Pharm Blessings Flashcards
Low H/H, low MCV?
Iron deficiency anemia
What is the MC cause of iron deficiency in:
a) premenopausal women
b) postmenopausal women
c) men
a) menorrhagia
b) GI bleed
c) GI bleed
What is the 1st line med for iron deficiency anemia?
Iron (ferro sulfate)
What is the major side effect of iron supplements?
GI issues - nausea, vomiting, constipation
(can co-prescribe stool softeners)
Which iron supplement is the least expensive?
Ferro sulfate
What is a benefit of ferro sulfate with regards to incresing iron content?
Has the highest content of elemental iron per tablet
Which type of deficiency can the DM drug Metformin cause?
Vit B12
What is a major cause of hemotologic disease in DM? in those with kidney disease?
iron deficiency
EPO deficiency
What is one symptom presentation difference between B12 deficiency and folate deficiency?
B12 can present with numbness/tingling in extremities
What level of Hct and particularly Hgb should you NOT prescribe epogin?
Why?
11
(NOT 12 like the slides say)
Puts at increased risk of stroke, MI
Is folic acid made in your body, or retrived from your diet?
From your diet only
What is folic acid used for within the body?
cell division, making up reticulocytes
What other nutrient does folic acid need to work properly?
Vit B12
What test should you almost always perform before prescribing folic acid?
Vitamin B12 levels
(folic acid needs vitamin B12)
What test should you perform before Rx-ing epogin?
IRON LEVELS
(the building blocks for epogin)
True or False:
Only use EPO if pt is on dialysis.
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 :)
What test can you perform to tell whether the GI system is absorbing Vit B12 properly?
Shilling test - measures intrinsic factor
What the the big concern with undiagnosed B12 deficiency?
Can cause neurological disorders, which can become permanent.
Where do we obtain Vit B12?
Where is it stored?
Obtained from diet
Stored in liver
We emphasized 3 drugs that decrease absorption of B12 and folate. What are they?
Phenytoin, methotrexte, and alcohol
Does a high MCV indicate macro- or microcytic RBCs?
macrocytic
What is the most common cause of anemia in otherwise healthy adults in the US?
Blood loss, particularly from the GI tract
Most likely caused by chronic dz
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?
Serum increase: a few weeks
Fully replenished: 3-6 months
Other than GI bleeding, what can lower iron levels by decreasing absorption?
Malnutrition, alcoholism
Pregnancy
Gastric disease (IBS, gastritis, Chron’s)
If there is an acute bleed, how long might it take before H+H levels change?
24-48 hours
At what Hgb level should you definitely be considering transfusion?
7 or lower
In a CKD patient with anemia, what drug should you definitely think about prescribing?
Epogin
What do you use Neutrogin for?
neutropenia
Ohhh, you’re halfway there
Woahhhhh livin’ on a prayer
(but really, livin’ on a prayer that I pass on Monday)
In what conditions is lower extremity claudication common in?
Tobacco use, HTN, DM
What is the DOC for claudication?
(and peripheral artery disease)
Cilostazol (Pletal)
But a walking program will do wonders!!!
What is the MOA of Cilostazol (Pletal)?
phosphodiesterase inhibitor
inhibits plately phosphodiasterase thus preventing aggregation
What do you prescribe for pernicious anemia?
lifelong B12 injection IM
DOC = cyanicobalamin B12
What happens in children when they overdose on iron?
Iron toxicity! Iron leeches out into their kidney and liver, causing damage
How do you counteract iron toxicity?
DOC = Deferoxamine (desferal)
What is the MOA of deferoxamine (desferal)?
Iron chelator
Chelates iron from hemosiderin, ferritin, and transferrin
How long does it take to deplete B12 stores in an otherwise healthy patient?
3-5 years
If a patient has Vit B12 deficiency, what happens if we treat with JUST folate?
Sx will improve, but neuropathy will continue and may be irreversible
What is the DOC for knee/hip replacement surgery?
Rivaroxaban (Xarelto)
How should you advise your patient to take Rivaroxaban (Xarelto)?
Take w/ food to increase bioavailability
If you reeeeeaalllyyy would like to put your pt on Xarelto or Pradaxa but you CAN’T, then what should you put them on?
Bridge: Low molecular weight heparin (Lovenox)
Ultimately: Warfarin (Coumadin)
Because warfarin (coumadin) works slowly, but you want immediate response w/ bridge
What labs will test Warfarin (Coumadin)?
PT/INR
What labs will test Heparin?
PTT
What is the DOC for a PE?
low molecular weight heparin (lovenox)
In what cases would you want to use Fondaparinux (Arixtra) over LMW heparin (lovenox)?
If pt has had adverse rxn to any type of heparin
If pt gets TTP from using heparin
What’s the safety difference between heparin and LMW heparin (lovenox)?
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
What is the DOC for DVTs?
Still LMW heparin (lovenox)
What is the irony about the complication of heparin?
Pt can bleed too heavily OR can have a hypercoagulable state
How are you going to treat a patient who is status post acute MI?
Aspirin (ASA) AND Clopidogrel (Plavix)
What is the MOA of aspirin?
anti-platelet drug
irreversible inactivation (via acetylation) of cyclo-oxygenase.
inhibits synthesis of thromboxane A2
prevents platelet aggregation and vasoconstriction by thromboxane A2
What is the MOA of Clopidogren (Plavix)
Platelet ADP inhibitor
Irreversibly blocks ADP receptor on platelets, preventing platelet/fibrinogen binding and platelet aggregation
What if your patient is status post acute MI, and has an ASA sensitivity?
rx only Clopidogrel (Plavix)
Your patient has A-fib and mitral valve stenosis.
What drug is she NOT a candidate for?
What is the DOC?
NOT candidate for Dabigatran (Pradaxa) or Rivaroxaban (Xarelto)
DOC = Warfarin (Coumadin)
Non-acute, so NO bridge therapy.
What is the MOA of Warfarin (Coumadin)?
Blocks Vit K-mediated carboxylation of clotting factors
2, 7, 9, 10
protein C, S
Your patient is on warfarin (coumadin).
Where do you want his INR?
What do you do if INR is elevated?
Want INR at 2-3
If elevated to ~12, rx Vit K (Mephyton)
If elevtaed to ~6, just skip a dose of Warfarin
If a patient is on Warfarin w/ a high INR and you Rx Vitamin K, what can happen?
Warfarin resistance can occur for 1-2 weeks after giving the Vit K
What is the shelf life on Dabigatran (Pradaxa)?
Unopened: 4 months
Opened: 30 days
Why would you Rx Warfarin (Coumadin) over Pradaxa?
Warfarin has a longer shelf life and less side effects
BUT what is Warfarin’s PG category?
X
Which drug is cheaper: Riveroxaban (Xarelto) or Dabigatran (Pradaxa)?
Pradaxaaaaaaaaaaa
(Also, food has no effect on Pradaxa unlike Xarelto)
What is the MOA of a tPA like Alteplase (Activase)?
plasminogen activator
activates plasminogen bound to fibrin
“a drug to lyse and destroy clot formation”
Realistically, when do we ever use tPA anymore?
Not often.
Still used in stroke patients if a) non-hemorrhagic and b) pt meets time criteria
What drug is used to counter the effects of tPAs?
You must inhibit fibrinolyses
Therefore, use Aminocaproic acid (Amicar)
Oh hey, think back to the last exam. What do we have to monitor when we put a patient on methotrexate?
Lung function! Can lead to pulmonary complications, esp in COPD patients
What drug do you give to reverse the effects of Heparin?
And again, how will you monitor Heparin?
Protamin sulfate
Monitor PTT
What drug do you give to reverse the effects of Warfarin (Coumadin)?
And again, how do you monitor?
Vitamin K
Monitor with PT/INR
What’s a problem-free philosophy?
https://www.youtube.com/watch?v=xB5ceAruYrI
^^^a 4 minute break won’t hurt ya^^^
