Module 8 Flashcards
Gastric acid will activate _____ which is a proteolytic enzyme.
Answer: pepsin
True or false, drugs (except antibiotics) do NOT alter the disease process for peptic ulcer disease?
True
What PUD drugs work to enhance mucosal defenses (choose all that apply)?
a) bismuth
b) sucralfate
c) antacids
d) misoprostol
Answer: b)sucralfate & d)misoprostol
Misoprostol also works to reduce gastric acidity
Which is not a risk factor for PUD?
a) age 60+
b) low-dose NSAIDs
c) alcohol
d) history of ulcers
Answer: b & c
Risks include: age 60+, history of ulcers, HIGH dose NSAIDs
What are the preferred prophylactic treatments for PUD (choose all that apply)?
a) H2 blockers
b) PPI
c) antacids
d) sucralfate
e) misoprostol
Answer: b)PPI & e)misoprostol
Note: PPIs are preferred over misoprostol
Misoprostol is effective but causes diarrhea
Antacids, sucralfate, H2 blockers are NOT recommended
What is the best treatment for ulcers caused by NSAIDS (choose all that apply)?
a) H2 blockers
b) PPI
c) antacids
d) sucralfate
e) misoprostol
Answer: a)H2 blockers & b) PPI
Also removing the offending NSAID if possible.
True or false, asymptomatic patients with H. Pylori should be treated with antibiotics.
False. Only symptomatic patients.
What are the “acronyms” for the first line PUD treatments?
CAMP & BMTP
Camp= clarithromycin, amoxicillin, metronidazole, and PPI
BTMP= Bismuth, tetracycline, metronidazole, PPI
The treatment of PUD involves at least ____ antibiotics and preferably _____.
The treatment of PUD involves at least 2 antibiotics and preferably 3. Note: standard treatment is QUADRUPLE therapy (CAMP, BTMP) for 14 days.
Can an H2 blocker be used in quadruple therapy for PUD?
Yes. PPIs & H2 are used in conjunction with 3 antibiotics typically.
What is the MOA of bismuth?
a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate
Answer: b) disrupts cell wall of H. pylori
It also may inhibit urease activity & prevent H.pylori from attaching to gastric surface
Side effects of Bismuth include (choose all that apply)?
a) pneumonia
b) neurologic injury
c) constipation
d) P450 inhibitor
e) black color of tongue & stool
Answer: b) neurologic injury (long term use) & e) harmless black color on tongue and stool
What is the MOA of H2 blockers?
a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate
Answer: a) reduces volume of gastric juice and hydrogen ion concentration
It also suppresses secretion of gastric acid which promotes ulcer healing. It inhibits the H+/K+/ATPase pump
H2 blockers have what suffix?
“-tidine”
Cimetidine, famotidine, nizatidine
PPIs have what suffix?
“-prazole”
Which is not a side effect of Famotidine (choose all that apply)?
a) fractures
b) pneumonia
c) P450 inhibitor
d) C. diff
e) antiandrogenic effects
Answer: a)fractures & d)C. diff
Fractures & C. diff are associated with PPIs
What is a side effect of Cimetidine?
a) fractures
b) rebound acid hypersecretion
c) prolonged QT
d) hallucinations
Answer: d)hallucinations
Cimetidine is an H2 blocker
Which is not an indicated use for H2 blockers (choose all that apply)?
a) gastric/duodenal ulcers
b) GERD
c) inflammatory bowel disorder
d) ICU patients to prevent stress ulcers
Answer: c & d
H2 blockers are used for gastric/duodenal ulcers; GERD; and Zollinger-Ellison
ICU patients are given PPIs to prevent ulcers
What medication can decrease the absorption of H2 blockers?
a) PPIs
b) warfarin
c) cimetidine
d) antacids
e) tetracycline
Answer: d) antacids
These should be taken 1 hour apart.
What is the MOA for PPIs?
a) reduces volume of gastric juice & H+ ions
b) disrupts cell wall of H. Pylori
c) blocks final common pathway of acid production
d) promotes secretion of bicarbonate
Answer: c) blocks final common pathway of gastric acid production
It also inhibits basal and stimulated acid release
True or false, the effects of PPIs last long after they are discontinued.
True. They bind irreversibly to enzymes so they have long-lasting effects even when the drug is “gone.”
Which is a side effect of PPIs (choose all that apply)?
a) C. diff
b) antiadrogenic effects
c) P450 inhibitor
d) rebound acid hypersecretion
e) hallucinations
Answer: a & d
PPIs can cause: pneumonia, fractures, rebound acid hypersecretion, hypomagnesemia, C. diff.
They can reduce absorption of HIV meds, ketoconazole, & itraconazole
Treatment with PPI should last _______.
4-8 weeks ideally but NO MORE than 5 years.
Side effects of PPI include (choose all):
a) low calcium
b) high magnesium
c) low B12
d) C. diff
Answer: a,c,d
PPI can cause low calcium, low magnesium, low B12, and C. diff
Sucralfate side effects include:
a) low magnesium
b) C. diff
c) hallucinations
d) constipation
Answer: d) constipation
A patient taking sucralfate may have decreased absorption of what other medication in their regimen (choose all that apply):
a) PPIs
b) tetracycline
c) quinolones
d) theophylline
Answer: c) quinolones & d)theophylline
Sucralfate decreases the absorption of these drugs, as well as phenytoin, digoxin, and warfarin so these medications should be given 2 HOURS APART from sucralfate.
Uses for Misoprostol include (choose all that apply):
a) GERD
b) Inflammatory bowel disease
c) Prevention of gastric ulcers in patients taking NSAIDs long term
d) abortions
Answer: c&d
Misoprostol is used to prevent gastric ulcers from long-term NSAID use and can also cause abortion of pregnancy
What is the MOA of Misoprostol?
a) suppresses secretion of gastric acid
b) decreases submucosal blood flow
c) disrupts the cell wall for H.Pylori
d) reduces volume of gastric juice secreted
Answer: a) suppresses secretion of gastric acid
It is also protective of the GI by stimulating the secretion of bicarbonate & mucus. It also maintains submucosal blood flow by vasodilation.
What is a side effect of misoprostol?
a) constipation
b) impaired drug absorption
c) diarrhea
d) rebound acid hypersecretion
Answer: c) diarrhea
Aluminum hydroxide causes ________ (diarrhea/constipation) whereas magnesium hydroxide can cause _______ (diarrhea/constipation).
Answer: aluminum hydroxide=constipation; magnesium hydroxide=diarrhea
True or false, antacids have the same rate of healing for PUD as H2 blockers.
True.
If gastric pH is above ______ (#) then pepsin activity will be decreased.
Answer: 5
What is the MOA of antacids:
a) stimulates production of prostaglandins
b) suppresses secretion of gastric acid
c) prevents final step in gastric acid secretion pathway
d) creates a barrier along the GI mucosa
Answer: a) stimulates production of prostaglandins (which are GI protective–think about misoprostol which is a “synthetic” prostaglandin)
It also neutralizes acid
Antacids can interact with many medications,but the ones emphasized by the weekly chat for pharmacology were:
a) tetracyclines
b) cimetidine
c) warfarin
d) sucralfate
Answer: b)cimetidine & d)sucralfate
Avoid by giving a 1 hour gap between these meds and the antacid
Which is not a trigger for GERD (choose all that apply)?
a) anticholinergic medications
b) alcohol
c) nitrates
d) chemotherapy
e) smooth muscle relaxants
Answer: d) chemotherapy
All of the other choices are triggers for GERD. Other triggers include spicy foods, caffeine, & tobacco.
What is the first line treatment for GERD?
a) avoid meals 2-3 hours before bed
b) antacids
c) PPI
d) H2 blockers
Answer: a) avoid meals 2-3 hours before bed
Other nonpharmacologic first line options are: elevate HOB; avoid medications which relax the LES (anticholinergic drugs, estrogens, CCB); and lose weight.
Phase 1 treatment for GERD (attempts to lose weight, avoiding meals before bedtime, etc were unsuccessful) [choose all that apply]:
a) lifestyle changes/diet changes
b) antacids
c) PPI
d) H2 blockers
Answer: a&b
Phase 1 for GERD: lifestyle changes/diet and antacids
Phase 2 treatment for GERD (lifestyle changes and diet modifications inadequate):
a) antacids
b) PPI
c) H2 blockers
Answer: c) H2 blockers
Even though PPI are more effective, there are more risks, so H2 is used before going to a PPI (if needed).
Phase 3 would be a PPI.
What are the two options for patients at phase 3 of GERD treatment (PPIs) if unsuccessful?
a) increase PPI to BID
b) add H2 to the PPI regimen
c) increase PPI to TID for meal coverage
d) refer out
Answer: a) increase PPI to BID & d) refer out
Can try either one.
Metoclopramide is used to treat:
a) constipation
b) GERD
c) PUD
d) emesis
e) inflammatory bowel disease
f) hyperemesis gravidarum
Answer: b) GERD d) emesis f)hyperemesis gravidarum
It blocks dopamine and works in treating GERD (2nd line agent) and in treating emesis.
Also a 2nd line agent in treating hyperemesis gravidarum after 10 weeks due to increased risk of cleft lip.
Side effects of Metoclopramide include (choose all):
a) tardive dyskinesia
b) P450 induction
c) blood dyscrasias
d) constipation
Answer: a) tardive dyskinesia & c) blood dyscrasias
Blood dyscrasias (and anemia) can occur with H2/PPI use.
Cleft lip can occur if given before 10 weeks gestation (2nd line treatment for hyperemesis gravidarum).
What is a side effect of Ondansetron (Serotonin receptor antagonist)?
a) constipation
b) QT prolongation
c) bradycardia
d) electrolyte imbalances
Answer: b) QT prolongation
Other SE: headache, diarrhea, dizziness
What is not a side effect of Ondansetron?
a) headache
b) diarrhea
c) dizziness
d) anticholinergic effects
Answer: d) anticholinergic effects
True or false, Ondansetron is less effective when combined with dexamethasone.
False. It is more effective.
What is the MOA for Ondansetron?
a) blocks neurokinin-1 receptors in CTZ
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks serotonin receptors in CTZ
Answer: d) blocks serotonin receptors in the CTZ
Hence, it is a serotonin receptor antagonist.
True or false, glucocorticoids (end “one”) when used for short term relief of nausea and vomiting carry the risk of adrenal suppression.
False, with short-term use there are no serious side effects like those you would see with long term use of glucocorticoids (adrenal suppression).
What is the MOA for glucocorticoids in relieving nausea and vomiting?
a) unknown MOA
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks serotonin receptors in CTZ
Answer: a) MOA unknown
Substance P/Neurokinin-1 antagonists have what suffix?
a) one
b) setron
c) azine
d) pitant
Answer: d) pitant
Drugs include: Aprepitant, Rolapitant, Netupitant, and Fosaprepitant
What statement is not true regarding Aprepitant?
a) it must be combined with other antiemetic drugs
b) it can prevent delayed CINV and acute CINV
c) it works by blocking dopamine 2 receptors in the CTZ
d) it is a substrate/inhibitor/inducer of P450
Answer: c) it works by blocking dopamine 2 receptors in the CTZ
The MOA for Aprepitant is by blocking neurokinin-1 type receptors in the CTZ
Which drugs used for nausea/vomiting have similar side effect profiles?
a) metoclopramide & lorazepam
b) ondansetron & droperidol
c) aprepitant & dexamethasone
d) promethazine & droperidol
Answer: d) promethazine (a phenothiazine) and droperidol (a butyrophenone)
Both have EPS, sedation, and hypotension as possible side effects.
They both block dopamine-2 receptors in the CTZ
Which is not a benefit of lorazepam?
a) production of anterograde amnesia
b) suppression of anticipatory emesis
c) help reduce EPS symptoms seen with phenothiazine antiemetics
d) can be provided as monotherapy for the reduction of CINV and surgical emesis/nausea
Answer: d) can be provided as monotherapy
Lorazepam should be given in combination to suppress CINV rather than as monotherapy.
What is a side effect associated with promethazine (Phenergan)?
a) anticholinergic effects
b) prolonged QT
c) blurred vision
d) increased levels of warfarin
Answer: a) anticholinergic effects
What is a side effect of Butyrophenones (Haloperidol)?
a) anticholinergic effects
b) prolonged QT
c) blurred vision
d) increased levels of warfarin
Answer: b) prolonged QT
Dronabinol & Nabilone are what type of drugs used for nausea/vomiting?
Cannabinoids
Used in CINV as 2nd line agents due to abuse potential.
What medication would be appropriate for chemotherapy which has a low risk of nausea/vomiting?
a) aprepitant
b) ondansetron
c) dexamethasone
d) lorazepam
Answer: c) dexamethasone
What medication(s) would be appropriate for a chemotherapy drug known to have a moderate/high risk of inducing nausea and vomiting (choose all that apply)?
a) aprepitant
b) lorazepam
c) ondansetron
d) dexamethasone
Answer: a, c, & d
A combination works best of aprepitant+dexamethasone+ondansetron
Note: lorazepam can be added to decrease anticipatory emesis/provide amnesia
What is considered first-line treatment for hyperemesis gravidarum?
a) ondansetron
b) doxylamine
c) metoclopramide
d) prochlorperazine
Answer: b) doxylamine+B6 (Dicletin & Diclegis)
If first line agents fail, then alteratives include: ondansetron, metoclopramide (after 10 weeks gestation), & prochlorperazine
What are side effects of Scopolamine?
a) diarrhea
b) QT prolongation
c) dry mouth
d) EPS
Answer: c) dry mouth
These are muscarinic antagonist (anticholinergic drugs) so they dry everything up. Can’t see, can’t pee, can’t spit, can’t shit.
What is the MOA for antihistamines in preventing motion sickness?
a) blocks neurokinin-1 receptors in CTZ
b) blocks H-1 receptors of neuronal pathway between inner ear and vomiting center of CNS
c) blocks dopamine 2 receptors in CTZ
d) blocks histamine-1 and muscarinic receptors
Answer: d) blocks histamine-1 and muscarinic receptors in neuronal pathway connecting the inner ear to the vomiting center
Which is not an antihistamine indicated for motion sickness prevention?
a) Cyclizine
b) Meclizine
c) Dimenhydrinate
Answer: THEY ARE ALL USED FOR MOTION SICKNESS
Side effects of antihistamines (Dimenhydrinate) used for motion sickness include?
a) diarrhea
b) constipation
c) EPS
d) bradycardia
Answer: b) constipation
They cause anticholinergic side effects (can’t see, can’t pee, can’t spit, can’t shit)
Specific antidiarrheal drugs treat _____ (underlying cause of diarrhea/general targeting of the bowel) whereas nonspecific antidiarrheal drugs treat _____(underlying cause of diarrhea/general targeting of the bowel).
Answer: specific antidiarrheals target the underlying cause of diarrhea whereas nonspecific antidiarrheals act on the bowel directly to provide symptomatic relief BUT THEY DO NOT influence underlying cause.
What drug is included in the formulation with Lotomil to decrease the abuse potential?
a) narcan
b) methylphenidate
c) atropine
d) epinephrine
Answer: c) atropine
What bacteria/virus indicates a need for antibiotic treatment of diarrhea (choose all that apply)?
a) E. coli
b) Campylobacter
c) Shigella
d) Rotavirus
Answer: b &c
Bacteria which indicate the use for antibiotics include: salmonella, shigella, campylobacter, and clostridium species
True or false, mild diarrhea rarely requires medication.
True. These are usually self-limited and do not need medications.
Diarrhea caused by E. coli should be treated with:
a) supportive therapy (fluids, rest)
b) Loperamide
c) Quinolone
d) Rifamixin
Answer: a) supportive therapy
Usually E. Coli diarrhea is self-limited and will run its’ course in a few days.
A 35 year old man has severe symptoms of diarrhea due to E. coli. What is an appropriate treatment (choose all that apply)?
a) Azithromycin
b) Loperamide
c) Quinolone
d) Rifamixin
Answer: c)quinolone OR d)rifamixin
Quinolones can be used to treat severe symptoms in nonpregnant women & adults. Rifamixin can also be used if patient is not pregnant, febrile, and if stools are not bloody.
A 5 year old is having severe symptoms of diarrhea due to E. coli. What is an appropriate treatment?
a) Azithromycin
b) Loperamide
c) Quinolone
d) Rifamixin
Answer: a) azithromycin
Children and pregnant women can be treated with azithromycin for severe E. coli associated diarrhea.
To prevent travelers’ diarrhea, what are prophylactic options (choose all that apply)?
a) azithromycin
b) loperamide
c) Dukoral
d) Bismuth
e) quinolones
Answer: c,d,e
Prophylactic options include vaccination with Dukoral (E. coli & Vibrio protection); and quinolone or Bismuth preparations taken orally as a preventative measure.
IBS involves symptoms present for at least ____ weeks in the past year which cannot be explained by structural or chemical abnormalities and has 2/3 of the following symptoms (pain with pooping, onset associated with change in frequency of stool, onset of pain associated with change in consistency).
Answer: at least 12 weeks in the last year
Which drug classes are not beneficial when treating IBS?
a) bulk-forming agents (Psyllium)
b) antispasmodics (Hyoscyamine/Dicyclomine)
c) antidiarrheals (Loperamide)
d) TCA
e) antihistamines
Answer: e) antihistamines
The other drug classes can be beneficial in managing IBS.
Other beneficial drugs include antibiotics and acid suppressants.
What drug requires a risk management program including the patient, provider, and pharmacist due to the risks associated with the medication?
a) Eluxadoline
b) Sulfasalazine
c) Infliximab
d) Alosetron
Answer: d) alosetron
This drug is used in women ONLY with severe IBS-D who have not responded to other treatment and have been suffering with the condition for at least 6 months.
Side effects of Alosetron include (choose all that apply):
a) constipation
b) infection
c) bowel perforation
d) agranulocytosis
e) fractures
f) death
Answer: a) constipation, c) bowel perforation, & f) death
The other side effect is ischemic colitis. This drug has a risk management program due to the severe GI toxicity and deaths.
Tegaserod is a drug used for short-term management of IBS-C in women under 55. What side effects does this medication have?
a) constipation
b) CV risks
c) osteoporosis
d) agranulocytosis
Answer: b) CV risks so it is only used in emergency situations
It cannot be used in women who have a history of CV events.
When prescribing Alosetron, the provider needs to remember that this drug:
a) can cause agranulocyctosis so regular CBCs should be obtained
b) will accumulate to toxic levels in renally impaired patients
c) is neurotoxic and early signs include EPS
d) is metabolized by P450
Answer: d) is metabolized by P450
This drug can have numerous implications on other drugs metabolized by P450 such as quinolones, cimetidine, clarithromycin, phenobarbitol, etc.
True or false, Alosetron can be used to treat IBS in both men and women.
False, it is only approved for use in women.
Which statement is not true regarding Lubiprostone?
a) it is used in IBS-C
b) women 18 and older can take
c) it carries the risk of bowel perforation
d) it can be used for chronic idiopathic constipation in men too
Answer c) it carries the risk for bowel perforation
In anemia, iron deficiency is caused by an issue with _______ (poor absorption/increased demand) whereas B12 is usually an issue with _______ (poor absorption/increased demand).
Answer:
Iron deficiency=usually due to increased demand
B12 deficiency=usually due to poor absorption
Crohn’s disease involves the _____ typically whereas ulcerative colitis involves the _____typically.
Crohn’s=transmural inflammation of terminal ileum (usually)
UC=inflammation of mucosa and submucosa of colon & rectum
Side effects of sulfasalazine (inflammatory bowel disease drug) include (choose all that apply):
a) nausea
b) rash
c) agranulocytosis
d) opportunistic infections
Answer: a,b,c
Sulfasalazine side effects include nausea, rash, fever, arthralgia, agranulocytosis, hemolytic anemia, and macrocytic anemia
What labs should be monitored in a patient taking sulfasalazine (inflammatory bowel disease drug)?
a) PT/INR
b) LFT
c) BMP
d) CBC
Answer: d) CBC
The drug can cause agranulocytosis, hemolytic anemia and macrocytic anemia
True or false, sulfasalazine is useful in severe attacks of ulcerative colitis.
False. It is most effective in mild/moderate UC
Is Sulfasalazine safe to take during pregnancy and while lactating?
Yes. It is used to manage symptoms of UC.
Budesonide is considered what class of drugs used for inflammatory bowel disease?
Glucocorticoid. Others include hydrocortisone and dexamethasone.
Uses for budesonide include:
a) mild- moderate ulcerative colitis (UC)
b) irritable bowel syndrome
c) mild-moderate crohn’s disease
d) PUD
Answer: c) mild-moderate Crohn’s disease
Side effects of budesonide include (choose all that apply):
a) adrenal suppression
b) increased risk of infection
c) bone marrow suppression
d) osteoporosis
Answer: a,b,d
Budesonide is a glucocorticoid used in inflammatory bowel disease. Side effects include osteoporosis, increased risk of infection, and prolonged use can lead to adrenal suppression/ Cushing syndrome.
Thus these drugs are not used for long-term maintenance.
Azathioprine & Mercaptopurine are used for what off label purpose (choose all that apply)?
a) ulcerative colitis
b) irritable bowel syndrome
c) crohn’s disease
d) PUD
Answer: a)ulcerative colitis and c)crohn’s disease
They can induce and maintain remission in both of these diseases. They work as immunosupressants.
Side effects of Mercaptopurine include:
a) neurotoxicity
b) hepatitis
c) Cushing syndrome
d) pancreatitis
e) bone marrow suppression
Answer: d)pancreatitis and e) bone marrow suppression
This drug is used as an immunosuppressant in inflammatory bowel disease. Other SE include neutropenia.
Cyclosporine used for inflammatory bowel disease carries what side effects (choose all that apply):
a) hepatotoxicity
b) renal impairment
c) neurotoxicity
d) pancreatitis
Answer: b&c
SE include renal impairment, neurotoxicity, generalized immunosuppression as these drugs are immunosuppressants.
A patient with acute/severe UC or CD which has not responded to glucocorticoids may be a candidate for what medication:
a) PPI
b) aminosalicylates
c) metoclopramide
d) cyclosporine
Answer: d) cyclosporine
It is an immunosuppressant which is STRONGER than azathioprine or mercaptopurine and acts FASTER.
IV therapy can induce remission and PO can maintain.
Infliximab used in inflammatory bowel disease carries what side effects:
a) opportunistic infections
b) infusion reactions
c) CV reactions
d) lymphoma
Answer: all of the above
It is a monoclonal antibody used to treat moderate-severe Crohn’s and UC
Drugs for inflammatory bowel disease which aren’t generally used for both conditions include:
Metronidazole & Cipro-used mainly for Crohn’s
Sulfasalazine-used mainly for UC
Budesonide-Crohn’s
left blank intentionally
A patient taking Infliximab should be monitored with what test frequently?
a) CXR
b) TB test
c) PT/INR
d) EKG
Answer: b) TB test
It is a monoclonal antibody used for managing inflammatory bowel disease which can facilitate the emergence of opportunistic infections such as TB.
Metoclopramide indications include:
a) GERD
b) PUD
c) hyperemesis gravidarum
d) CINV
e) diabetic gastroparesis
Answer: a,c,d,e
Uses include: GERD, CINV, diabetic gastroparesis, and managing hyperemesis gravidarum after 10 weeks gestation.
Deficiency of pancreatic enzymes can be caused by:
a) cystic fibrosis
b) pancreatitis
c) pancreatic duct obstruction
d) immunosuppressant drugs
e) bowel resection
Answer: a,b,c
Deficiencies can be caused by CF, pancreatitis, pancreatic duct obstruction and pancreatectomy
Replacement therapy of pancreatic enzymes includes:
Pancrelipase (Creon, Pancreaze, Pertzye, Viokace, Zenpep)
Treatment of choice for anal fissures is:
a) topical analgesics
b) nitroglycerin
c) corticosteroids
d) witch hazel
Answer: b) nitroglycerin ointment 0.4%
The MOA is by relaxing the internal anal sphincter and the ointment can also be used for hemorrhoids.
If RBC production is low, iron needs are _____; and if RBC production is high, iron needs are ______.
RBC production low=iron needs are low and vice versa
RBC production will determine the iron needs of the body.
True or false, iron deficiency anemia is caused by reduced uptake.
False, it is caused by increased demand.
Causes of iron deficiency can include (choose all that apply):
a) pregnancy
b) fetal growth
c) infancy and childhood blood volume expansion
d) sprue
e) chronic blood loss
Answer: all of the above
Sprue is a malabsorption syndrome that decreases folic acid uptake.
Another cause of iron deficiency due to poor absoprtion would include a gastrectomy.
Iron deficiency anemia has RBC which are _______ (macrocytic/microcytic); whereas B12 deficiency and folic acid deficiency can cause _______ (macrocytic/microcytic) anemia.
Answer: iron deficiency= microcytic
B12&folic acid deficient=macrocytic and sometimes megablastic (just means has 5+ lobes in nucleus)
Labs consistent with anemia include (choose all that apply):
a) low H&H
b) elevated Reticulocytes
c) low iron
d) low RBC
e) elevated serum iron binding capacity
Answer: a,c,d,e
Labs consistent with anemia include: reduced RBC, low reticulocyte, low H&H, low iron, increased serum iron binding, and absene of hemosiderin in bone marrow
Treatment for iron deficiency anemia includes:
a) ferric salts
b) B12 and iron
c) ferrous sulfate
d) folic acid and iron
Answer: c) ferrous sulfate
Other option is carbonyl iron (pure elemental iron)
Side effects of ferrous sulfate include:
a) GI upset
b) black colored tongue
c) stained teeth
d) toxicity in children
e) black stool
Answer: a,c,d,e
SE: GI upset, black colored stool, staining of teeth, and large amounts can be toxic in children
What drugs interact with iron absorption (choose all that apply):
a) fluoroquinolones decrease absorption
b) PPIs decrease absorption
c) tetracyclines decrease absorption
d) vitamin C increases absorption
Answer: c&d
Antacids & tetracycline decrease absorption of iron. Vitamin C increases absorption (but increases SE)
After initiating iron replacement, what labs should be reevaluated?
a) H&H in 1 week
b) ferritin in 4 weeks
c) Hgb, Hct, ferritin in 4 weeks
d) MCV, H&H, ferritin in 4 weeks
Answer: c) H&H and ferritin should be reevaluated in 4 weeks
What is true of iron deficient anemia replacement therapy?
a) it will be required for life
b) it can usually stop at 6 months
c) it can be stopped after Hgb is 15
d) after initial injection, treatment with folic acid alone is sufficient
Answer: c) it can be stopped after Hgb is about 15
At this point dietary iron is usually sufficient
True or false, combining antianemia agents is appropriate for severe anemia.
False. It can cause toxicity.
Which is not a consequence of B12 deficiency:
a) neurological issues
b) GI disturbances
c) cell division problems
d) immunosuppression
Answer: d) immunosuppression
B12 deficiency can cause anemia, neuro issues, demyelination of neurons, GI disturbances, and suppressed division of cells which line the mouth/stomach/intestine which can cause oral ulceration, bleeds, infection, and GI upset.
Which of the following statements about B12 is incorrect:
a) it helps convert folic acid to active form
b) it is required for tissues undergoing growth and division
c) deficiencies can impair DNA synthesis
d) treatment with folic acid alone is the preferred treatment method
e) it can cause microcytic anemia
Answer: d &e
B12 helps convert folic acid to its’ active form. Thus without B12 we have no “active” folic acid and therefore no DNA synthesis. Treatment is NEVER folic acid alone (it always includes B12). B12 deficiency can cause macrocytic anemia.
A deficiency in intrinsic factor will cause what type of anemia?
Pernicious anemia
Intrinsic factor is required for B12 to attach to in the stomach. Without intrinsic factor, only 1% of B12 can be absorbed by diffusion which is not sufficient.
True or false, B12 deficiency is usually caused by an absorption problem.
True
Causes of B12 deficiency include (check all that apply):
a) strict vegetarians
b) alcohol
c) absence of intrinsic factor
d) Sprue
Answer: a,b,c
B12 deficiency can be caused by: strict vegetarian diet, Celiac disease, alcohol, bariatric surgery (most common cause), antacid use (B12 must have an acidic environment to be absorbed), B12 antibodies, and regional enteritis.
Sprue is seen in folic acid deficiency.
Therapy of choice for B12 deficiency (not caused by an intrinsic factor deficiency) is:
a) ferrous sulfate
b) folic acid
c) cyanocobalamin
d) carbonyl iron
Answer: c)cyanocobalamin (B12) orally
If severely deficient, IM injection with folic acid can be used.
