotrexate, trimethoprim and pyrimethamine
long term therapy with phenytoin
how much folic acid is given to resverse megaloblastic anemia
1 mg/day
