Pharmacology Flashcards
35 yo white female presents with weakness, dizziness, and epigastric pain. History of peptic ulcer disease, heavy menstrual bleeding, & chronic headaches. Meds: Tetracycline (ance), Ibuprofen (HA), and Esomeprazole (peptic ulcer dz). Has 2 children in the last 3 years -Presents: pale, lethargic, looks aged, pale nail beds -Labs abnormal!: Hgb 9 (n: 14-18) Hct 27% (n: 40-44%) Serum iron 40 (n: 50-160) Serum ferritin 9 (n: 15-200) 4+ guaiac stools (n=neg)
Which of the listed agents would be given to this patient PO? A. Ferric gluconate B. Ferrous sulfate C. Iron dextran D. Iron-sucrose complex E. Sodium ferric gluconate complex
B. Ferrous sulfate
For PO option, ferrous is better absorbed (Fe2+)
Note: Proton pump inhibitors and tetracycline may compromise absorption of dietary iron
SE of Ferrous sulfate? A. Bronchospasm B. Constipation C. Fever D. Hypertension E. Injection site reactions
B. Constipation
Inform pt to take on empty stomach + separately from tetracycline for better absorption
(oral iron therapy may cause nausea, constipation, abd cramps, dark stools)
Pt on iron therapy's 1 year old male child presents with vomiting, diarrhea that has become bloody. And x-ray shows he took her pills. Which would be given? A. Acetylcysteine B. Activated charcoal C. Deferoxamine D. Flumazenil E. Pralidoxime
C. Deferoxamine (IV, IM) or deferasirox (PO)
(chelating agent for iron)
Activated charcoal..ineffective in iron poisoning
6 mo after initiating therapy with ferrous sulfate tx, pt returns with same weakness and dizziness and is more fatigued, still pale, lethargic, + pale nail beds. Pt admits that she missed some doses but still takes peptic ulcer drugs. Stool positive for occult blood. Candidate for which therapy? A. Cyanocobalamin B. Deferasirox C. Epoetin alpha D. Folic acid E. Iron dextran
E. Iron dextran (IM and IV available)
Parenteral iron therapy is indicated for which pts?
Formulated to avoid severe toxicity of free ferric iron upon admin
Bypasses irons storage regulatory mechanisms of the intestine and can deliver more iron than can safely be stored
Pts documented with iron def who are unable to tolerate or absorb oral iron and for those with chronic extensive chronic anemia who cannot be maintained with oral iron alone
Indicated for pts with :
- excessive continuing blood loss
- IBD
- Chronic kidney dz
- Cancer
- Malabsorption conditions
35 yo male with 25 year history of diabetes mellitus diagnosed with renal failure and placed on hemodialysis 3x weekly. Throughout the year, he undergoes numerous blood transfusions to correct his anemia and becomes dependent on the transfusions. Complains of constant fatigue, poor appetite, + low energy. Lab values consistent with renal failure. -Labs: Hbg 8 (n:14-18) Hct 26% (n:42-52%) Ferritin 360 (n: 15-200) Serum iron 98 (n: 50-160)
Production of which hematopoietic growth factor is most likely reduced in this pt? What tx is most likely to correct this pt's anemia and is the most appropriate? A. Cyanocobalamin B. Darbepoetin alpha C. Filgrastim D. More transfusions E. Oprelvekin
Erythropoetin
(primarily made by kidneys so decreased)
Answer: B. Darbepoetin alpha (stimulate hematopiesis)
(Filgrastim: myeloid growth factor (not w/ AML, CML), neutropenia)
Oprelvekin: megakaryocyte growth factor (IL-11), thrombocytopenia)
note: Transfusions are associated with increased risk of hepatitis, viral infections, iron overload,
treatment‐related acute lung injury, and immunogenic reactions
Epoetin alpha, darbepoetin alpha, methoxy polethylene glycol-epoetin beta are all forms of what?
Erythropoietin
produced by kidney
-Indicated for use in anemia associated with end‐stage renal disease, drug‐induced
anemia (e.g., chemotherapy, zidovudine), AIDS, patients with low endogenous EPO
levels, autologous blood transfusions
-Nearly always coupled with oral or parenteral iron supplementation in patients
with chronic kidney disease
Erythropoietin
- Epoetin alpha
- darbepoetin alpha
- methoxy polyethylene glycol‐epoetin beta
Darbepoetin alpha is administered at dose of 0.45 mcg/kg. The pt responds appropriately with a dose-dependent rise in Hct. Which drug-related adverse effect is most likely?
A. Black stools B. Bone pain C. Cough D. Hypertension E. Malignancies
D. Hypertension
(kidneys making renin, angiotensin, ADH sys so that is not normal, unable to regulate BP well, so now erythropoetin are there to cause cardiovascular effects, also increases blood viscosity
Erythropoietic stimulating agents (ESAs) used cautiously in the clinic…why?
- Increased mortality in diseases such as cancers
- Not recommended for anemic pts who are not receiving chemotherapy or radiotherapy
- Increased risk of death by cardiovascular events when ESAs used to increase Hgb
- HTN, Thrombotic complications
41 yo female begins 1st course of adjuvant chemo for metastatic breast cancer. Following premedication with Ondansetron, she receives a combo of doxorubicin, cyclophosphamide, fluorouracil (anti-neoplastic drugs).24 hrs later, she starts a 10-day regimen of filgrastim. Why?
A. Control of nausea and emesis
B. Prevent doxorubicin‐induced cardiotoxicity
C. Reduce the risk and severity of chemotherapy‐induced neutropenia
D. Stimulate the gastric mucosa to repair damage caused by the chemotherapy
drugs
E. Stimulate the production of red blood cells
C. Reduce the risk and severity of chemotherapy‐induced neutropenia
55 yo female presents with 3 wk hx of frequent stools (3-5/day) with bright red blood. Lethargy, dizziness, ataxia, paresthesias in hands and feet. 9 mo prior, reported progressive confusion and lethargy, but a CBC revealed only mild leukocytosis. Bone marrow aspirate shows megaloblastic blood cell precursors. Which lab value is most expected?
A. Bilirubin – 0.5 mg/dL (n: 0.1‐1.0 mg/dL)
B. B12 – 94 pg/mL (n: 200‐1000 pg/mL)
C. Erythropoietin – 20 mU/mL (n: 4‐26 mU/mL)
D. Folate – 0.5 ng/mL (n: 2‐20 ng/mL)
E. Hgb – 12 g/dL (n: 12‐16 g/dL)
B. B12….can cause megaloblatic anemia and presents with neuro issues
-Bilirubin – elevated in pernicious anemia
-Erythropoietin – may be elevated to make up for blood loss; elevated in chemotherapy‐induced anemia;
depressed in anemia of chronic disease
-Folate – deficiencies cause pernicious anemia but without the neurological symptoms
-Hgb – may be lower due to recent blood loss
- Results from impaired DNA synthesis in replicating cells leading to a large immature nucleus.
- Clinical effects of vit B12 and folic deficiencies can occur.
Megaloblastic anemia
Tx for megaloblastic anemia?
-Low vitamin B12, then vitamin B12 supplementation (Cyanocobalamin and hydroxocobalamin)
-Low folic acid – folic acid supplementation (No effect on the neurological symptoms associated with megaloblastic anemias even
though it will largely correct the anemia caused by the vitamin B12 deficiency)
-Again, determine whether malabsorption is an issue (PO vs. IV)
For the following hematopoietic GF, what clinical condition is being treated or prevented? Who are the recipients?
Erythropoietin, darbepoetin alfa
Anemia
•Patients with chronic renal failure
•HIV‐infected patients treated with zidovudine
•Cancer patients treated with myelosuppressive cancer
chemotherapy
•Patients scheduled to undergo elective, noncardiac,
nonvascular surgery
For the following hematopoietic GF, what clinical condition is being treated or prevented? Who are the recipients?
Filgrastim: Granulocyte colony-stimulating factor (G-CSF)
Sargramostim: Granulocyte-macrophage colony stimulating factor (GM-CSF)
Neutropenia (cancer pts treated w/ myelosuppressive cancer chemo)
Stem cell or bone marrow transplantation
Mobilization of peripheral blood progenitor cells (PBPC’s) (transplants)
For the following hematopoietic GF, what clinical condition is being treated or prevented? Who are the recipients?
Oprelvekin (IL-11 )
Thrombocytopenia
Patients with nonmyeloid malignancies who receive
myelosuppressive cancer chemotherapy
For the following hematopoietic GF, what clinical condition is being treated or prevented? Who are the recipients?
Romiplostim
Thrombocytopenia
Patients with idiopathic thrombocytopenic purpura
What are the 3 oral iron drugs?
- Ferrous sulfate
- Ferrous gluconate
- Ferrous fumarate
(Only ferrous salts should be used because ferrous iron is most efficiently absorbed)
What are the 3 parenteral iron drugs?
- Iron dextran (IM or IV, hypersensitivity rxns)
- Iron-sucrose complex (IV)
- Sodium ferric gluconate complex (IV)
What are the 2 iron chelators that may be used in iron overdose?
- Deferoxamine
- Deferasirox (reduces liver iron)
What are the two B12 drugs?
- Cyanocobalamin
- Hydroxocobalamin
What are the two erythrocyte-stimulating agents
- Epoetin alpha (Epogen, Procrit)
- Darbepoetin alpha
What are the two myeloid growth factors that are granulocyte stimulating? (G-CSF)
Filgrastim (Neupogen)
Pegfilgrastim
What is the myeloid growth factors that are granulocyte-macrophage stimulating? (GM-CSF)
What are the SE?
Sargramostim
Can cause fever, malaise, arthralgias, myalgias, and a capillary leak syndrome
characterized by peripheral edema and pleural or pericardial effusions so not used as much as the G-CSF drugs!
What are the two megakaryocyte growth factors?
Oprelvekin (IL-11 b)
Romiplostim
Increased erythropoiesis is associated with an increase in the number of ________ receptors on developing erythroid cells
transferrin
Iron store depletion and iron deficiency anemia are associated with an increased concentration of serum _________
transferrin
What drug can be used in pts that dont respond to G-CSF alone?
Plerixafor
Results in mobilization of hematopoietic stem and progenitor cells from bone marrow
into peripheral blood
Use in combination with filgrastim
What is the MOA of Oprelvekin (IL-11)?
Stimulate the growth of primitive megakaryocytic progenitors; increases the number of peripheral platelets and neutrophils
Which drug is a recombinant thrombopoeitin?
Romiplostim
Sctivates Mpl thrombopoietin receptor to cause a dose-dependent increase in
platelet count
What are the SE of Oprelvekin (IL-11)?
-Fatigue, headache, dizziness, and cardiovascular effects
(e.g., anemia, dyspnea,
transient atrial arrhythmias) are the most common
-Hypokalemia
What are the 5 first line NRTIs?
Abacavir (ABC) Emtricitabine (FTC) Lamivudine (3TC) Tenofovir (TDF) Zidovudine (ZDV)
