Hematologic Agents

Question 1

What is Erythropoetin?

Answer 1

an endogenous glycoprotein that regulates erythrocyte production

Question 2

how does Erythropoetin work?

Answer 2

starts in yolk sac=liver=kidneys; maintains RBC production by inhibiting apoptosis or erythroid progenitors by stimulating their proliferation and differentation into normoblasts; does not cross the placenta; fetus produces their own

Question 3

Indications for rEpo:

Answer 3

used to treat and prevent aneamia due to a variety of causes including renal failure and immaturity

Question 4

Clinicals Trials

Answer 4

anemia of prematurity, hyporegenerative anemia of the neonates with Rh hemolytic disease, anema of BPD, congenital heart disease

Question 5

Dosage of rEpo

Answer 5

Text: 400 U per kg given 3 x week SQ for a minimum of 2 weeks; rEpo 200 U per kg every day IV for a minimum of 3 weeks

Question 6

What must be given concomitantly with Epo

Answer 6

6-8 mg/kg/day of elemental iron

Question 7

adverse effects:

Answer 7

Adults: HTN, thrombus formation, polycythemia and rec cell aplasia

Question 8

Adverse effects

Answer 8

ROP; early high-dose rEpo may have a protective effect on the retina by ameliorating the first stage of ROP; One study suggested that an increased risk of ROP in patients started on early high dose rEpo and iron

Question 9

Sede effects of rEpo

Answer 9

potential effects on iron balance

Question 10

Possible other effects

Answer 10

Neuroprotection, protection of the other organs such as the heart and the kidneys

Question 11

What is G-CSF? Neupogen

Answer 11

a physiological regulator of neutrophil production and function; multiple effects on white cell aturation and function; enhancement of neutrophil functions (chemotaxis, phagocytosis, superoxide production, bacterial activity)

Question 12

Clinical Trials Neupogen

Answer 12

infants with bacterial sepsis, infants whos mothers had PIH, alloimmune neutropenia, autoimune neutropenia, chronic idiopathic neutropenia

Question 13

Other info in Neupogen G-CSF

Answer 13

rare adverse effects-thrombicytopenia, osteoporosis, contraindicated in patients with a known hypersensitivity to e-coli derived proteins or any components composed of the product

Question 14

What is (r)GM-CSF (neulasta)

Answer 14

granulocytic-macrophage colony-stimulating factor; increases neutrophil counts and may decrease mortality die to sepsis when used prophylactically (significant increase in the ANC within 48 hours of administration)

Question 15

Clinical trials

Answer 15

neonatal sepsis and prophylaxis against nosocomial infections

Question 16

OTC iron products most are 10 mg/ml with dosing of 1 ml per day

Answer 16

EXCEPT for Ferrous Sulfate Drops ( Fer-in-Sol, Mead Johnson, Evansville, IN and generic brands)