Kruse - Anemia Drugs Flashcards
Symptoms of anemia
Pallor, fatigue, dizziness, exertional dyspnea, tachycardia, increased blood volume, vasodilation
Iron deficiency = ____ anemia
Microcytic, hypochromic
Iron must be in the ___ state to be absorbed
Ferrous (2+)
Oral iron is administered in what form? Why?
Drug names?
Ferrous (2+) salts - for easiest absorption
Ferrous sulfate, Ferrous gluconate, Ferrous fumarate
Adverse effects of oral iron
GI - nausea, epigastric pain, cramps, constipation, black stools, diarrhea
Who receives parenteral iron?
- Iron deficiency who can’t tolerate or absorb oral iron
- Extensive chronic anemia who need more than oral (advanced renal disease w/ hemodialysis and EPO treatment, small bowel resection, IBD of small bowel, or malabsorption)
How to avoid iron toxicity since it’s infused as ferric form?
Colloid containing core of iron oxyhydroxide around carbohydrates, thus released slowly after infusion
Ways to administer iron dextran?
- Deep IM injection
- IV infusion
Adverse effects of iron dextran
Headache, light-headed, fever, arthralgias, N/V, back pain, flushing, urticaria, bronchospasm, anaphylaxis
What should always be done first when giving iron dextran?
Give a small test dose, to rule out hypersensitivity
3 forms of parenteral iron
- Iron dextran
- Sodium ferric gluconate
- Iron-sucrose
Why would you give sodium ferric gluconate or iron-sucrose complexes, instead of iron dextran?
Less chance of hypersensitivity
Small child w/ vomiting, abdominal pain, bloody diarrhea, followed by shock and lethargy. Improves for a bit, then declines. Most likely?
Acute iron toxicity (accidental tablet ingestion OD)
How to treat acute iron toxicity?
Deferoxamine + whole bowel irrigation
Who is most likely to have chronic iron toxicity?
Hemochromatosis (excessive absorption), or those who receive many RBC transfusions over time
How to remove iron deposits from liver in chronic toxicity?
Deferasirox
Treatment of chronic iron toxicity
Intermittent phlebotomy + Deferasirox (liver)
B12 deficiency = ____ anemia
Megaloblastic, macrocytic
Most common causes of B12 deficiency
- Lack of intrinsic factor
- Deficient uptake mechanism in distal ileum
- Strict vegetarian (many years later)
B12 deficiency causes the accumulation of what 3 things?
N5-methyl-THF
Homocysteine
Methylmalonic acid
B12 deficiency causes the depletion of what important chemical?
THF
Characteristic findings of B12 or folic acid deficiency
Megaloblastic, macrocytic anemia w/ leukopenia or thrombocytopenia, and hypercellular BM w/ megaloblastic erythroid precursors
Most common symptoms of B12 deficiency
Paresthesias, weakness, spasticity, ataxia
Almost all cases of B12 deficiency are due to a lack of ___, thus all B12 must be administered via ____
Absorption; parenteral injections
Folic acid deficiency causes
- Alcoholics w/ poor diet and less hepatic storage
- Pregnant women w/ increased need
- Hemolytic anemics w/ increased need
- Malabsorption syndromes
- Renal dialysis
Drugs causing folic acid deficiency
- MTX
- TMP
- Pyrimethamine
- Phenytoin
What does folic acid deficiency NOT have, compared to B12 deficiency?
Neural symptoms
Epoetin alpha vs. Darbepoetin alpha
Darb = more glycosylated, thus much longer half life (less frequent dosing)
What to look for following EPO administration?
Risk in reticulocyte count, then rise in Hct and Hgb
Diseases requiring EPO administration?
- Chronic kidney disease (low endogenous EPO)
- BM disease (aplastic anemia, MPD, MDS, MM, AIDS, myelosuppressive chemo)
EPO is almost always coupled w/ administration of ___ in CKD?
Iron, and sometimes folate
Adverse effects of EPO
- HTN
- Thrombotic complications
Filgrastim…what is it?
Recombinant human G-CSF
How to give G-CSF less frequently than Filgrastim?
Pegfilgrastim (polyethylene glycol = longer 1/2 life)
Sargramostim…what is it?
Recombinant human GM-CSF
Plerixafor…what is it?
MoA
Mobilizer of hematopoietic stem cells and progenitor cells from BM into peripheral blood
Inhibits SDF-1-alpha (BM stromal cells) from binding CXCR4 (blood cells)
When and how is Plerixafor used?
When G-CSF alone does not work well
Used w/ Filgrastim
G-CSF does what? (2)
Stimulates proliferation of NEUTROPHILS, and increases hematopoietic stem cells in peripheral blood for transplantation
GM-CSF does what?
Stimulates proliferation of granulocytes, erythrocytes, and megakaryocytes
When is G-CSF (Filgrastim) used?
Chemo-induced neutropenia, other causes of neutropenia, myelodysplasia, and aplastic anemia, autologous stem cell transplantation
Side effect of Filgrastim
Bone pain
Side effects of Sargramostim
Fever, malaise, arthralgias, myalgias, peripheral edema, effusions
Oprelvekin…what is it?
Recombinant IL-11 (megakaryocyte growth factor)
Romiplostim…what is it?
MoA
Recombinant TPO
Activate Mpl TPO receptor
Oprelvekin causes increased _____
Platelets and neutrophils
After giving Romiplostim, when can the effects be seen?
5 days after administration
Use of Oprelvekin
Thrombocytopenia in non-myeloid cancer chemo
Use of Romiplostim
Thrombocytopenia in chronic ITP that hasn’t responded to corticosteroids, Ig, or splenectomy
IL-11 toxicities
Fatigue, headache, dizzy, anemia, dyspnea, transient atrial arrhythmias
Romiplostim toxicities
Mild headache when administered
