Hematopoietic Drugs Flashcards
Minerals
Ferrous sulfate Ferrous gluconate Ferrous fumarate Iron dextran Iron sucrose Sodium ferric gluconate
Minerals - MoA
Absorbed from intestines into the circulation where it is bound to transferrin and transported to tissues, including bone marrow and liver(stored as ferritin)
Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Clinical use
Iron deficiency anemia
Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Adverse effects
Few adverse effects but can cause Epigastric pain Nausea Vomiting Diarrhea or Constipation Black stools Liquid iron preparations can stain the teeth. Lethal toxicity
Ferrous sulfate, Ferrous gluconate and Ferrous fumarate - Interactions
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.
Iron dextran - Clinical use
Iron deficiency anemia in patients who cannot tolerate oral preparations or fail to respons to oral iron therapy
Iron dextran - Adverse effects
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.
Iron sucrose and Sodium ferric gluconate - Clinical use
Anemia in patients with chronic kidney disease
Vitamins
Folic acid
Cyanocobalamin
Hydroxocobalamin
Vitamins - MoA
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.
Folic acid - Clinical use
Megaloblastic anemia
Folic acid - Adverse effects
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
Cyanocobalamin and Hydroxocobalamin - Clinical use
Pernicious anemia (Vitamin B12 deficiency anemia)
Hydroxocobalamin used for out of hospital empiric treatment of cyanide poisoning, resulting from smoke inhalation.
Hematopoietic Growth Factors
Epoetin alfa Darbepoetin alfa Epoetin beta Filgrastim Sargramostim Pegfilgastrim Oprelvekin
Hematopoietic Growth Factors - MoA
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.
Epoetin alfa, Darbepoetin alfa and Epoetin beta - Classification
Erythropoiesis- stimulating agents (ESAs)
Erythropoiesis- stimulating agents (ESAs) - Clinical use
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
Erythropoiesis- stimulating agents (ESAs) - Special consideration
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
Erythropoiesis- stimulating agents (ESAs) - Adverse effects
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.
Filgrastim - Classification
Recombinant human granulocyte colony stimulating factor (G-CSF)
Filgrastim - Clinical use
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
Sargramostim - Classification
Recombinant human granulocyte macrophage CSF
GM-CSF
Sargramostim - Clinical use
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.
Pegfilgastrim - Clinical use
Neutropenia associated with cancer chemo and bone marrow transplantation.
Oprelvekin - Classification
Recombinant IL-11
Oprelvekin - MoA
It is a thrombopoietic growth factor that stimulates the proliferation of megakaryocyte progenitor cells and induces megakaryocyte maturation, resulting in increased platelet production.
Oprelvekin - Clinical use
Prevent severe thrombocytopenia and reduce the need for platelet transfusions following myelosuppressive chemotherapy in high-risk patients with nonmyeloid malignancies
Drugs that cause folate deficiency
Folate reductase inhibitors such as trimethoprim, pyrimethamine, methotraxate
Drugs that inhibit folate absorption such as cholestyramine and phenytoin
