Hematinics Lecture PDF

Question 1

Ferritin

Answer 1

Storage form of iron in mucosal and liver cells, apoferrin becomes this upon binding iron

Question 2

Trasnferrin

Answer 2

Iron binding protein for distribution throughout body

Question 3

Physiologic needs of iron require diet to contain ___ more iron than body needs because of how little is abosrbed (think about what the RDA represents)

Answer 3

10x

Question 4

Observations of cells of iron deficiency anemia (2)

Answer 4

• microcytic

- hypochromatic

Question 5

Ferrous sulfate info and what is it DOC for?

Answer 5

• Least expensive PO oral iron replacement therapy

- DOC for iron deficiency anemias or sometimes used prophylactically

Question 6

Ferrous sulfate ADR’s (9)

Answer 6

• nausea
• heartburn
• bloating
• constipation
• diarrhea
• peptic ulcers
• dark green stool
• staining of teeth
• toxicity

Question 7

Ferrous sulfate drug interactions (2)

Answer 7

• Antacids reduce absorption

- tetracyclines forms chelates decreasing absorption of both agents

Question 8

2 ways food affects PO iron therapy and recommendation

Answer 8

• Food helps protect iron induced GI upset
• Food decreases absorption of iron by 50-70%

Recommended to administer between meals

Question 9

Ferrous gluconate/fumarate/aspartate function

Answer 9

Salts which are alternatives to ferrous sulfate, only difference is percent of iron content, produce same pharm effects, therapeutic responses, and ADRs

Question 10

Carbonyl iron function

Answer 10

Pure elemental iron in microparticles to enhance bioavailability and can be administered at an increased dosage safely (good for children)

Question 11

Iron dextran administration, function, indications

Answer 11

• IV or IM, preferabely IV, Iron preparation consisting of ferric hydroxide and dextrans
• reserved for those who cannot tolerate oral iron (such a those with intestinal disease or blood loss)

Question 12

Iron dextran ADR’s (4)

Answer 12

• anaphylaxis
• arthralgia
• circulatory failure
• localized discoloration if administered IM

Question 13

2 examples of Iron dextran

Answer 13

Infed, DexFerrum

Question 14

Sodium ferric gluconate complex (ferrlecit) indication

Answer 14

Iron deficiency anemia in CKD patients undergoing long term hemodialysis

Question 15

Sodium ferric gluconate complex (ferrlecit) ADR’s (2)

Answer 15

• anaphyaxis

- flank pain and malaise

Question 16

Iron sucrose (venofer) indications

Answer 16

Iron deficiency anemia patients with CKD

Question 17

Iron sucrose (venofer) ADR’s (2)

Answer 17

Hypotension and cramps

Question 18

Ferumoxytol (feraheme)function

Answer 18

Indicated for iron deficiency anemia in patients with CKD regardless of receiving erythopoietin or dialysis

Question 19

Ferumoxytol (feraheme) ADR (2)

Answer 19

• generally well tolerated

- can interfere with MRI up to 3 months after dosing

Question 20

B12 essential metabolic functions (2)

Answer 20

• DNA synthesis

- catalyze folic acid allowing for cell growth and division

Question 21

B12 absorption pathway

Answer 21

• Requires intrinsic factor secreted by parietal cells of stomach to form complex
• complex dissociates after absorption
• transported by transcobalamin II into tissues
• most B12 stored in liver, years to develop deficiency

Question 22

2 major causes of B12 deficiency

Answer 22

• impaired absorption due to enteritis or celiac disease

- lack of intrinsic factor (perhaps from gastric bypass!)

Question 23

Pernicious anemia

Answer 23

Atype of megaloblastic anemia where B12 deficiency due to lack of intrinsic factor resulting in low RBC count

Question 24

Consequences of B12 deficiency at a cellular level

Answer 24

-Tissues that undergo rapid growth and division are impacted

Question 25

Megaloblastic anemia/macrocytic anemia definition, how can we reverse it?

Answer 25

-Occurs due to b12 deficiency resulting in erythroblasts maturing but division being prevented, most likely fatal, can reversed with large doses of folic acid except for irreversible neurologic damage

Question 26

finish b12 preparations and replacements,

Answer 26

fuckkkk

Question 27

Erythroblasts are different from proerythroblasts in that they have ____

Answer 27

hemoglobin

Question 28

Anemia definition

Answer 28

Decrease in erythrocyte number, size, or hemoglobin content either due to blood loss, hemolysis, bone marrow dysfunction, or nutritional deficiences

Question 29

During pregnancy, what happens to iron requirements?

Answer 29

They increase very high, often requiring supplementation

Question 30

Vegans run the risk of this vitamin deficiency because it is only obtained from animal products or fortified foods

Answer 30

B12

Question 31

Megaloblastic/macrocytic anemia definition

Answer 31

Appears as numbers of megaloblasts in the blood because of impaired DNA synthesis (as a result of B12 deficiency)

Question 32

Some folic acid can be…

Answer 32

…activated by an alternative pathway independent of B12 permitting DNA synthesis to proceed

Question 33

Parasthesias of extremities and reduction in DTR’s indicates…

Answer 33

…neurologic damage from B12 deficiency

Question 34

The neurologic effects of B12 defiency cannot be reversed with…

Answer 34

….Folic acid supplementation and activation via the alternative pathway, it is unrelated to the effects on folic acid

Question 35

Cyanocobalamin function and DOC for what?

Answer 35

Purified crystalline form of vit B12 and DOC for B12 deficiency

Question 36

Cyanocobalamin administration (what do you do for patients with severe neurologic defect?

Answer 36

-Parenteral administration