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OS1 - Heme > Pharmacologic Approach to Anemia > Flashcards

Pharmacologic Approach to Anemia Flashcards

1
Q

What are the 3 main causes of anemia?

A

blood loss
reduced RBC production
Increased RBC destruction

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2
Q

Hepcidin causes decreased production of this hormone by the kidney peritubular cells.

A

EPO

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3
Q

When is parenternal Fe therapy preferable to oral treatment of Fe deficient anemia?

A

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

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4
Q

Which form of Fe is bound to ferritin, ferrous (Fe2+) or ferric (Fe3+)?

A

Ferric

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5
Q

The drugs that begin with “defer-“ that are given to prevent Fe overload act by doing what?

A

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.

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6
Q

Iron dextran is associated with what severe condition?

A

allergic anaphylaxis.

It is often given with prophylactic corticosteroids

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7
Q

What is the most common cause of B12 deficiency?

A

malabsorption

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8
Q

What is cobalamin?

A

B12

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9
Q 
For which of the following anemias should supplemental B12, folate, or Fe NOT be administered?
Pernicious
microcytic hypochromic
megaloblastic
hemolytic
A

Hemolytic

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10
Q

What is the normal route of Fe elimination?

A

Feces

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11
Q

Pts with unexplained Fe deficiency anemia should be evaluated for:

A

occult GI bleeding

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12
Q

Why are hematopoietic growth factor drugs administered by injection?

A

acid instability

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13
Q

When administering EPO to help with anemia, what is the theory that governs how much you administer?

A

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.

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14
Q

List a few circumstances under which you would want to be very careful when administering therapeutic EPO.

A

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.

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15
Q

What is the difference between darbepoetin and epoetin?

Are either removed by hemodialysis?

A

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.

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16
Q

Which hormones are responsible for upregulation of pluripotent stem cell production?

A

SCF/FL

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17
Q

Which cytokines/hormones are responsible for upregulation of lymphocyte progenitor production?

A

IL-1, 2, 3, 4, 6

18
Q

Which cytokines/hormones are responsible for upregulation of myelogenic progenitor production?

A

GM-CSF, IL-3

19
Q

What does oprelvekin do?

A

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.

20
Q

What hormone is given to enhance RBC proliferation?

A

EPO

21
Q

What hormone(s) are given to enhance granulocyte, eosinophil, and basophil proliferation?

A

GM-CSF, G-CSF

22
Q

What hormone(s) are given to enhance monocyte proliferation?

A

GM-CSF, M-CSF

23
Q

What cytokine(s)/hormone(s) are given to enhance megakaryocyte proliferation?

A

IL-6, 11 (Oprelvekin)

Thrombopoietin

24
Q

What is filgrastim?

What are its indications?

A

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

25
Q

What is sargramostim?

What are its indications?

A

Sargramostim is a recombinant granulocyte macrophage colony-stimulating factor (GM-CSF, for all myeloid line cells) that functions as an immunostimulator.
Given < 24 hrs prior to and after cytotoxic chemotherapy

26
Q

Where does the majority of the Fe used to support hematopoiesis come from?

A

reclaimed from catalysis of the Hb in senescent or damaged erythrocytes.

27
Q

Your pt is Fe deficient. What do you prescribe as therapy?

A

Ferrous sulfate or ferrous gluconate 325 mg (this is 65mg elemental Fe or 36mg for f. gluconate) Q 3-4 hrs
200-400 mg of elemental Fe should be given daily to correct Fe deficiency most rapidly

28
Q

How long should oral Fe therapy continue after correction of the cause of Fe loss?

A

3-6 months. Corrects anemia, replenishes Fe stores.

29
Q

Why is Iron Dextran administered?

A

Because parenteral admin. of inorganic free ferric Fe produces serious dose dependent tox. severely limiting the dose that can be administered. Fe dextran is administered IV or IM when oral Fe salts are not an option

30
Q

How do you treat chronic Fe overload?

A

intermittent phlebotomy. Remove about 1 unit blood per week.

31
Q

What is the recommended dose of folic acid to reverse megaloblastic anemia?

A

oral, 1 mg daily. continue therapy until underlying cause of deficiency is removed or corrected

32
Q

List 4 drugs that induce folate deficiency.

A

Methotrexate **
Trimethoprim
Pyrimethamine
Phenytoin (reduces intestinal uptake)

33
Q

What drug can be used as a folate deficiency rescue

A

leucovorin

34
Q

What hormone necessary to RBC production may be low in renal failure?

A

EPO

35
Q

Would you expect EPO levels to be high or low in primary bone marrow disorders/malignancies?

A

High

36
Q

Would administration of EPO be good or bad when treating a blood line malignancy?

A

Bad. It would be counterproductive

37
Q

Myeloid growth factors interact with receptors that are members of which superfamily?

A

JAK/STAT

38
Q

What drug would you give if your goal was to accelerate the rate of neutrophil recovery after dose-intensive myelosuppressive chemo?

A

G-CSF analogs like Filgrastim or Pegfilgrastim

39
Q

Sargramostim is a drug analog for what growth factor?

A

GM-CSF. Same indications as G-CSF but broader cell line effects because it stimuletes growth of entire myeloid line.

40
Q

What is Romiplostin?

A

Drug that activates TPO to induce thrombocyte production.

OS1 - Heme (31 decks)

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