PAH, Anemia, SCD Flashcards
What are the two oral chelators
Deferasirox
Deferiprone
What is first line for Hemodiaylisis pts?
IV iron
What is group 1 PAH?
No identifiable causes
called primary or idiopathic
Macrocytic anemia is characterized by what lab findings?
Decreased Hgb increase MCV >100
Treatment for dry eyes?
Cyclosporine
What 4 specific drugs need to be separated from iron products?
Quinolones, tetracyclines, levothyroxine, Bisphosphanates
What can decrease the serum concentrations of folic acid?
Green tea and sulfasalazine
Boxed warning for bosentan
Hepatotoxicity
Dosing for timolol
1 drop daily or BID
Non drug treatment for SCD? 2
Blood transfusion no higher than 10 g/dL
Bone marrow transplant
More severe bacteria that can cause conjuctivitis?
2
N. Gonorrhoeae
or Chlamydia
What are the most effective drugs for lowering IOP?
What do they end in?
Prostaglandin analogs
Prost
Conjuctivitis or pink eye commonly occurs in what population and can it spread?
Young children and is highly contagious
Acular
Ketorolac
What is consider the most potent of all PAH meds?
IV agents
How is PH defined?
mean PAP (mPAP) >=25 mmHg
Additional Vaccines Due to Functional Asplenia
4 speciifc timing
- 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
What is the dosing for cosopt?
1 drop BID
Parenteral iron is reserved due to cost and side effects for what 5 populations?
- 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
SCD causes what issue?
Fibrosis of the spleen causing functional asplenia
Restasis?
Cyclosporine emulsion eye drop
Drugs that cause retinal changes/ retinopathy?
2
- Chloroquine
- Hydroxychloroquine
High risk drugs for hemolytic anemia when G6DP def? 8
- Chloroquine
- Dapsone
- Methylene blue
- Nitrofurantoin
- Primaquine
- Probenecid
- Rasburcase
- Sulfonamides
Bosentan can decrease the effects of?
Decrease effects of hormonal contraceptives
What do carbonic anhydrase inhibitors do and what do they end in?
zolamide
Reduce humour production
Ferrous sulfate 325 mg tablet
How much elemental iron?
65
If pts are not responders to vasoactivity test or fail CCB tx what are the next 4 drug classes
- Prostaglandin analogs and receptor agonists
- Endothelin receptor antagoinists ERAs
- PDE-5 inhibitors
- soluble guanylcyclase
Droxia, Hydrea, Siklos
Hydroxyurea
What drugs should be avoided in PAH and why?
Drugs that decrease prostaglandin like NSAIDs
What 3 CCBs are recommended to PAH vaso responders?
- Long acting nifedipine
- Diltiazem
- Amlodipine
OD and OS?
Right eye
Left eye
What is a warning of Carbonic anhydrase inhibitors?
Sulfa allergy
Most common cause of B12 def?
Perncious anemia
Ferumoxytol`
Feraheme
Side effects of Iron products? 3
- Constipation
- Black tarry stools
- Nausea
Dried Ferrous sulfate
30%
Who is hydroxyurea also indicated for?
Pts with acute chest syndrome, chronic symptomatic anemia or disability
consider in all children > 9 months
Which drugs can cause vision trouble at night and why?
Cholinergics like carbachol and pilocarpine
Cause pupil constriction
2 PDE 5 inhibitors
Brand and Generic?
- Revatio: Sildenafil
- Adcirca: Tadalafil
What is Nascobal and what is the dosing?
Nasal Vit B12 500 mcg in 1 nostril once weekly
Epogen, Procrit
Epoetin Alfa
Examples of cough cold and motion sickness meds that can increase IOP? 2
- Antihistamines
- Scopalamine
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
NSAIDs for ocular inflammation?
Ketorolac Acular
What type of formulation is L-glutamine?
Oral powder mixed with room temp beverage
Long term use of what 3 drugs can cause B12 def?
Metformin, H2RA and PPIs
What is the dosing for Lumigan?
1 drop QHS
Smoking increases the clearance of what drug?
Riociguat
What does Riociguat do?
Sensitizes sGC to endogenous nitric oxide and directly stimulates the receptor which incrreases cGMP
Important insturctions for Gels
Shake once before use
wait 10 minutes after inserting other eye drops before using gel
PDE5 SEs
HA
How should iron dextran be given?
First give a test dose to see if they have an allergic response
Flolan
Epoprostenol
Which BBs are non-selective?
All but betaxolol
Bosentan is a substrate and inducer of?
Sb 3A4
Induc 2C9
Black box warning for Iron containing products?
Accidental overdose leading cause of poisoning in children call 911 or poison control immediately
What conditions should you be cautious with when counseling someone on timolol? 5
COPD, Chronic Bronchitis, emphysema, asthma, advanced cardiac disease
How are ESAs stored?
Refridgerator
What does L-glutamine do for SCD pts?
Reduces the number of acute complications
What should be monitored for hydroxyurea?
CBC q2-4 wks until stable then 2-3 months
Polytrim
TMP/Polymyxin B
Maxitrol
Neo/poly/dexamethasone
Ferrous Sulfate
20%
Macrocytic anemia is caused by?
b12 or folate def
Color discrimination? 3 drugs what are the changes for each?
- Digoxin yellow green with toxicity
- PDE-5 Inhibitors (Sildenafil) green tinge around objects
- Voriconazole color vision changes
Xalantan
Latanoprost
Timoptic, Timoptic XE, Istalol
Timolol
All IV irons have risk of?
Hypersensitivity Rxn
What do loop diuretics do in PAH?
Treat volume overload
Polysaccarharide iron complex
100%
Contraindications for Riociguat? 3
- Pregnancy
- Use with PDE-5s
- Use with nitrates
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
What 5 things should you monitor when treating pts with ESA?
- Hgb
- Hct
- TSAT
- Serum Feritin
- BP
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
Triferic
What is the indication?
Indicated only for patients with hemodialyisis dependent CKD and should be added to the bicarbonate concentrate of the dialysate
6 select drugs that can cause PAH?
- Cocaine
- SSRIs during pregnancy this increases the risk in the newborn
- Wt loss drugs (diethylpropion, lorcaserin, phendimetrazone)
- Methamphetamines
- Dasatinib (Sprycel)
- Diazoxide (Proglycem)
B12 def anemia can cause of side effects?
Serious neurologic disfunction including peripheral neuropathy
What vaccines are advised in PAH?
FLu and pneumococcal
Remodulin
Treprostinil
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
Age indication for Endari
>=5 with SCD