Heme Pharm Flashcards
Formulations of Iron
Oral and IV
- Ferrous sulfate (DOC)
- Ferrous glucosamine
- Ferrous fumarate
- IV: Venofer
Oral iron patient instruction
Avoid enteric coated bc of poor absorption
Take with vitamin C (oral or OJ) and on empty stomach
IDA treatment
Iron is continued until anemia is resolved and iron stores are replenished (6-8 months)
HgB slowly rises 1-2 weeks after start, but should return by 6-8 weeks
ADRs to Oral Iron
GI problems (metallic taste, n/v, constipation/diarrhea, gastritis)
Black/green tools
Who should receive IV iron?
Patients who can’t tolerate GI side effects
Need to grow stores in 1-2 visits
Ongoing blood loss > iron absorption
Co existing inflammatory condition
IV iron
Iron sucrose (venofer)
Given 5-10 doses per day
Low anaphylactic risk
can cause Hypotension (esp. in hemodialysis patients)
What might cause no response to iron supplementation
Not taking iron
Reduced absorption
Blood loss/re-bleeding
Wrong diagnosis, more than one cause
Inflammation
What to do if someone doesn’t respond do iron
Confirm they are taking and no more blood loss
Look for inflammation
Might be a malabsorption issue – Celiac or H. Pylori
ESAs used
Epoetin Alfa (Epogen, Procrit) Darbepoetin Alfa (aranesp)
ALFA
ESA indications
Anemia of CKD (3b+)
Concurrent with chemo therapy that IS NOT curative (to avoid transfusions)
ESA dosage
Given enough to control HgB levels
If levels fall below 10 but alter dosage if getting close to 11
who should NOT use ESA
Those with chemotherapy that intends to be curative (can cause tumor growth)
Palliative care
ESA precaution
Increases BP – caution with uncontrolled HTN
Increased risk of seizures
Can cause Pure red cell aplasia – now CI
ESA BBW
- Increased risk of serious cardio events if HgB is elevated above 11g/dL
- Shortened survival, increased risk of tumor progression or recurrence
- Death, CV, stroke in CKD
Indications for G-CSF
Prophylaxis - in anticipation of heavy chemo, during retreatment after neutropenia fever
Afebrile neutropenia
NOT given to febrile bc of serious allergic reactions
GSFs available
Filtration (Neupogen, Granix)
Pegfilgrastam (Neulasta)
Aspirin MOA
Irreversible inhibits COX-1 and COX-2 decreased Thromboxane A2
NO platelet aggregation
Aspirin ADRs
GI ulcers/gastritis
Hypersensitivity reactions (asthma and polyps)
Bleeding
ASA Contraindications
- Use with alcohol increases bleeding
- High dose is CI in pts with CKD
- Children and teens (Reye’s syndrome)
- 3rd trimester/Pregnancy
Commonly used oral thienopyridines
Plavix (Clopidigrel)
Prasurgrel (Effient)
Ticagrelor (Brilinta)
Thienopyridine MOA
Blocks GP IIb/IIIa activation, reducing aggregation
Clopidogril/Plavix indications (3)
Heart attacks
STROKE
Peripheral artery disease
Clopidogril/Plavix ADRs
Bleeding (esp. if old or underweight)
TTP - usually happens quickly)
Higher concentration in patients w/CKD
Can have poor metabolizers - still clot despite taking drug
Prasugrel/Effient
Indications
Acute coronary syndrome
CAD
