Lippincott Chapter No 33: Drugs For Anemiq

Question 1

33.1 All of the following are classifications of dietary
deficiencies causing nutritional anemia except:
A. Vitamin B12 (cyanocobalamin).
B. Folic acid.
C. Vitamin D.
D. Iron.

Answer 1

Correct answer = C. Vitamin D deficiency does exist, but
this does not cause anemia in patients. Vitamin B12, folic
acid, and iron deficiencies all contribute to anemia.

Question 2

33.2 Which of the following iron supplements contains the
highest percentage of elemental iron?
A. Ferrous sulfate.
B. Carbonyl iron.
C. Ferrous gluconate.
D. Ferric ammonium citrate.

Answer 2

Correct answer = B. Ferrous sulfate contains 20% (or 30%
in the anhydrous formulation), ferrous gluconate contains
12% elemental iron, and ferric ammonium citrate contains
18% elemental iron. These are all well below the percent
of elemental iron in carbonyl iron, which contains 100%
elemental iron.

Question 3

33.3 A 56-year-old female is discovered to have megaloblastic
anemia. Her past medical history is significant for
alcoholism. Which of the following would be the best
treatment option for this patient?
A. Oral vitamin B12.
B. Parenteral vitamin B12.
C. Oral folate.
D. Oral vitamin B12 with oral folate.

Answer 3

Correct answer = D. The patient has a history of alcoholism,
which would suggest folic acid deficiency anemia. However,
folic acid administration alone reverses the hematologic
abnormality and masks possible vitamin B12 deficiency,
which can then proceed to severe neurologic dysfunction
and disease. The cause of megaloblastic anemia needs to
be determined in order to be specific in terms of treatment.
Therefore, megaloblastic anemia should not be treated with
folic acid alone but, rather, with a combination of folate and
vitamin B12.

Question 4

33.4 A 60-year-old female presents to her primary care
physician complaining of dizziness and fatigue. Following
laboratory testing, the patient is diagnosed with iron
deficiency anemia, and oral iron supplementation
is needed. Which of the following would be the most
appropriate dosing regimen for the patient?
A. Ferrous fumarate 325 mg once daily.
B. Ferrous gluconate 256 mg once daily.
C. Polysaccharide–iron complex 150 mg two to three
times daily.
D. Ferrous sulfate 325 mg two to three times daily.

Answer 4

Correct answer = D. The recommended dose of iron sup-
plementation in iron deficiency anemia is typically about
150 mg of elemental iron in two to three divided doses.
Extended-release formulations (such as polysaccharide–
iron complex) may be dosed once daily. Ferrous sulfate
325 mg contains approximately 65 mg of elemental iron,
ferrous fumarate 325 mg contains about 107 mg elemen-
tal iron, ferrous gluconate 256 mg contains approximately
30 mg elemental iron, and polysaccharide–iron complex
150 mg contains 150 mg elemental iron.

Question 5

33.5 A 63-year-old female patient with anemia secondary
to chronic kidney disease and a hemoglobin level of
8.6 g/dL is treated with epoetin alfa. Eight days after
the initial dose of epoetin alfa, the patient’s hemoglobin
is 11.3 mg/dL. Why is it appropriate to discontinue
treatment with epoetin alfa?
A. Treatment goals of hemoglobin greater than
12 g/dL and a rise in hemoglobin of greater than
1 g/dL in a 2-week period are associated with
cardiovascular events and decreased survival.
B. The patient has not responded to the epoetin alfa
and therefore requires treatment with a different
agent for her anemia.
C. Epoetin alfa is less effective than darbepoetin alfa,
and treatment with epoetin alfa should be transitioned
to darbepoetin to receive maximum benefit.
D. Epoetin alfa is not indicated for treatment of anemia
secondary to chronic kidney disease.

Answer 5

Correct answer = A. Answer B is incorrect because the
patient has responded to the epoetin alfa, as the patient’s
hemoglobin has increased following its administration.
Answer C is incorrect because there is no clear evidence
to claim that either agent is more effective than the other in
treatment of anemia. Answer D is incorrect because epoetin
alfa is indicated for the treatment of anemia secondary to
chronic kidney disease.

Question 6

33.6 Which of the following might be beneficial to reduce the
frequency of painful crises in a patient with sickle cell
disease?
A. Epoetin alfa.
B. Filgrastim.
C. Hydroxyurea.
D. Sargramostim.

Answer 6

Correct answer = C. Clinical evidence supports the use of
hydroxyurea for reducing the frequency and severity of pain-
ful sickle cell crises during the course of sickle cell disease.
Epoetin alfa helps increase hemoglobin and red blood cell
production in anemias secondary to chronic kidney disease,
HIV, bone marrow disorders, and other disorders. Filgrastim
and sargramostim stimulate granulocyte production in the
marrow to increase the neutrophil counts and reduce the
duration of severe neutropenia