Pharmacologic Approach to Anemia Flashcards
What are the 3 main causes of anemia?
blood loss
reduced RBC production
Increased RBC destruction
Hepcidin causes decreased production of this hormone by the kidney peritubular cells.
EPO
When is parenternal Fe therapy preferable to oral treatment of Fe deficient anemia?
Pt is unable to take things PO
Pt has extensive chronic anemia not maintained with oral Fe alone
- advanced chronic renal disease requiring hemodialysis and tx with EPO
- various postgastrectomy conditions
- previous small bowel resection (duodenum)
- infl. bowel disease involving duodenum
- malabsorption syndromes
Which form of Fe is bound to ferritin, ferrous (Fe2+) or ferric (Fe3+)?
Ferric
The drugs that begin with “defer-“ that are given to prevent Fe overload act by doing what?
chelating Fe for elimination in urine. Removes Fe from hemosiderin, ferritin, and transferrin, but not Fe from hemoglobin. Therefore, it does not affect hemoglobin formation.
Iron dextran is associated with what severe condition?
allergic anaphylaxis.
It is often given with prophylactic corticosteroids
What is the most common cause of B12 deficiency?
malabsorption
What is cobalamin?
B12
For which of the following anemias should supplemental B12, folate, or Fe NOT be administered? Pernicious microcytic hypochromic megaloblastic hemolytic
Hemolytic
What is the normal route of Fe elimination?
Feces
Pts with unexplained Fe deficiency anemia should be evaluated for:
occult GI bleeding
Why are hematopoietic growth factor drugs administered by injection?
acid instability
When administering EPO to help with anemia, what is the theory that governs how much you administer?
Lowest dose sufficient to reduce need for RBC transfusion. Giving too much will increase RBC production too much and make blood hyper viscous, causing problems.
List a few circumstances under which you would want to be very careful when administering therapeutic EPO.
Hemoglobin > 11g/dL, esp. with renal impairment/failure
Certain malignancies
All surgery pts. Give DVT prophylaxis. Should receive Fe supplementation throughout course of EPO therapy.
What is the difference between darbepoetin and epoetin?
Are either removed by hemodialysis?
Darbepo is the glycosylated form with a 22hr 1/2 life compared to the 1/2 life of EPO which is on the order of minutes. Neither drug is removed by hemodialysis.
Which hormones are responsible for upregulation of pluripotent stem cell production?
SCF/FL
Which cytokines/hormones are responsible for upregulation of lymphocyte progenitor production?
IL-1, 2, 3, 4, 6
Which cytokines/hormones are responsible for upregulation of myelogenic progenitor production?
GM-CSF, IL-3
What does oprelvekin do?
It is a recombinant interleukin eleven (IL-11), a thrombopoietic growth factor that directly stimulates the proliferation of hematopoietic stem cells and megakaryocyte progenitor cells and induces megakaryocyte maturation resulting in increased platelet production.
What hormone is given to enhance RBC proliferation?
EPO
What hormone(s) are given to enhance granulocyte, eosinophil, and basophil proliferation?
GM-CSF, G-CSF
What hormone(s) are given to enhance monocyte proliferation?
GM-CSF, M-CSF
What cytokine(s)/hormone(s) are given to enhance megakaryocyte proliferation?
IL-6, 11 (Oprelvekin)
Thrombopoietin
What is filgrastim?
What are its indications?
Filgrastim is a granulocyte colony-stimulating factor (G-CSF for all granulocytes) analog used to stimulate the proliferation and differentiation of granulocytes; it is a pharmaceutical analog of naturally occurring G-CSF.
Given < 24hrs prior to and after cytotoxic chemotherapy
