Linger Anemia CIS Flashcards
Iron drugs
Oral preparations:
Ferrous sulfate
Ferrous gluconate
Ferrous fumarate
Parenteral preparations:
Iron dextran
Iron-sucrose complex
Sodium ferric gluconate complex
Iron Chelators
Deferoxamine
Deferasirox
Vitamin B12 Preparations
Cyanocobalamin
Hydroxocobalamin
Erythrocyte-stimulating agents (ESAs)
Epoetin alfa (Epogen, Procrit) Darbepoetin alfa
Myeloid growth factors
Granulocyte colony-stimulating factor (G-CSF):
Filgrastim (Neupogen)
Pegfilgrastim
Granulocyte-macrophage colony-stimulating factor: (GM-CSF)
Sargramostim
Megakaryocyte growth factors
Oprelvekin, Interleukin-11
Romiplostim
what is Oprelvekin used for?
to treat patients with prior thrombocytopenia following chemotherapy
what do granulocyte factors stimulate?
production and function of neutrophils
GM-CSF also stimulates other myeloid & megakaryocyte precursors
G-CSF and, to a lesser degree, GM-CSF mobilize PBMCs for autologous stem cell transplantation
Which of the listed agents may be appropriately given for low iron PO?
Ferric gluconate Ferrous sulfate Iron dextran Iron-sucrose complex Sodium ferric gluconate complex
Ferrous sulfate
ferrous, Fe2+, better absorbed. Ferric can only be given IM or IV
What should you tell the patient about the prescribed ferrous sulfate?
Patient information:
Childproof container
Take on empty stomach
Gastric side effects (e.g., nausea, constipation, abdominal cramps, dark stools)
Separate iron supplement and tetracycline/proton pump inhibitor
Iron and tetracycline absorption are decreased when administered concomitantly
Increased stomach pH decreases ferrous salt solubility
When would parenteral iron therapy be indicated for this patient?
Continuing blood loss less than the rate of RBC production
Dark stools
Malabsorption
Patient’s refusal to give up dairy products
Malabsorption
dark stools- expected side effect
Other indications for parenteral therapy: Intolerance to oral therapy Advanced chronic renal disease Small bowel resection Inflammatory bowel disease Gastrectomy
what agent can we give for iron overdose?
Acetylcysteine Activated charcoal Deferoxamine Flumazenil Pralidoxime
Deferoxamine- iron chelator
acetylcysteine is for tylenol overdose
activated charcoal- for several things but not iron
flumazenil- for benzodiazepines
pralidoxime- Ach regenerator
Iron Poisoning:
1- GI, .5-6 hrs
Abdominal pain, vomiting, diarrhea, hematemesis, melena, lethargy, shock, metabolic acidosis
2- Latent 6-24 hours
Improvement in GI symptoms; may have poor perfusion, tachypnea, tachycardia
3- Shock and Metabolic acidosis 4 hrs- 4 days
Hypovolemic, distributive, or cardiogenic shock with profound metabolic acidosis, coagulopathy, renal insufficiency/failure, pulmonary dysfunction/failure, CNS dysfunction
4- Hepatotoxicity- within 2 days
Coma, coagulopathy, jaundice. Severity is dose dependent
- Bowel obstruction- 2-4 weeks
Vomiting, dehydration, abdominal pain, usually gastric outlet obstruction
Anemia of chronic disease
mild to moderate anemia associated with a number of disorders including:
Rheumatoid arthritis Systemic lupus erythematosus Chronic infections Chronic renal failure AIDS Neoplastic disease/myelosuppressive chemotherapy
Malignancy-Related Anemia
50-60% of patients with non-Hodgkin lymphoma, multiple myeloma, or treatment for ovarian and lung cancer develop anemia that requires blood transfusions
Anemia associated with chemotherapy predominantly occurs following treatment with agents that inhibit DNA synthesis
- Antimetabolites – folic acid analogs, hydroxyurea, purine antagonists, pyrimidine antagonists
- Alkylating agents – nitrogen mustards, nitrosoureas, platinum compounds
- Many others
Which agent will stimulate an increase in the production of reticulocytes?
Cyanocobalamin Epoetin alpha Filgrastim Oprelvekin Pegfilgrastim
Epoetin alpha
Common anemia management options in anemia of chronic disease brought on by chemotherapy
Delay the course of chemotherapy
Red blood cell transfusion allowing increased chemotherapy tolerance
Treatment with erythropoiesis stimulating agents (ESAs)
Erythropoiesis Stimulating Agents (ESAs)
Epoetin alpha and darbepoetin alpha are the most common
Reticulocytes peak after 10 days; Hct and Hgb rise within 2-6 weeks
Decreases the need for blood transfusions
Most common cause of nonresponse is iron deficiency
Black Box warnings for ESAs
Reduced overall survival and/or increased risk of progression or recurrence in anemic patients with breast, cervical, head and neck, lymphoid, and non-small cell lung cancer
Not recommended for anemic cancer patients receiving myelosuppressive chemotherapy when the expected outcome is curative (controversial)
Studies show an increased risk of death and serious CV events (e.g., MI, stroke) when ESAs were used to achieve higher target Hgb compared with lower Hgb levels
Other risks include hypertension and thrombosis
Several causes of macrocytic anemias:
Anemia associated with B12 deficiency
Anemia associated with folic acid deficiency
Anemia caused by metabolic or inherited defects associated with decreased ability to utilize vitamin B12 or folic acid
treatment of various causes of macrocytic anemias
Low vitamin B12 – vitamin B12 supplementation
Cyanocobalamin and hydroxocobalamin
Low folic acid – folic acid supplementation
No effect on the neurological symptoms associated with megaloblastic anemias
Determine whether malabsorption is an issue (PO vs. IM/IV)
