Pharm: Anemias

Question 1

What is the most common cause of chronic anemia?

Answer 1

Iron Deficiency

Question 2

What are the common symptoms of iron def?

Answer 2

pallor, fatigue, dizziness, exertional dyspnea, generalized features of tissue hypoxia, cv adaptations to iron def.

Question 3

Without adequate iron, what happens to the cells?

Answer 3

they form microcytic hypochromic anemia

Question 4

whose iron doses should be increased?

Answer 4

children, pregnant or menstruating women

Question 5

what is the most common cause of iron def in men and postmen women? men women?

Answer 5

GI bleeding

menstruation

Question 6

What are the three drugs used for oral iron supplementation?

Answer 6

ferrous sulfate, ferrous gluconate, ferrous fumarate

Question 7

what percentage of oral iron can be absorbed? as such how much should be adminstered per day?

Answer 7

25%

200-400 mg of iron should be given per day

Question 8

what are the toxic effects of oral iron therapy?

Answer 8

nausea, epigastric discomfort, abdominal cramps, constipation and diarrhea. stools turn black

Question 9

what is the way to parenterally administer iron?

Answer 9

iron dextran

Question 10

when would iv admin be used?

Answer 10

advanced chronic renal disease requiring dialysis and tx with epo
postgastrectomy
previous small bowel resection
ibs involved proximal small bowel
malabsorption

Question 11

what are the challenges to iv tx of iron deficiency?

Answer 11

there is a serious dose-dependent toxicity

Question 12

how do we work to prevent the toxicity of iv admin of iron dextran for iron deficiency?

Answer 12

colloidal formulations (carbs surrounding a core of iron oxyhydroxide)
iron dextran

Question 13

what are the toxic effects of iv iron therapy?

Answer 13

headache, light-headed, fever, arthralgias, nausea, vomiting, back pain, urticaria, bronchospasm and sometimes anaphylaxis

Question 14

what is acute iron toxicity in young children?

Answer 14

iron tablets look like candy (takes about 10 pills)

leads to necrotizing gastroenteritis (vomiting, bloody diarrhea, shock)

Question 15

how do you detox from acute iron toxicity?

Answer 15

whole bowel irrigation (charcoal will not work)

deferoxamine (iron-chelating compound)

Question 16

when does hemochromatosis commonly occur?

Answer 16

inherited or ppl with chronic red cell transfusions

Question 17

how can you treat chronic iron tox?

Answer 17

deferasirox given orally (to treat due to blood transfusions)

Question 18

in the absence of anemia, what is the msot common treatment for chronic iron overload?

Answer 18

phlebotomy

Question 19

what does b12 deficiency lead to?

Answer 19

megaloblastic anemia, gi symptoms and neurologic abnormalities

Question 20

what are symptoms of b12 def?

Answer 20

megaloblastic macrocytic anemia
neurologic syndromes (paresthesias in peripheral nerves and weakeness and progressed to spasticity ataxia and other cns dysfunctions)

Question 21

what are common causes of b12 def?

Answer 21

pernicious anemia or gastrectomy

Question 22

what are some rare causes of b12 def?

Answer 22

bacterial overgrowth of small bowel
chronic pancreatitis
thyroid disease

Question 23

what vitamins are frequently used to treat b12 def?

Answer 23

cyanocobalamin and hydroxocobalamin (preferred)

Question 24

When is folic acid def commonly found?

Answer 24

in alcoholics and those with liver disease, poor diet and diminished hepatic stoarge of folates

Question 25

what is the oral therapy used in folic acid

Answer 25

1 mg of folic acid daily is sufficient

Question 26

what are drug-induced deficiencies of folic acid?

Answer 26

methotrexate, trimethoprim and pryimethamine (the latter two are less likely)
phenytoin reduced folate uptake
leucovorin (which modulates 5-fu function)

Question 27

what three minerals are linked to depression with there are depressed levels?

Answer 27

zinc, magnesium and folate

Question 28

what is levomofolate?

Answer 28

biologically active form of folic acid found inthe circulation. readily crosses the blood brain barrier where it modulates the production of serotonin, norep and dopamine.

Question 29

what is epoietin alfa?

Answer 29

agonist of epoR, which stimulates the erythroid proliferation and differentiation, tx of anemia and chronic renal failure, hiv, infxn cancer, and prematurity

Question 30

where is endogenous epo primarily produced

Answer 30

kidney

Question 31

what are more common non-life threatening effects of epo supplementation

Answer 31

htn, heachaches, arthralgias, nausea

Question 32

in addition to prematurity, children treated for hiv with what drug benefit from epo tx?

Answer 32

zidovudine (retrovir)

Question 33

what are the myeloid growth factors?

Answer 33

g-csf, gm-csf and pegfilgrastim

Question 34

what does g-csf do?

Answer 34

stimulates proliferation and differentiatoin of progenitors already committed to the neutrophil lineage. actiavtes the phagocytic nature of neutrophils, and mobilizes hema stem cells to increase in concentration in peripheral blood (used to collect for hsct)

Question 35

what does gm-csf do

Answer 35

same as g-csf except that it targets multipotential stem cells, allowing a rise in erythroid and megakaryocyte progenitors

Question 36

how does gm-csf act with il2

Answer 36

stimulates mature t cell proliferation

Question 37

what is oprelvekin?

Answer 37

an il11 type that activates il11 receptors, stimulating growth of multiple lymphoid and myeloid cells including megakaryocyte progenitors and increases number of circulating platelets and neutrophils

Question 38

what are the toxicities of oprelvekin?

Answer 38

anemia, dyspnea, and transient atrial arrhythmias

Question 39

what is romiplostin?

Answer 39

tpo-mimetic fusion protein that contains two identical single-chain subunits, each consisting of human igg1 fc domain. remains active longer than endogenous tpo