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Pharmacology > Pharm 12-Anemia > Flashcards

Pharm 12-Anemia Flashcards

1
Q

Anemia

A

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

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2
Q

What’s required to produce RBCs?

A

kidney, bone marrow, iron, protein

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3
Q

Process which produces red blood cells

A

erythropoiesis

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4
Q

Describe the process of erythropoiesis.

A
  1. Kidney senses hypoxia (anemia) and increases endogenous erythropoietin production
  2. Erythropoietin acts on E-progenitor cells in bone marrow to produce new RBCs
  3. Kidney sense increased tissue oxygenation
  4. Kidney decreases erythropoietin production
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5
Q

What’s the life of a normal RBC?

A

100 days

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6
Q

What percent of your blood do you lose every day?

A

1%

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7
Q

Clinical Vampirism

A

HCT lowered; bone marrow hasn’t responded

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8
Q

What are some reasons that our patients will be anemic?

A

Renal failure, clinical vampirism, trauma, cancer, pregnant, “little old ladies”

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9
Q

How do perfusionists cause anemia?

A

Dilutional anemia, hemolysis, stupid perfusion practices

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10
Q

What can you do to combat anemia?

A

Start mannitol drip, but not much you can do as a perfusionist

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11
Q

What patients only want their own blood in their vasculature?

A

Jehovah’s Witness

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12
Q

What are the 4 anemia therapeutics?

A
  1. Iron
  2. B12
  3. Folic Acid (B9)
  4. Erythropoietin
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13
Q

What is required for the hemoglobin molecule to carry O2?

A

Iron

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14
Q

Where is iron stored?

A

Intestinal mucosal cells, liver, spleen, and bone marrow as ferritin

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15
Q

What causes iron deficiency?

A

Inadequate iron stores and/or intake

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16
Q

What’s a disadvantage of iron injections?

A

Extremely painful

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17
Q

What’s a disadvantage of oral iron supplements?

A

GI upset

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18
Q

What does iron deficiency anemia classically cause?

A

Hypochromic, microcytic anemia; improper red blood cell production

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19
Q

Microcytic

A

smaller cell than normal

20
Q

Hypochromic

A

Hypochromic anemia is a generic term for any type of anemia in which the red blood cells (erythrocytes) are paler than normal.

21
Q

What are some causes of folic acid deficiency?

A

Pregnancy, lactation, intestinal pathology (Crohn’s Disease) preventing absorption, alcoholism, certain drugs

22
Q

What is required for DNA synthesis?

A

Folate

23
Q

What is the rate limiting step for the formation of RBCs?

A

Ability to engage in DNA synthesis (not erythropoietin kicking in the bone marrow)

24
Q

What does folate deficiency classically cause?

A

Megaloblastic anemia

25
Q

Megaloblastic anemia

A

RBCs larger than normal

26
Q

What is the most common cause of B12 deficiency?

A

Poor B12 absorption

27
Q

What is the anemia caused by B12 deficiency called?

A

Pernicious anemia

Megaloblastic anemia

28
Q

Pernicious anemia

A

Pernicious anemia is a decrease in red blood cells that occurs when your intestines cannot properly absorb vitamin B12

29
Q

How is anemia from B12 deficiency treated?

A 
B12 injections
Folic acid (b/c of megaloblastic anemia)
30
Q

What are some erythropoetin drugs?

A

Epogen, Procrit

31
Q

Epogen and Procrit are both synthetic forms of what?

A

Erythropoetin-alfa; both have identical protein structure and vary in their glycosylation

32
Q

What is the “albumin-free” erythropoetin?

A

Darbepoetin (Aranesp)

33
Q

Why would an “albumin-free” erythropoietin drug be important?

A

Some people have rxns to albumin
Jehovah’s witness won’t take anything that has albumin in it; used as part of a comprehensive blood conservation/blood management program

34
Q

How long does it take for Darbepoetin (Aranesp) to kick in?

A

Week (s); so it’s not appropriate for acute blood loss

35
Q

What is Darbepoetin (Aranesp) usually giving with?

A

Iron; required for the hemoglobin molecule to carry oxygen

36
Q

Why does erythropoetin have a high potential for abuse?

A

Athletic ability

37
Q

What are some side effects of erythropoietin?

A 
Stroke
Increased tumor risk
Thromboembolic events (DVT, etc)
Severe HTN
Death
38
Q

What are the sickle cell drugs?

A

Hydroxyurea (Hydrea, Droxia)

Pentoxifylline (Trental)

39
Q

Hydroxyurea (Hydrea, Droxia)

A

Failure effective in preventing painful, acute criss associated with sickling claudication

Causes sickle cell hemoglobin (HbS) to get diluted by an increased production of fetal Hgb (HbF) particularly when used with epo-alfa

40
Q

How soon before surgery would you start Hydroxyurea (Hydrea, Droxia)?

A

A couple months before surgery

41
Q

How does Hydroxyurea (hydrea, droxia) work?

A

Works by changing Hgb that bone marrow produces

42
Q

Claudication

A

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

43
Q

Pentoxifylline (Trental)

A

Rheologic modifier
Increases the flexibility of RBCs so they are less likely to clog capillaries
Decreases blood viscosity

44
Q

Future possibilities for use of Pentoxylline (trental)

A

TIA
Strokes
Raynaud’s
Diabetic ulcers

45
Q

Pica

A

a symptom of iron deficiency anemia; hunger or ice, dirt, paper, etc.

46
Q

Koilonychias

A

a symptom of iron deficiency anemia; upward curvature of the finger and toe nails

Pharmacology (23 decks)

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