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Paige: Heme/Onc Module! > Pharm Blessings > Flashcards

Pharm Blessings Flashcards

1
Q

Low H/H, low MCV?

A

Iron deficiency anemia

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2
Q

What is the MC cause of iron deficiency in:

a) premenopausal women
b) postmenopausal women
c) men

A

a) menorrhagia
b) GI bleed
c) GI bleed

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3
Q

What is the 1st line med for iron deficiency anemia?

A

Iron (ferro sulfate)

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4
Q

What is the major side effect of iron supplements?

A

GI issues - nausea, vomiting, constipation

(can co-prescribe stool softeners)

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5
Q

Which iron supplement is the least expensive?

A

Ferro sulfate

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6
Q

What is a benefit of ferro sulfate with regards to incresing iron content?

A

Has the highest content of elemental iron per tablet

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7
Q

Which type of deficiency can the DM drug Metformin cause?

A

Vit B12

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8
Q

What is a major cause of hemotologic disease in DM? in those with kidney disease?

A

iron deficiency

EPO deficiency

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9
Q

What is one symptom presentation difference between B12 deficiency and folate deficiency?

A

B12 can present with numbness/tingling in extremities

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10
Q

What level of Hct and particularly Hgb should you NOT prescribe epogin?

Why?

A

11

(NOT 12 like the slides say)

Puts at increased risk of stroke, MI

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11
Q

Is folic acid made in your body, or retrived from your diet?

A

From your diet only

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12
Q

What is folic acid used for within the body?

A

cell division, making up reticulocytes

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13
Q

What other nutrient does folic acid need to work properly?

A

Vit B12

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14
Q

What test should you almost always perform before prescribing folic acid?

A

Vitamin B12 levels

(folic acid needs vitamin B12)

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15
Q

What test should you perform before Rx-ing epogin?

A

IRON LEVELS

(the building blocks for epogin)

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16
Q

True or False:

Only use EPO if pt is on dialysis.

A

I guess it’s true?

Apparently White said that - it’s in the docs.

Seems weird to me but who knows, just give it a 5 and move on :)

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17
Q

What test can you perform to tell whether the GI system is absorbing Vit B12 properly?

A

Shilling test - measures intrinsic factor

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18
Q

What the the big concern with undiagnosed B12 deficiency?

A

Can cause neurological disorders, which can become permanent.

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19
Q

Where do we obtain Vit B12?

Where is it stored?

A

Obtained from diet

Stored in liver

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20
Q

We emphasized 3 drugs that decrease absorption of B12 and folate. What are they?

A

Phenytoin, methotrexte, and alcohol

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21
Q

Does a high MCV indicate macro- or microcytic RBCs?

A

macrocytic

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22
Q

What is the most common cause of anemia in otherwise healthy adults in the US?

A

Blood loss, particularly from the GI tract

Most likely caused by chronic dz

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23
Q

When you use iron replacement, how long until you see increase in iron serum levels?

Until the anemia is “cured”/iron stores are completely replenished?

A

Serum increase: a few weeks

Fully replenished: 3-6 months

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24
Q

Other than GI bleeding, what can lower iron levels by decreasing absorption?

A

Malnutrition, alcoholism

Pregnancy

Gastric disease (IBS, gastritis, Chron’s)

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25
Q

If there is an acute bleed, how long might it take before H+H levels change?

A

24-48 hours

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26
Q

At what Hgb level should you definitely be considering transfusion?

A

7 or lower

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27
Q

In a CKD patient with anemia, what drug should you definitely think about prescribing?

A

Epogin

28
Q

What do you use Neutrogin for?

A

neutropenia

29
Q

Ohhh, you’re halfway there

A

Woahhhhh livin’ on a prayer

(but really, livin’ on a prayer that I pass on Monday)

30
Q

In what conditions is lower extremity claudication common in?

A

Tobacco use, HTN, DM

31
Q

What is the DOC for claudication?

(and peripheral artery disease)

A

Cilostazol (Pletal)

But a walking program will do wonders!!!

32
Q

What is the MOA of Cilostazol (Pletal)?

A

phosphodiesterase inhibitor

inhibits plately phosphodiasterase thus preventing aggregation

33
Q

What do you prescribe for pernicious anemia?

A

lifelong B12 injection IM

DOC = cyanicobalamin B12

34
Q

What happens in children when they overdose on iron?

A

Iron toxicity! Iron leeches out into their kidney and liver, causing damage

35
Q

How do you counteract iron toxicity?

A

DOC = Deferoxamine (desferal)

36
Q

What is the MOA of deferoxamine (desferal)?

A

Iron chelator

Chelates iron from hemosiderin, ferritin, and transferrin

37
Q

How long does it take to deplete B12 stores in an otherwise healthy patient?

A

3-5 years

38
Q

If a patient has Vit B12 deficiency, what happens if we treat with JUST folate?

A

Sx will improve, but neuropathy will continue and may be irreversible

39
Q

What is the DOC for knee/hip replacement surgery?

A

Rivaroxaban (Xarelto)

40
Q

How should you advise your patient to take Rivaroxaban (Xarelto)?

A

Take w/ food to increase bioavailability

41
Q

If you reeeeeaalllyyy would like to put your pt on Xarelto or Pradaxa but you CAN’T, then what should you put them on?

A

Bridge: Low molecular weight heparin (Lovenox)

Ultimately: Warfarin (Coumadin)

Because warfarin (coumadin) works slowly, but you want immediate response w/ bridge

42
Q

What labs will test Warfarin (Coumadin)?

A

PT/INR

43
Q

What labs will test Heparin?

A

PTT

44
Q

What is the DOC for a PE?

A

low molecular weight heparin (lovenox)

45
Q

In what cases would you want to use Fondaparinux (Arixtra) over LMW heparin (lovenox)?

A

If pt has had adverse rxn to any type of heparin

If pt gets TTP from using heparin

46
Q

What’s the safety difference between heparin and LMW heparin (lovenox)?

A

you usually want to use heparin because it is easier to adjust the dosage and there is a drug to counteract it if you overshoot

Use LMW heparin if small problem, or if pt developed HIT/TTP

47
Q

What is the DOC for DVTs?

A

Still LMW heparin (lovenox)

48
Q

What is the irony about the complication of heparin?

A

Pt can bleed too heavily OR can have a hypercoagulable state

49
Q

How are you going to treat a patient who is status post acute MI?

A

Aspirin (ASA) AND Clopidogrel (Plavix)

50
Q

What is the MOA of aspirin?

A

anti-platelet drug

irreversible inactivation (via acetylation) of cyclo-oxygenase.

inhibits synthesis of thromboxane A2

prevents platelet aggregation and vasoconstriction by thromboxane A2

51
Q

What is the MOA of Clopidogren (Plavix)

A

Platelet ADP inhibitor

Irreversibly blocks ADP receptor on platelets, preventing platelet/fibrinogen binding and platelet aggregation

52
Q

What if your patient is status post acute MI, and has an ASA sensitivity?

A

rx only Clopidogrel (Plavix)

53
Q

Your patient has A-fib and mitral valve stenosis.

What drug is she NOT a candidate for?

What is the DOC?

A

NOT candidate for Dabigatran (Pradaxa) or Rivaroxaban (Xarelto)

DOC = Warfarin (Coumadin)

Non-acute, so NO bridge therapy.

54
Q

What is the MOA of Warfarin (Coumadin)?

A

Blocks Vit K-mediated carboxylation of clotting factors

2, 7, 9, 10

protein C, S

55
Q

Your patient is on warfarin (coumadin).

Where do you want his INR?

What do you do if INR is elevated?

A

Want INR at 2-3

If elevated to ~12, rx Vit K (Mephyton)

If elevtaed to ~6, just skip a dose of Warfarin

56
Q

If a patient is on Warfarin w/ a high INR and you Rx Vitamin K, what can happen?

A

Warfarin resistance can occur for 1-2 weeks after giving the Vit K

57
Q

What is the shelf life on Dabigatran (Pradaxa)?

A

Unopened: 4 months

Opened: 30 days

58
Q

Why would you Rx Warfarin (Coumadin) over Pradaxa?

A

Warfarin has a longer shelf life and less side effects

59
Q

BUT what is Warfarin’s PG category?

A

X

60
Q

Which drug is cheaper: Riveroxaban (Xarelto) or Dabigatran (Pradaxa)?

A

Pradaxaaaaaaaaaaa

(Also, food has no effect on Pradaxa unlike Xarelto)

61
Q

What is the MOA of a tPA like Alteplase (Activase)?

A

plasminogen activator

activates plasminogen bound to fibrin

“a drug to lyse and destroy clot formation”

62
Q

Realistically, when do we ever use tPA anymore?

A

Not often.

Still used in stroke patients if a) non-hemorrhagic and b) pt meets time criteria

63
Q

What drug is used to counter the effects of tPAs?

A

You must inhibit fibrinolyses

Therefore, use Aminocaproic acid (Amicar)

64
Q

Oh hey, think back to the last exam. What do we have to monitor when we put a patient on methotrexate?

A

Lung function! Can lead to pulmonary complications, esp in COPD patients

65
Q

What drug do you give to reverse the effects of Heparin?

And again, how will you monitor Heparin?

A

Protamin sulfate

Monitor PTT

66
Q

What drug do you give to reverse the effects of Warfarin (Coumadin)?

And again, how do you monitor?

A

Vitamin K

Monitor with PT/INR

67
Q

What’s a problem-free philosophy?

A

https://www.youtube.com/watch?v=xB5ceAruYrI

^^^a 4 minute break won’t hurt ya^^^

Paige: Heme/Onc Module! (8 decks)

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