PAH, Anemia, SCD Flashcards
1
Q
What are the two oral chelators
A
Deferasirox
Deferiprone
2
Q
What is first line for Hemodiaylisis pts?
A
IV iron
3
Q
What is group 1 PAH?
A
No identifiable causes
called primary or idiopathic
4
Q
Macrocytic anemia is characterized by what lab findings?
A
Decreased Hgb increase MCV >100
5
Q
Treatment for dry eyes?
A
Cyclosporine
6
Q
What 4 specific drugs need to be separated from iron products?
A
Quinolones, tetracyclines, levothyroxine, Bisphosphanates
7
Q
What can decrease the serum concentrations of folic acid?
A
Green tea and sulfasalazine
8
Q
Boxed warning for bosentan
A
Hepatotoxicity
9
Q
Dosing for timolol
A
1 drop daily or BID
10
Q
Non drug treatment for SCD? 2
A
Blood transfusion no higher than 10 g/dL
Bone marrow transplant
11
Q
More severe bacteria that can cause conjuctivitis?
2
A
N. Gonorrhoeae
or Chlamydia
12
Q
What are the most effective drugs for lowering IOP?
What do they end in?
A
Prostaglandin analogs
Prost
13
Q
Conjuctivitis or pink eye commonly occurs in what population and can it spread?
A
Young children and is highly contagious
14
Q
Acular
A
Ketorolac
15
Q
What is consider the most potent of all PAH meds?
A
IV agents
16
Q
How is PH defined?
A
mean PAP (mPAP) >=25 mmHg
17
Q
Additional Vaccines Due to Functional Asplenia
4 speciifc timing
A
- Meningococcal series + routine boosters
- Meno Serogroup B (Bexsero, Trumenda) >= 10
- Pneumo poly (Pneumovax)>= 2 booster 5 years later and at age 65
- Pneumo conjugated prevnar x 1 in any pt >= 6 years of age if not given in childhood
18
Q
What is the dosing for cosopt?
A
1 drop BID
19
Q
Parenteral iron is reserved due to cost and side effects for what 5 populations?
A
- CKD pts on hemodiaylsis
- CKD receiving erythropoeisis stimulating agents
- Unable to tolerate oral iron celiac disease,
- Losing iron really quickly
- As an alternative when blood transfusions are not accepted by patients
20
Q
SCD causes what issue?
A
Fibrosis of the spleen causing functional asplenia
21
Q
Restasis?
A
Cyclosporine emulsion eye drop
22
Q
Drugs that cause retinal changes/ retinopathy?
2
A
- Chloroquine
- Hydroxychloroquine
23
Q
High risk drugs for hemolytic anemia when G6DP def? 8
A
- Chloroquine
- Dapsone
- Methylene blue
- Nitrofurantoin
- Primaquine
- Probenecid
- Rasburcase
- Sulfonamides
24
Q
Bosentan can decrease the effects of?
A
Decrease effects of hormonal contraceptives
25
What do carbonic anhydrase inhibitors do and what do they end in?
zolamide
Reduce humour production
26
27
Ferrous sulfate 325 mg tablet
How much elemental iron?
65
28
If pts are not responders to vasoactivity test or fail CCB tx what are the next 4 drug classes
1. Prostaglandin analogs and receptor agonists
2. Endothelin receptor antagoinists ERAs
3. PDE-5 inhibitors
4. soluble guanylcyclase
29
Droxia, Hydrea, Siklos
Hydroxyurea
30
What drugs should be avoided in PAH and why?
Drugs that decrease prostaglandin like NSAIDs
31
What 3 CCBs are recommended to PAH vaso responders?
1. Long acting nifedipine
2. Diltiazem
3. Amlodipine
32
OD and OS?
Right eye
Left eye
33
What is a warning of Carbonic anhydrase inhibitors?
Sulfa allergy
34
Most common cause of B12 def?
Perncious anemia
35
Ferumoxytol`
Feraheme
36
Side effects of Iron products? 3
1. Constipation
2. Black tarry stools
3. Nausea
37
Dried Ferrous sulfate
30%
38
Who is hydroxyurea also indicated for?
Pts with acute chest syndrome, chronic symptomatic anemia or disability
consider in all children \> 9 months
39
Which drugs can cause vision trouble at night and why?
Cholinergics like carbachol and pilocarpine
Cause pupil constriction
40
2 PDE 5 inhibitors
Brand and Generic?
1. Revatio: Sildenafil
2. Adcirca: Tadalafil
41
What is Nascobal and what is the dosing?
Nasal Vit B12 500 mcg in 1 nostril once weekly
42
Epogen, Procrit
Epoetin Alfa
43
Examples of cough cold and motion sickness meds that can increase IOP? 2
1. Antihistamines
2. Scopalamine
44
What are the goals of Iron Def Anemia Tx?
Increase in serum Hgb by 1g/dL every 2-3 wks
Continue Tx for 3-6 mo after anemia has resolved and iron stored return to normal
45
NSAIDs for ocular inflammation?
Ketorolac Acular
46
What type of formulation is L-glutamine?
Oral powder mixed with room temp beverage
47
Long term use of what 3 drugs can cause B12 def?
Metformin, H2RA and PPIs
48
What is the dosing for Lumigan?
1 drop QHS
49
Smoking increases the clearance of what drug?
Riociguat
50
What does Riociguat do?
Sensitizes sGC to endogenous nitric oxide and directly stimulates the receptor which incrreases cGMP
51
Important insturctions for Gels
Shake once before use
wait 10 minutes after inserting other eye drops before using gel
52
PDE5 SEs
HA
53
How should iron dextran be given?
First give a test dose to see if they have an allergic response
54
Flolan
Epoprostenol
55
Which BBs are non-selective?
All but betaxolol
56
Bosentan is a substrate and inducer of?
Sb 3A4
Induc 2C9
57
Black box warning for Iron containing products?
Accidental overdose leading cause of poisoning in children call 911 or poison control immediately
58
What conditions should you be cautious with when counseling someone on timolol? 5
COPD, Chronic Bronchitis, emphysema, asthma, advanced cardiac disease
59
How are ESAs stored?
Refridgerator
60
What does L-glutamine do for SCD pts?
Reduces the number of acute complications
61
What should be monitored for hydroxyurea?
CBC q2-4 wks until stable then 2-3 months
62
Polytrim
TMP/Polymyxin B
63
Maxitrol
Neo/poly/dexamethasone
64
Ferrous Sulfate
20%
65
Macrocytic anemia is caused by?
b12 or folate def
66
Color discrimination? 3 drugs what are the changes for each?
1. Digoxin yellow green with toxicity
2. PDE-5 Inhibitors (Sildenafil) green tinge around objects
3. Voriconazole color vision changes
67
Xalantan
Latanoprost
68
Timoptic, Timoptic XE, Istalol
Timolol
69
All IV irons have risk of?
Hypersensitivity Rxn
70
What do loop diuretics do in PAH?
Treat volume overload
71
Polysaccarharide iron complex
100%
72
Contraindications for Riociguat? 3
1. Pregnancy
2. Use with PDE-5s
3. Use with nitrates
73
What should be used in children when born if they are diagnosed with SCD?
How long should it be continued?
What is the dosing?
* PCNs Twice daily
* Until 5 yo
74
What 5 things should you monitor when treating pts with ESA?
1. Hgb
2. Hct
3. TSAT
4. Serum Feritin
5. BP
75
Warniings for Flolan?
Rebound PH Dont DC or decrease dose abruptly
CHronic IV infusions can cause sepsis or blood stream infections
Epoprostenol has an extrememly short half life 6 minutes
76
Triferic
What is the indication?
Indicated only for patients with hemodialyisis dependent CKD and should be added to the bicarbonate concentrate of the dialysate
77
6 select drugs that can cause PAH?
1. Cocaine
2. SSRIs during pregnancy this increases the risk in the newborn
3. Wt loss drugs (diethylpropion, lorcaserin, phendimetrazone)
4. Methamphetamines
5. Dasatinib (Sprycel)
6. Diazoxide (Proglycem)
78
B12 def anemia can cause of side effects?
Serious neurologic disfunction including peripheral neuropathy
79
What vaccines are advised in PAH?
FLu and pneumococcal
80
Remodulin
Treprostinil
81
How long does it take for symptoms of SCD to develop and why?
2-3 months after birth and fetal Hgb ehich blocks sickling of RBCs
82
Age indication for Endari
\>=5 with SCD
83
What are the 5 examples of anticholinergic that increase IOP?
1. TCAs
2. Oxybutnin
3. Tolterodine
4. Benztropine
5. trihexphenidyl
84
Contraindications of PDE-5
Use with nitrates or riociguat
85
Recommended dose for oral iron therapy
100-200 mg elemental per day
86
Common cause of bacterial conjuctivitis?
Staph Aureus
87
Aranesp
Darbepoetin
88
What do prostaglandin analogs do?
Increase aqueous outflow
89
Ferrous sulfate dried
ER
160 mg tablet
50 mg elemental iron
90
What is recommended as first line for patients with severe B12 def or neurologic symptoms?
B12 injections Cyanocobalamin
91
What 4 things should a parent do to reduce the risk of conjuctivitis?
1. Not touch their eyes
2. Hand hygiene
3. Change towels and wash clothes daily
4. Discard eye cosmetics
92
Since PAH can put you in a prothrombic state wha can pts treated with and what is the goal?
Warfarin can be considered
1.5-2.5 gail INR
93
Iron Chelation Tx
What isnt used and why?
Defuroxime was used but not any more cause of toxicities and its IV
94
What 4 sets of drugs increase IOP?
1. Anticholinergics
2. Cough/cold and motion sickness med
3. Chronic steroids especially in the eye
4. Topiramate
95
What steroids effect IOP most significantly?
Ophthalmic roid prednisolone (Predforte)
96
Antihistamines for allergic conjuctivitis? 2
1. Azelastine
2. Olaptadine (Patanol, Pataday)
97
Most common virus for conjuctivitis?
Adenovirus
98
Warnings for ERAs?
Hepatotoxicity, decreased Hgb and Hct, fluid retention
99
Key Vaccines in SCD
Routine Childhood series 2
1. H Flu Type B (Hib)
2. Pneumo conjugated (PCV13 Prevnar)
100
What do alpha 2 agonists do for glaucoma and what do they end in?
Nidine
Increase both outflow and decrease production
101
How should Iron be Taken?
What can it cause?
Taken on an empty stomach
Can cause black stools which is common, if constipated ask doctor for stool softeners.
102
What diet should PAH patients follow and what is the /day restriction?
Sodium restriction
\<2.4 g/day
103
Pts with group five PAH class should be given?
IV epoprostenol
104
Cosopt, Cosopt PF
Timolol + dorzolamide
105
Folic acid can decrease the serum concentration of what 4 drugs?
Fosphenytoin, phenytoin, primidone, phenobarbital
106
2 main side effects of BBs? for glaucoma
Stinging
Burning
107
If patients are considered responders to vasoreactivity testing what class of drugs is recommended?
CCBs
108
Endari
L-Glutamine
109
Ferrous Fumurate
33%
110
What are the 3 goals for glaucoma treatmetn?
1. Make less fluid with BB liks timolol
2. Move fluid out with prostaglandin analogs
3. Or do both
111
2 warnings for hydroxyurea?
1. Fetal embryo toxicity
2. Avoid live vaccines
112
Ocuflox
Ofloxacin
113
Warnings and side effects of cGC
Riociguat
Hypotension
HA
114
What does ESA do?
Decreases the need for blood transfusions but are ineffective if iron stores are low
115
Do BB eye drops contain BAK?
Yes some do
116
What CCB is not recommended in PAH?
Verapamil
due to the more significant negative inotropic effects compared to diltaizem
117
AD and AS?
Right ear: AD
Left ear: AS
118
How can eye inflammation be reduced? 3 things
1. Cold compress
2. NSAID if mild
3. Steroids if severe
119
Roid eye drops for Inflammation?
Prednisolone
Omnipre, Preforte, Pred Mild
Limit use due to increase ocular pressure
120
What is the test to see if someone has hemolytic anemia?
Positive coombs test
121
Common chronic complication of SCD?
Pulmonary HTN
Others but this is underlines
122
How is Pulomonary HTN characterized?
continous high BP in the pulmonary arteries
123
Drug tx for SCD? 6
1. Immunizations
2. Abx
3. Analgesics for pain
4. Hydroxyurea
5. L-Glutamine
6. Chelation therapy to reduce iron overload from tranfusion
124
Floppy iris syndrome what issues can it cause and what drugs can cause ti?
1. Problems in cataract surgery
2. Alpha blockers (Doxazosin)
125
What are the treatments for Anemia in CKD?
Iron and ESA
126
Otitis Externa Drug Treatment?
Ciprodex
Ciprofloaxacin and dexamethasone
127
Prostaglandins end in?
Prost
128
What is the component that can be abosrbed in contact lenses?
Benzalkonium Chloride (BAK)
Can discolor contact lenses wait 15 minutes to put contacts back in
129
How should unopened bottles of latanaprost be stored?
In fridge
130
What drug is preferred if pressure is only in one eye?
BBs
131
Side effects of Flolan
4
Vasodilator rxns, FLushing
Jaw pain
infusion site pain
132
2 generic names for endothelin receptor antagonists?
1. Bosentan
2. Ambresentan
133
What other drugs should you consider for PAH pts?
Loop diuretics and Possibly digoxin
134
Vigamox
Moxifloxacin
135
PAH can lead to wht?
Puts you in a prothrombic state
136
How do you know if hydroxyurea is at toxic levels? 2 labs
ANC\<2,000/mm3
Platelet \<80,000/mm3
137
Boxed warning for Riociguat?
Embryo-fetal tox neg preg before starting and checked monthly
138
What drug can decrease the absorption of B12?
Colchine
139
Cyanocobalamin, B12 dosing?
IM or Deep SC
140
How is hydroxyurea taken?
Oral
141
Boxed warning for ERAs?
Emryo fetal tox, must have negative preg before use and monthly
142
How long is contraception needed for hydroxyurea?
during and after stopping 1 year males 6 months females
143
What drug interactions for hydroxyurea?
Drugs that cause myelosuppression
Limuss
Wear sun protection
144
Vision loss/Abnormal Changes
5
1. Digoxin with toxicity blurriness or halos
2. PDE-5 vision loss in one or both eyes can be permanent
3. Isotretinoin decrease nice vision which can be permanent
4. Vigabitrin permanent vision loss, high risk
5. Voriconazole: abnormal vision, photophobia
145
What supplementation is used for hydroxyurea?
FOlic acid
146
ERA side effects?
HA
147
What is hydroxyurea and what does it do?
Disease modifying agent that stimulates the production of HgbF
148
Anemia of CKD is primarily due to?
Def in Erythropoeitin
149
Latisse
Bimatoprost for eyelash growth
150
COntraintications of ERAs?
Pregnancy
151
Ferrous gluconate
12%
152
4 warnings of PDE-5s
1. Hearing loss
2. Vision loss
3. Nonarteritic anterior ischemic optic neuropathy
4. Priapism
5. Hypotension
153
4 main topical antibiotics used for the treatment of bacterial conjuctivitis
1. Moxifloxacin
2. Neo/pol/dexamethasone
3. Ofloxacin
4. TMP/Polymyxins
154
Timoptic XE, Timolol GFS dosing?
Gels
Daily
155
What do ERAs do?
Endothelin is a potent vasoconstrictor
ERAs block these on the pulmonary smooth muscle
156
Boxed warning for Epogen or Procrit? 6
1. Increased risk of death
2. MI
3. Stroke
4. VTE
5. Thrombosis
6. Tumor progression
Use lowest effective dose
157
What do BBs do for glaucoma?
Reduce aqeuous humor production
158
What is the treatment for viral conjuctivitis?
No topical treatment
159
What is the dosing for Aranesp?
Darbapeotin
Its once weekly
the half life is much longer than Epoetin alfa so it can be given weekly instead of 3x/wk
160
What is the major warnings for prosts?
* Darkening of the Iris, eyelid skin and eyelashes, can increase length and number of eyelashes
161
What type of agent is hydroxyurea?
Hazardous
Wear disposable gloves to limit exposure dont open the capsule
162
3 drugs that cause optic neuropathy?
1. Amiodarone + corneal deposits
2. Ethambutol
3. Linezolid
163
What do PDE-5 inhibitors do?
Prevent degradation of cGMP
this increases cGMP and causes pulmonary vasculature relaxation and vasodilation
164
Travatan Z
Travoprost
165
Lumigan
Bimatoprost
166
What do prostacyclin analgues do for PAH patients?
Prostacyclin synthase is reduced in pts with PAH which decreae prostacyclin I2 which is a potent vasodilator
Analogues are potent vaso dilators and also inhibitors of platelet aggregation
167
What do cholinergic (miotics) do for glaucoma?
Increase outflow
168
What benefit could digoxin have in PAH?
Improve cardiac output and control HR
169
What 6 drugs can cause pulmonary fibrosis?
1. Amiodarone
2. Bleomycin
3. Dronedarone
4. Methotrexate
5. Nitro
6. Sulfasalazine
170
What other vitamin can increase the absorption of Iron?
Vit C
171
What drug requires ice packs for stability?
Flolan Epoperstenol
172
What is Blepharitis and what is the treatment?
Eyelid inflammation and treat with warm moist compress
173
For cancer pts ESA is not recommended when?
Pts outcome is cure
174
What drug can decrease the efficacy of B12?
Chloramphenicol
175
When is Hydroxyurea indicated? In SCD
Adults who have \>=3 acute pain crisis in 1 year
176
SCD most commonly effects what population?
African Americans
177
Venofer
Iron sucrose
178
179
PRostcyclin analog Drug interactions? 2 sets
1. Increase effects of antiplatelets, antihypertensives and anticoagulants
2. Troprostinil (remodulin): levels are increased by 2C8 inhibitors (gemfibrozil) also should be avoided in selexipag
180
Oral iron absorption is decreased with? 3 things
1. Food take iron on an empty stomach
2. High gastric pH, avoid H2RA, PPIs separate from antacids
3. Sustained release or enteric coated tablets cause less GI irritation
181
Dx and Tx of Iron def anemia
Lab Findings
3 bullets 7 findings
1. Decrease Hgb, Microcystosis \<80, Decrease RBC
2. Decreased serum iron, ferritin, and TSAT
3. Availlable iron binding sites increase TIBC
182
PDE-5s are substrates of?
3A4
183
What is the goal for the treatment of glaucoma?
Decrease IOP
184
What are the two types of Acute Sickle cell crisis and what is the cause?
Caused by vascular occlusion
Most common types VOC: Vasooclussive crisis
or Acute pain crisis
If pain in chest it is acute chest syndrome
185
Bosentan levels can be increased with? 3 bullets
2C9 inhibitors: Amiodarone, fluconazole
3A4 inhibitors: ritonavir
Cyclophosphamide and Glyburide on contraindicated
186
4 key Side Effects of Prosts?
1. Blurred vision
2. Stinging
3. Increased pigmentation of the iris or eyelashes
4. Eyelash growth
187
Carbonyl Iron
100%
188
Dosing for Epogen or Procrit?
3x/wk
189
When should epogen or procrit therapy be initiated and when should it be stopped?
When Hgb is \<10
Decrease or interrupt dosing when Hgb approaches or exceeds 11
CKD patients on HD specifically
190
Treatment of cerumen block
Carbamide peroxide (Debrox) triethanolamine
191
What are the 3 prostaglandin analogs
Bimatoprost
Latanaprost
Travoprost
192
What product does not contain BAK?
Travatan Z
193
Pts with severe pain or VOC should be given what?
IV opioids or PCA
194
11 drugs that cause hemolytic anemia?
1. Beta lactamase inhibitors
2. Cephalosporins
3. Isoniazid
4. Levodopa
5. Methyldopa
6. PCN especially piperacillin
7. Platinum based chemo
8. Quinidine
9. QUinine
10. Ribavirin
11. Rifampin
195
Azasite generic, storage and stability
Store in fridge
stable for 14 days at room temp
196
Folic acid can decrease the efficacy of what drug?
Raltetrexed Avoid combination
197
What prostaglandin also has an indication for eyelash hypertrichosis as well as glaucoma?
What are the two brand names
* Bimatoprost
* Lumigan for glaucoma
* Latisse for hypotrichosis
198
What is required for hydroxyurea?
Contraception
199
Caution should be used in patients on PDE5 with what other class?
Alpha Blockers or other HTN meds
200
Boxed warning for hydroxyurea?
Myelosuppression
201
How should Flolan be stored?
Protected from light before and during infusion
202
Sepsis and mengingitis can occur in SCD due to what 3 main pathogens?
1. S. Pneumo
2. H. Influe
3. N. Mengingitiis
203
Black box warning for iron dextran and ferumoxytol
Serious anaphylactic rxn
204
Epogen or Procrit risk in CKD pts
Increased risk of death and CV events when Hgb\>11
205
What two classes of drugs have boxed warnings for fetal embryo toxicity?
ERAs: Bosentan
cG stimulators riociguat
206
What do Rho Kinase inhibitors do and what do they end in?
Sudil
Increase aqeuous outflow
