[PHARM] Anemia and Hematopoietic GF's [Wollff] Flashcards
There is an increased risk for what serious AE’s associated with epoetin alfa?
- MI
- Stroke
- Venous thrombo-embolism
- Thrombosis of vascular access and tumor progression or recurrence
What are the 2 effects of using eculizumab for paroxysmal nocturnal hemoglobinuria and atypical HUS?
- Inhibits terminal complement-mediated intravascular hemolysis in PNH
- Inhibits complement-mediated thrombotic micorangiopathy in pt’s w/ atypical HUS
List some common presenting sx’s of neutropenia?
- Low-grade fever
- Sore mouth
- Odynophagia
- Gingival pain and swelling
- Perirectal pain and irritation
What is filgrastim and pegfilgrastin; how do they differ?
- Both are G-CSF
- Pegfilgrastim is longer lasting (PEGylated = conjugated to polyethylene glycol)
How does darbepoetin alfa differ from epoetin alfa?
Has 3x longer half-life
What is the MOA of Plerixafor?
Partial agonist at CXCR4 receptor, important for homing of hematopoietic stem cells to BM
What is the MOA of Eltrombopag; effects in pt’s?
- Potent, orally available NON-peptide TPO receptor agonist
- ↑ platelet count in: healthy pt’s, those with ITP, and thromobocytopenia due to hepatitis C
What is Plerixafor used for?
In patient who do not mobilize sufficient stem cells for autologous transplant with just G-CSF
What is an AE associated with Eltrombopag?
Hepatotoxicity when used in combo w/ interferon and ribavirin in pt’s with hepatitis C
What are the 2 clinical uses for Eltrombopag?
- Excess platelet destruction due to idiopathic thrombocytopenic purpura
- Cirrhosis due to hepatitis C
What is the MOA of Romiplostim?
- A “peptibody” of human IgG1 kappa heavy chain constant regions (an Fc fragment)
- Binds TPO receptor
- Must be given SQ because it’s a peptide!
What is the only disease modifying therapy for sickle cell anemia?
Hydroxyurea
What is the MOA of epoetin alfa?
- Stimulates erythropoiesis
- ↑ reticulocyte count ≤10 days
- ↑ RBC count, hemoglobin, and hematocrit in 2-6 weeks
Between Filgrastim and Sargramostim which has fewer AE’s and should be used?
Filgrastim (G-CSF)
What are 3 types of iron supplements that can be taken orally; what should they be taken with?
- Ferrous sulfate, gluconate, or fumarate that is ideally NOT enteric-coated and NOT-sustained release
- Pt should take with ONLY water/juice, not with food
What are some of the serious AE’s associated with the GM-CSF, Sargramostim?
- Contains benzyl alcohol, can cause fatal “grasping syndrome” in prematue infants
- Fluid retention —> edema; also pleural effusion and pericardial effusion
- Dyspnea from sequestration of granulocytes in pulmonary circulation
- Occsaional transient SVT
- May worse pre-existing renal and hepatic dysfunction
What are the clinical uses of epoetin alfa?
- Anemia due to: CKD; cancer chemotherapy; and zidovudine tx for HIV
- ↓ allogenic RBC transfusions in pt’s undergoing elective surgery
Which drugs are the most common immune and non-immune causes of drug-induced thrombocytopenia?
- Immune = heparin
- Non-immune = quinidine and quinine
What is the main AE associated with Plerixafor?
Hypersensitivity rxn
When would oral vs. parenteral therapy for Vit B12 supplementation be indicated to tx deficiency?
- Oral: generally effective, EVEN in pt’s w/ pernicious anemia
- Parenteral therapy: used if neurological sx’s are present
What is sargramostim?
GM-CSF
What are 3 major drugs/classes that may cause aplastic anemia?
- Cancer chemotherapeutics, especially alkylating agents, antimetabolites, and cytotoxic antibiotics
- Chloramphenicol, an Abx that is no longer used
- Benzene
Nitrous oxide inhaled for analgesia during surgey can have what effect on B12?
Inactivates cyanocobalamin (common form of B12)
What is the effect and clinical use of Romiplstim?
- ↑ the platelet count in: healthy pt’s, pt’s with ITP and pt’s with myelodysplastic C syndrome
- Use for excess platelet destruction due to idiopathic thrombocytopenia purpura (ITP)
