IC3 Flashcards
Aplastic anaemia: what are the 2 syndromes?
1) Dose-dependent direct drug toxicity
2) Idiosyncratic - by means of toxic metabolites
Drugs that induce aplastic anaemia
1) Cancer chemotherapies, chloramphenicol
2) Carbamazepine, phenytoin
Drug treatment for aplastic anaemia
- Immunosuppressants
- GM-CSF (sargramostim)
- G-CSF (filgrastim, pegfilgrastim)
- IL-14
First step in management of drug-induced blood disorders
Withdraw causative drug where possible
Drugs that induce immune thrombocytopenia
Heparin, sulfonamides, carbamazepine, phenytoin, GP IIb/IIIa inhibitors
Drug treatment for immune thrombocytopenia
Immunosuppressants
Agranulocytosis: what are the 3 syndomes?
1) Direct drug toxicity
2) Toxic metabolite
3) Immune (hapten or complement) mediated
Agranulocytosis: causative drugs
Thiamazole, carbimazole, clozapine, beta lactams, propylthiouracil
Agranulocytosis: drug treatment
G-CSF or GM-CSF
Name for G-CSF
Granulocyte-colony stimulating factor
Name for GM-CSF
Granulocyte-macrophage colony-stimulating factor
Immune haemolytic anaemia: 3 syndromes
1) Drug-induced true autoantibody production
2) Innocent bystander (immune complex) autoantibody production
3) Hapten-induced haemolysis
Immune haemolytic: causative drugs
1) Methyldopa
2) Quinine, quinidine
3) Penicillins, cephalosporins, streptomycin
Non-immune haemolytic anaemia: syndrome
Protein adsorption
Non-immune haemolytic anaemia: causative drugs
Cisplatin, oxaliplatin, beta lactamase inhibitors
Haemolytic anaemia: drug treatment
1) Steroids and immunoglobulins have been used in serious cases
2) For autoimmune hemolytic anaemia, rituximab (human anti- CD20 monoclonal antibody) can be used
Drugs used for neutropenia treatment
Myeloid growth factors e.g. G-CSF, GM-CSF
Drugs used for thrombocytopenia treatment
Megakaryocyte growth factors / Platelet-Stimulating Agents (PSAs)
1) recombinant IL-11 (oprelvekin)
2) Fc-fusion protein thrombopoietin receptor agonist e.g.,
romiplostim
3) Oral nonpeptide thrombopoietin receptor agonists e.g., eltrombopag
Features of RBC in iron-deficient anaemia
Few, small haemoglobin-poor RBC (paller)
Features of RBC in VitB12/ folate-deficient anaemia
Very few, large Hb-rich RBC (redder)
Acute adverse effects of iron supplements
Necrotizing gastroenteritis with vomiting, abdominal pain, and bloody diarrhoea followed by shock, lethargy, dyspnea, metabolic acidosis, coma and death
Chronic adverse effects of iron supplements
Haemochromatosis with iron deposited in heart, liver, pancreas and other organs → organ failure, death
Why is Hydroxocobalamin precursor preferred over cyanocobalamin?
Greater protein binding hence retained longer in circulation
Why is vitamin B12 administered parenterally instead of orally?
Oral not usually effective as deficiencies are usually caused by GI malabsorption
Adverse effects for hydroxocobalamin
1) Photosensitivity
2) Injection site pain
3) Hypotension, hot flushing
DDI with hydroxocobalamin
PPI (reduce oral absorption)
Adverse effects of folic acid supplements
- GI disorders: Bitter or bad taste, nausea, abdominal distension, flatulence
- Immune system disorders: Rarely, allergic reactions (e.g.rash,pruritus, erythema, urticaria, dyspnoea, shock); allergic sensitization.
- Metabolism and nutrition disorders: Rarely,anorexia.
Contraindication for ESA
Uncontrolled hypertension
ADR for ESA
- Hypertension, oedema; increased platelet count, thrombosis, stroke; hyperkalaemia; seizures; myalgia, arthralgia, limb pain; gastrointestinal effects including nausea and vomiting
- Epoetin alfa: Pruritus
- Darbepoetin alfa: Dyspnoea, cough, bronchitis
ADR for G-CSF
bone pain, reversible when drug discontinued
ADR for GM-CSF
fever, malaise, arthralgias, myalgias
ADR for Megakaryocyte growth factors
Thromboembolic events
ADR for IL-11 (Oprelvekin)
Fluid retention, peripheral oedema,
dyspnoea on exertion
