Hematopoietic Drugs

Question 1

Minerals

Answer 1

Ferrous sulfate
Ferrous gluconate
Ferrous fumarate
Iron dextran
Iron sucrose
Sodium ferric gluconate

Question 2

Minerals - MoA

Answer 2

Absorbed from intestines into the circulation where it is bound to transferrin and transported to tissues, including bone marrow and liver(stored as ferritin)

Question 3

Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Clinical use

Answer 3

Iron deficiency anemia

Question 4

Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Adverse effects

Answer 4

Few adverse effects but can cause
Epigastric pain
Nausea
Vomiting
Diarrhea or Constipation
Black stools 
Liquid iron preparations can stain the teeth. 
Lethal toxicity

Question 5

Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Interactions

Answer 5

Bile acid binding resins (cholestyramine) reduce the absorbtion of iron, wheras ascorbic acid (Vit C) increase the absorbtion.

Iron can reduce the absorbtion of: tetracyclines, fluoroquinolones, levothyroxine and vit E. adm of these drugs should be separated for 2h.

Question 6

Iron dextran - Clinical use

Answer 6

Iron deficiency anemia in patients who cannot tolerate oral preparations or fail to respons to oral iron therapy

Question 7

Iron dextran - Adverse effects

Answer 7

IV: peripheral flushing, hypotensive reactions

IM: injection site reactions, including pain, inflammation, sterile abscess and brown discoloration of skin for this reason, the preparation must be given by deep intramuscular injection into to outer quadrant of the buttock.

Question 8

Iron sucrose and Sodium ferric gluconate - Clinical use

Answer 8

Anemia in patients with chronic kidney disease

Question 9

Vitamins

Answer 9

Folic acid
Cyanocobalamin
Hydroxocobalamin

Question 10

Vitamins - MoA

Answer 10

Serve as cofactor in biochem reactions involving the addition of single carbon untis to various substances. The adm of one vit can partially compensate deficiency of another.

Question 11

Folic acid - Clinical use

Answer 11

Megaloblastic anemia

Question 12

Folic acid - Adverse effects

Answer 12

Neural tube birt defects, such as spina bifida and megaloblastic anemia when inadequate dietary intake during pregnancy

Irreversible neurologic damage can occur if a B12 deficiency is incorrectly treated with folic acid

Question 13

Cyanocobalamin and Hydroxocobalamin - Clinical use

Answer 13

Pernicious anemia (Vitamin B12 deficiency anemia)

Hydroxocobalamin used for out of hospital empiric treatment of cyanide poisoning, resulting from smoke inhalation.

Question 14

Hematopoietic Growth Factors

Answer 14

Epoetin alfa
Darbepoetin alfa
Epoetin beta
Filgrastim
Sargramostim
Pegfilgastrim
Oprelvekin

Question 15

Hematopoietic Growth Factors - MoA

Answer 15

Endogenous glycoproteins that bind to specific receptors on bone marrow progenitor cells and induce their differentiation and proliferation thereby increasing production of erythrocytes and various leukocytes.

Question 16

Epoetin alfa, Darbepoetin alfa and Epoetin beta - Classification

Answer 16

Erythropoiesis- stimulating agents (ESAs)

Question 17

Erythropoiesis- stimulating agents (ESAs) - Clinical use

Answer 17

Anemia caused by chronic renal failure

Anemia resulting from chemotherapy for nonmyeloid malignancies

Anemia caused by zidovudine therapy for HIV (Epoetin alfa)

Anemia in premature infants

Question 18

Erythropoiesis- stimulating agents (ESAs) - Special consideration

Answer 18

Because the use of iron stores is increased in patients receiving ESAs, patients should be given iron supplements to maintain transferrin saturation levels of at least 20% to support erythropoiesis

Question 19

Erythropoiesis- stimulating agents (ESAs) - Adverse effects

Answer 19

Increase risk of hypertension, stroke, MI, heart failure and death.

Enhance tumor progression and shorten survival in pat with breast, non-small cell lung, head and neck, lymphoid and cervical cancers.

Question 20

Filgrastim - Classification

Answer 20

Recombinant human granulocyte colony stimulating factor (G-CSF)

Question 21

Filgrastim - Clinical use

Answer 21

Neutropenia associated with cancer chemo and bone marrow transplantation.
Aplastic anemia
Hairy cell leukemia
Myelodysplasia
Drug induced and congenital agranulocytosis

Mobilize hematopoietic progenitor cells into the peripheral blood when blood is being collected for leukapheresis

Prevent neutropenia in patients exposed to lethal radiation

Prevent zidovudine-induced neutropenia in patients with HIV

Question 22

Sargramostim - Classification

Answer 22

Recombinant human granulocyte macrophage CSF

GM-CSF

Question 23

Sargramostim - Clinical use

Answer 23

Neutropenia associated with cancer chemo and bone marrow transplantation.

Accelerate myeloid cell (granulocyte) recovery in patients undergoing allogenic bone marrow transplantation or chemotherapy for lymphoma, acute myeloid leukemia, or Hodgkin disease.

It has also been used to enhance stem cell mobilization before collection for stem cell transplantation to accelerate myeloid cell recovery after allogenic bone marrow transplantation

Also reduce the incidence of fever and infections in patients with severe chronic neutropenia.

Question 24

Pegfilgastrim - Clinical use

Answer 24

Neutropenia associated with cancer chemo and bone marrow transplantation.

Question 25

Oprelvekin - Classification

Answer 25

Recombinant IL-11

Question 26

Oprelvekin - MoA

Answer 26

It is a thrombopoietic growth factor that stimulates the proliferation of megakaryocyte progenitor cells and induces megakaryocyte maturation, resulting in increased platelet production.

Question 27

Oprelvekin - Clinical use

Answer 27

Prevent severe thrombocytopenia and reduce the need for platelet transfusions following myelosuppressive chemotherapy in high-risk patients with nonmyeloid malignancies

Question 28

Drugs that cause folate deficiency

Answer 28

Folate reductase inhibitors such as trimethoprim, pyrimethamine, methotraxate

Drugs that inhibit folate absorption such as cholestyramine and phenytoin