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Heme/Onc > Pharm II: Cases/Lecture info > Flashcards

Pharm II: Cases/Lecture info Flashcards

1
Q

Why are tetracycline abx contraindicated with Iron?

A

They bind iron

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2
Q

What to monitor with Iron?

A

Serum ferritin, transferin saturation (TSAT=(serum Fe/TIBC)x100), Hgb, reticulocytes

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3
Q

What forms does deferoxamine come in?

A

PO (seldom), IV, IM, SQ

Usually IV!

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4
Q

What do you not use deferoxamine not used to treat?

A

Hemochromatosis

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5
Q

Wht drug depletes folic acid levels?

A

Methotrexate

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6
Q

What to monitor with folic acid?

A

Serum folic acid, RBC folate level, variable drug dosing 1-5mg daily

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7
Q

How is Iron transported in the body?

A

In the blood bound to transferrin

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8
Q

Where is iron stored in the body?

A

Intestinal mucosal cells, macrophages in the liver, spleen, bone

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9
Q

What is ferritin?

A

Iron + apoferritin

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10
Q

What % of ferrous iron dose is absorbed daily?

A

25%

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11
Q

Why is there a iron caution in children?

A

Iron overdose is lethal!

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12
Q

What iron drugs are IV/IM?

A

Iron dextran (IM, IV)-test dose, sodium ferric gluconate complex, iron sucrose (IV)

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13
Q

What is the daily elemental iron goal?

A

200-400mg

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14
Q

What is the daily max incorporate iron rate?

A

50-100mg

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15
Q

What is the storage pool of Vit. B12?

A

3000-5000mcg

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16
Q

What is the amount of Vit. B12 needed daily?

A

2mcg

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17
Q

What is the oral dosing for Vit. B12?

A

1000mcg daily (variable absorption at 500mcg or less)

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18
Q

What is the IM dosing for Vit. B12?

A

100-1000mcg every 1 to 3 months

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19
Q

What is tx for folate deficiency?

A

Folic acid 1mg daily

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20
Q

What can deplete folic acid storage?

A
  • Chronic alcoholism

- In end stage renal disease: dialysis removes folic acid

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21
Q

What do you need to rule out before treating with folic acid?

A

Coexisting B12 deficiency

22
Q

What does erythrocyte stimulating agent (ESA) treatment do?

A

increases reticulocytes in 5-10 days and Hgb/Hct in 2-6 weeks

23
Q

What does a person have to also take with ESA tx?

A

Iron supplementation, may also meed increased anti-coagulation

24
Q

What are “white clots”?

A

Arterial clots form around activated platelets

25
Q

What are “red clots”?

A

Venous clots from around activated fibrin and RBCs

26
Q

What are the sources of UFH?

A

pork intestinal mucosa and bovine lung tissue source

27
Q

Does UFH have any fibrinolytic activity (can’t lyse established clot)?

A

NO!

28
Q

How is LMWH Enoxeparin eliminated?

A

Renal elimination, no renal adjust CrCl >30mL/min

29
Q

Protamine sulfate drug class?

A

Indirect thrombin inhibitor antagonist

30
Q

Indications for protamine sulfate?

A

Excess heparin impact

31
Q

MOA of protamine sulfate?

A

Binds to heparin and neutralizes its anticoagulant effect

32
Q

How is protamine sulfate administered?

A

IV

33
Q

What is protamine sulfate composed of?

A

Mixture of polypeptides isolated from salmon sperm

34
Q

Which drug is protamine sulfate less effective with?

A

Less effective with LMWH then with HMWH

35
Q

What does protamine sulfate have no effect on?

A

fondaparinux

36
Q

How long will it take to see lab improvement with Ferrous sulfate for iron def anemia?

A

1-2 weeks

37
Q

How much Ferrous sulfate should you give to elderly?

A

1 325mg tab PO 1x daily and then maybe up to 2x daily if needed. 3x daily may be too much and will “bind” them up

38
Q

What is happening to anemia of chronic disease?

A

Not absorbing iron well

39
Q

What can be supplemented with Iron to help with absorption?

A

Vitamin C

40
Q

What is occurring with chronic disease anemia?

A

Decreased iron absorption

41
Q

What do you seen when you have anemia and heart failure?

A

Exacerbated symptoms

42
Q

What is the major cause for people to stop taking Iron supplements?

A

GI problems - nausea, vomiting

43
Q

What type of anemia is iron def?

A

Microcytic anemia

44
Q

Which iron supplement has the highest level of environmental iron per tablet?

A

Ferrous sulfate!

45
Q

What drug inhibits the absorption of B12 and folate?

A

Metformin!

46
Q

What may a patient complain of with B12 def anemia?

A

Numbness in lower extremities

47
Q

What don’t you get patient’s if there Hgb is above 11? Why?

A

Epogen, patient’s at increased risk for stroke and MI

48
Q

What should you test before giving folate to patients?

A

B12 levels

49
Q

What is the Schillings test?

A

Test to measure intrinsic factor to see if GI is absorbing B12

50
Q

What happens if you don’t catch B12 def?

A

Can cause permanent neurologic damage…YIKES!

51
Q

What is the most common cause of Iron def anemia in an otherwise healthy patient?

A

GI bleed or other blood loss!

52
Q

How long does iron treatment take to correct the anemia and fully replenish iron stores?

A

3-6 months

Heme/Onc (4 decks)

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