Medications for Anemia Treatment Flashcards
When should iron supplementation be employed?
TSAT < 30%
Serum ferritin <500 ng/mL
When can oral iron be used?
Oral iron will not be sufficient in patients undergoing hemodialysis
-Can be used for CKD patients or peritoneal dialysis patients
What are examples of oral iron medications?
Ferrous salts (sulfate, gluconate, fumerate)
What dosing is used for oral iron?
200mg of elemental iron per day at least
What are some considerations when using oral iron as a treatment?
-Best absorbed in an acidic environment!
-Can be taken with orange juice (unless patient is taking a megavitamin with Vitamin C)
-Is not enteric coated a this would prevent absorption in the acidic stomach
-Should not be used in patients who take medications that affect the acidity of the stomach (H2 blockers, PPI)
-Separate from calcium by 2 hours!
-Can cause upset stomach
Why do we switch to oral iron in ESKD?
Hepcidin blocks FPN in the liver which prevents patients from being able to absorb the iron into their bloodstream
**Dialysis is not the reason why we switch, even though the switch often occurs when a patient goes on dialysis
What are the 5 IV iron agents?
1) Iron dextran (InFed, Dexferrum)
2) Sodium ferric gluconate (Ferrlicit)
3) Iron sucrose (Venofer)
4) Ferric carboxymaltose (Injectafer)
5) Ferumoxytol (Feraheme)
What are some considerations when using IV Iron dextran (InFed, Dexferrum)?
-CHEAP
-Needs test dose (25 mg)
What are some considerations when using Iron sucrose (Venofer)?
Has a second indication for non-dialysis chronic kidney disease patients
What are some considerations when using Ferumoxytol (Feraheme)?
Supaparamagnetic compound
*Not a good choice if patient is going to have MRI’s!
What is Triferic (ferric pyrophosphate citrate)?
An iron compound added to dialysate
When should Erythropoiesis Stimulating Agents (ESAs) be used to treat anemia?
After all other correctable causes of anemia have been addressed
*To raise Hb
*Used to prevent a blood transfusion
At what lab values should ESAs be started?
CKD 3-5: Hb< 10g/dL, Hb falling at rapid rate
CKD 5: Hb between 9 and 10 g/dL
What warning is associated with ESA use and how long you should use it?
Do not use ESA to push Hb above 11.5 g/dL
*increased risk of cardiovascular events
What are the 3 kinds of Erythropoiesis Stimulating Agents (ESAs)?
1) Recombinant human erythropoietin (rHuEPO, epoetin alfa, Epogen, Procrit EPO)
2) Darbepoetin alfa (Aranesp)
3) Methoxy polyethylene glycol-epoetin beta (Mircera)
Which ESA has the longest half-life?
Methoxy polyethylene glycol-epoetin beta (Mircera)
What is the main adverse effect that can occur when taking ESAs?
23% of patients will develop high blood pressure
*But if we do not give them this medication they will likely die, so we just have to monitor patients closely
What is a major cause of ESA therapy failure?
Lack of vitamins or IRON
Can ESAs be used in combination with iron supplements?
Yes, PSA is often used with iron because when more red blood cells are being generated, the need for iron increases
When should Hypoxia Inducible Factor (HIF) Prolyl Hydroxylase Inhibitors (PHI) (HIF-PHIs) be used?
For the treatment of anemia due to chronic kidney disease in patients who have been on dialysis for at least 4 months
What is the name of the singular HIF-PHI drug?
Daprodustat (Jesduvroq)
What is the role of hypoxia-inducible factor in anemia?
Promotes gene transcription of erythropoietin (EPO)that is necessary for the maturation of red blood cells
What are the considerations associated with Daprodustat (Jesduvroq) use?
-Discontinue use if the hemoglobin (Hb) >12 g/dL
-Decrease dose by 1/2 if patient has any hepatic impairment
-Do not give with strong CYP2C8 inhibitors
Which of the following IV products requires a test dose the first time it is administered?
A. iron sucrose
B. iron dextran
C. sodium ferric gluconate
D. ferrous sulfate
B. iron dextran
