Pharm II: Cases/Lecture info Flashcards
Why are tetracycline abx contraindicated with Iron?
They bind iron
What to monitor with Iron?
Serum ferritin, transferin saturation (TSAT=(serum Fe/TIBC)x100), Hgb, reticulocytes
What forms does deferoxamine come in?
PO (seldom), IV, IM, SQ
Usually IV!
What do you not use deferoxamine not used to treat?
Hemochromatosis
Wht drug depletes folic acid levels?
Methotrexate
What to monitor with folic acid?
Serum folic acid, RBC folate level, variable drug dosing 1-5mg daily
How is Iron transported in the body?
In the blood bound to transferrin
Where is iron stored in the body?
Intestinal mucosal cells, macrophages in the liver, spleen, bone
What is ferritin?
Iron + apoferritin
What % of ferrous iron dose is absorbed daily?
25%
Why is there a iron caution in children?
Iron overdose is lethal!
What iron drugs are IV/IM?
Iron dextran (IM, IV)-test dose, sodium ferric gluconate complex, iron sucrose (IV)
What is the daily elemental iron goal?
200-400mg
What is the daily max incorporate iron rate?
50-100mg
What is the storage pool of Vit. B12?
3000-5000mcg
What is the amount of Vit. B12 needed daily?
2mcg
What is the oral dosing for Vit. B12?
1000mcg daily (variable absorption at 500mcg or less)
What is the IM dosing for Vit. B12?
100-1000mcg every 1 to 3 months
What is tx for folate deficiency?
Folic acid 1mg daily
What can deplete folic acid storage?
- Chronic alcoholism
- In end stage renal disease: dialysis removes folic acid
What do you need to rule out before treating with folic acid?
Coexisting B12 deficiency
What does erythrocyte stimulating agent (ESA) treatment do?
increases reticulocytes in 5-10 days and Hgb/Hct in 2-6 weeks
What does a person have to also take with ESA tx?
Iron supplementation, may also meed increased anti-coagulation
What are “white clots”?
Arterial clots form around activated platelets
What are “red clots”?
Venous clots from around activated fibrin and RBCs
What are the sources of UFH?
pork intestinal mucosa and bovine lung tissue source
Does UFH have any fibrinolytic activity (can’t lyse established clot)?
NO!
How is LMWH Enoxeparin eliminated?
Renal elimination, no renal adjust CrCl >30mL/min
Protamine sulfate drug class?
Indirect thrombin inhibitor antagonist
Indications for protamine sulfate?
Excess heparin impact
MOA of protamine sulfate?
Binds to heparin and neutralizes its anticoagulant effect
How is protamine sulfate administered?
IV
What is protamine sulfate composed of?
Mixture of polypeptides isolated from salmon sperm
Which drug is protamine sulfate less effective with?
Less effective with LMWH then with HMWH
What does protamine sulfate have no effect on?
fondaparinux
How long will it take to see lab improvement with Ferrous sulfate for iron def anemia?
1-2 weeks
How much Ferrous sulfate should you give to elderly?
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
What is happening to anemia of chronic disease?
Not absorbing iron well
What can be supplemented with Iron to help with absorption?
Vitamin C
What is occurring with chronic disease anemia?
Decreased iron absorption
What do you seen when you have anemia and heart failure?
Exacerbated symptoms
What is the major cause for people to stop taking Iron supplements?
GI problems - nausea, vomiting
What type of anemia is iron def?
Microcytic anemia
Which iron supplement has the highest level of environmental iron per tablet?
Ferrous sulfate!
What drug inhibits the absorption of B12 and folate?
Metformin!
What may a patient complain of with B12 def anemia?
Numbness in lower extremities
What don’t you get patient’s if there Hgb is above 11? Why?
Epogen, patient’s at increased risk for stroke and MI
What should you test before giving folate to patients?
B12 levels
What is the Schillings test?
Test to measure intrinsic factor to see if GI is absorbing B12
What happens if you don’t catch B12 def?
Can cause permanent neurologic damage…YIKES!
What is the most common cause of Iron def anemia in an otherwise healthy patient?
GI bleed or other blood loss!
How long does iron treatment take to correct the anemia and fully replenish iron stores?
3-6 months
