Iron deficiency anaemia

Question 1

What is it

Answer 1

the reduction of red blood cell production due to low iron stores in the body.

Question 1

name 2 possible serious underlying causes of anaemia

Answer 1

gastric erosion
GI cancer

Question 2

What to do if pt has confirmed iron deficiency anaemia

Answer 2

treatment with iron prep initiated
exclude any serious underlying causes e.g. gastric erosion, GI cancer - but do not delay iron treatment whilst waiting investigations

Question 3

When is prophylaxis with iron prep important (6)

Answer 3

malabsorption, menorrhagia, pregnancy, after subtotal or total gastrectomy, in haemodialysis patients, and in the management of low birth-weight infants such as preterm neonates.

Question 4

true or false - prophylaxis with iron prep may be appropriate in haemodialysis pt

Answer 4

true

Question 5

true or false - prophylaxis with iron prep may be appropriate after subtotal or total gastrectomy

Answer 5

true

Question 6

iron salts should only be given via this route unless good reasons for using another route

Answer 6

by mouth

Question 7

is there any differences in efficacy of absorption of iron between the different ferrous salts

Answer 7

only marginal differences between one another in efficiency of iron absorption

Question 8

choice of preparation (which iron salt) is usually decided by … (2)

Answer 8

incidence of SE
cost

Question 9

is Hb regeneration rate affected by the type of salt used?

Answer 9

It is little affected by the type of salt used as long as sufficient iron is given

Question 10

Low or high doses or iron salts initially recommended?

Answer 10

lower initial daily doses are recommended, as these may be just as effective as higher doses, with lower rates of SE and better compliance

Question 11

monitoring for Hb response to oral iron & how long to continue

Answer 11

• monitor in the first 4 weeks for Hb response to oral iron
• continue treatment for around 3 months after normalisation of Hb conc
• dose of oral iron salts can be increased if therapeutic response is slow and treatment is tolerated

Question 12

Some oral preparations of iron contain ascorbic acid. Why?

Answer 12

To aid absorption of the iron but the therapeutic advantage of such preps is minimal and cost may be increased

Question 13

Use of MR preps of iron
- licensing
- use
- how they work
- SE

Answer 13

licensed for OD dosage
but have no therapeutic advantage
should not be used
formulated to release iron gradually
low incidence of SE but this may be due to small amounts of iron available for absorption as the iron is carried past the 1st part of the duodenum into an area of the gut where absorption may be poor

Question 14

Parenteral iron generally reserved for the following ..

Answer 14

when oral therapy is unsuccessful bc pt cant tolerate oral iron
or pt does not take it reliably
or if there is continuing blood loss, or in malabsorption

Question 15

Parenteral iron role in chemo-induced anaemia

Answer 15

Parenteral iron may also have a role in the management of chemotherapy-induced anaemia, when given with erythropoietins, in specific patient groups

Question 16

many patients with chronic renal failure who are receiving haemodialysis (and some who are receiving peritoneal dialysis) may require…

Answer 16

iron by the intravenous route on a regular basis

Question 17

Parenteral iron does not produce a faster haemoglobin response than oral iron provided that the oral iron preparation is taken reliably and is absorbed adequately. The exception to this is when it is used for ….

Answer 17

patients with severe renal failure receiving haemodialysis

Question 18

Doses of parenteral iron

Answer 18

Depending on the preparation used, parenteral iron is given as a total dose or in divided doses.

Question 19

Common SE For all oral iron (4)

Answer 19

constipation
diarrhoea
GI Discomfort
nausea

Question 20

SE of iron - constipation

Answer 20

Iron can be constipating and occasionally lead to faecal impaction.

Question 21

SE of iron - diarrhoea

Answer 21

Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.

Question 22

T or F - iron can exacerbate diarrhoea in pt with IBD

Answer 22

yes

Question 23

monitoring of pt parameters

Answer 23

Monitor haemoglobin concentration within the first 4 weeks of treatment, then regularly thereafter to assess response (e.g. every 4 weeks). Once haemoglobin is within the normal range, treatment should be continued for around a further 3 months to replenish the iron stores. After treatment, monitor blood count periodically (e.g. every 6 months) to detect recurrence.

Question 24

Once Hb is within the normal range, treatment should be continued for a further …… months to replenish the iron stores

Answer 24

3 months

Question 25

After iron treatment, should you monitor the blood count to detect recurrence of iron-deficiency anaemia

Answer 25

Monitor it periodically e.g. every 6 months to detect recurrence

Question 26

How to take oral iron

Answer 26

It is recommended to take iron on an empty stomach to allow for better absorption, although it can be taken after food to reduce gastro-intestinal side-effects if necessary.

Question 27

T or F - recommended to take iron on empty stomach to allow for better absorption

Answer 27

true

can be taken after food to reduce GI SE if needed

Question 28

Cautions for all oral iron -

Answer 28

high doses in elderly
no evidence of enhanced iron absorption above these doses

Question 29

Iron salts poisoning - what are the symptoms

Answer 29

nausea, vomiting, abdominal pain, diarrhoea, haematemesis, and rectal bleeding

Hypotension and hepatocellular necrosis can occur later

Question 30

These symptoms indicate severe iron salts poisoning

Answer 30

Coma, shock, and metabolic acidosis

Question 31

iron salts poisoning - mortality is reduced by intensive and specific therapy with the following drug which chelates iron

Answer 31

desferrioxamine mesilate

Question 32

When to give desferrioxamine mesilate in relation to serum-iron conc measurements

Answer 32

• measure serum-iron conc as an emergency and IV desferrioxaminde is given to chelate absorbed iron in excess of expected iron binding capacity
• in severe toxicity, give it IV immediately without waiting for result of serum-iron measurement

Question 33

Iron interacts severely with this antipsychotic. What is the drug and what is the interaction?

Answer 33

Clozapine can cause constipation, as can Iron ; concurrent use might increase the risk of developing intestinal obstruction. Manufacturer advises caution.

Question 34

Iron has an interaction with this abx drug class. Which drug class & what is the interaction

Answer 34

Macrolides e.g. demeclocycline, doxycycline, eravacycline, lymecycline, minocycline, oxytetracycline, tetracycline

Oral iron decreases the absorption of these oral drugs. They should be taken 2-3 hours after iron

Question 35

Iron interactions with antacids, calcium carbonate,

Answer 35

oral Antacids, calcium carbonate decrease the absorption of oral Iron. Manufacturer advises iron should be taken 1 hour before or 2 hours after antacids.

Question 36

Iron interactions with parkinsons drugs (3)

Answer 36

entacapone is predicted to decrease absorption of oral iron. separate administration by at least 2 hrs

levodopa, carbidopa decreases absorption of oral levodopa. separate administration

Question 37

iron interacts with this class of abx
hint - the class has a lot of MHRA alerts and should only be used if nothing else can be used

Answer 37

quinolones
ciproflox, levoflox, moxiflox, ofloxacin.
oral iron decreases exposure to these oral abx, separate adminstration by at least 2 hours

Question 38

interaction with Ibandronate

Answer 38

oral Iron is predicted to decrease the absorption of oral Ibandronate. Manufacturer advises Ibandronate should be taken 1 hour before or 6 hours after iron.

Question 39

interaction with Levothyroxine

Answer 39

oral Iron decreases the absorption of oral Levothyroxine. Manufacturer advises separate administration by at least 4 hours.

Question 40

interaction with Risedronate

Answer 40

oral Iron decreases the absorption of oral Risedronate. Manufacturer advises separate administration by at least 2 hours.

Question 41

interaction with zinc

Answer 41

oral Zinc is predicted to decrease the efficacy of oral Iron and oral Iron is predicted to decrease the efficacy of oral Zinc. Manufacturer makes no recommendation.