Exam I, Linger, anemia Tx, lec Part II Flashcards
where is EPO in the body
peritubular interstitial cells of the kidney
how does inflammation or infection change EPO levels
suppress EPO secretion
how does EPO dosing need to be adjusted in patient with chronic renal failure
3x/week rather than once because dialysis
how is darbepoetin different than epoietin alpha
longer half life
MOA EPO
induces erythropoiesis by stimulating division and differentiation of committed erythroid progenitor cells
induces release of reticulocytes from bone marrow into blood stream
how does EPO change Hct and Hb? how long for drug effect?
increase Hct and Hb in 2-6 weeks
reticulocyte count inc in 10 days
why does chronic kidney disease cause anemia
kidneys cannot produce GF needed for erythropoiesis
what is EPO coulped with
iron supplementation
what are clinical uses EPO
chronic kidney disease
myelosuppressive chemo patients at last 2 mo regimen
anemia with HIV
reoperative elective surgery when Hb borderline low
ESA not indicated in what conditions
cancer patients receiving hormonal therapy, or chemi when expected to be curative
surgery patients who are willin to donate blood
surgery patients cardiac or vascular
RBC substitute requiring immediate correction anemia
off label use EPO
Tx symptomatic anemia in myelodysplastic syndrome
Sx toxicity of epo
HTN and thrombotic complications
icnresed mortality when used aggressivley in patients with chronic renal failure
what is EPO use contraindicated in
uncontrolled HTN
what is use of romiplostim
thrombocytopenia
idiopathic thrombocytopenic purpura
what is used of IL-11 or oprelvekin
thrombocytopenia in patients with nonmyeloid malignancies who receive myelosuppressive cancer chemo
what is difference of filgrastim and pegfilgrastim
peg has longer half life
which myeloid growth factor was made in yeast
sargramostim
what are the R of signaling with myeloid GF
members of cytokine R superfamily and initiate the JAK/STAT signal transduction pathway
what do the G-CSF drugs do
stimulate proliferation and differentiation of progenitors already committed to neutrophil lineage
how do the G-CSF drugs change peripheral blood
increase [ ] of hematopoietic stem cells in peripheral blood
What is effect of GM-CSF
stimualte myelopoiesis
early and late granulocytic progenitor cells and erythroid and megakaryocyte progenitors
stimulates function of mature neutrophils
stimulates T cell proliferation together with IL-2
which myeloid GF increases [ ] of peripheral blood stem cells the most
G-CSF
What are uses of myeloid GF clinically
neturopenia from chemo
netruopenia from anything
patients undergoing high dose chemo because mobilizes the peripheral stem cells for collection by leukapheresis prior to chemo
what are signs of G-CSF toxicity
bone pain
signs of GM-CSF toxicity
fever, malaise, arthralgias, myalgias, capillary leak syndrome (peripheral edema and pleural or pericardial effusions)
why is recombinatnt thrombopoietin not used clinically
production of autoAb that result in development of thrombocytopenia
MOA oprelvekin IL-11
activates specific cell surface cytokine R to stimulate growth of multiple lymphoid and myeloid cells
acts synergistaclly with other growth factors to stimulate the growth of primitive megakaryocytic progenitors
increases # peripheral platelets and neutrophils
what is romiplostim
peptide agonist of the thrombopoeitin R Mpl
half life of this drug is inversely related to serum platelemt count
romiplostim
MOA romiplostim
activates Mpl thrombopoietin R to cause dose dependent increase in platelet count that begins 5 days after subQ injection and peaks at 12-15 days
what is IL-11 used for clinically
secondary prevention thrombocytopenia in patients receiving cytotoxic chemo for non-myeloid cancers
what would you give to reduce number of platelet transufions in patient receieving cytotoxic chemo
IL-11 oprevlekin
what is romiplostim used for
thrombocytopenia in patients with idiopathic thombocytopenic purpura who do not respond well to corticosteroids, Ig or splenectomy
toxicity effects of IL-11
fatigue HA, dizziness and CV effects like transient arrhythmias
hypokalemia
What are side effects romiplostim
mild HA on day of administration
