Pharmacology Flashcards
Explain Iron Salt Supplements
They are all Ferrous
Ferrous sulfate, “” gluconate, Fumarate, Lactate
Taken on an empty stomach an hour before meals.
Things with ascorbic acid increase absorption (Orange Juice)
Antacids, eggs, milk, coffee, and tea reduce absorption
Indications: Iron deficiency, fatigue, pregnancy
ADR: Abdominal pain, constipation
- Gastrointestinal hemorrhage
- Black Box: Cause Iron poisoning in children
Considerations: levothyroxine shouldn’t be taken together within 4 hours
- Don’t take within 2 hrs of tetracycline antibiotics.
- Don’t use in patients with hemochromatosis.
Explain Nutritive Agent Vitamin B12
Cyanocobalamin
Paenteral, oral, and nasal spray
IM injections of 1000-2000 mcg will achieve neuro and hematologists responses.
Oral for those that have marginally low levels.
Nasal spray used for patients in remission following IM injection with no nervous system involvement
Pregnancy C
Indications: Cobalamin deficiency, pernicious anemia
ADR: Well Tolerated!
-Rarely see hyperuricemia and hypokalemia
Considerations: Intranasal 1 hr before or after food or hot liquid
- Tablets with food and not within 2 hours of other medications
- No alcohol while using oral formulation
What does Vitamin B12 Anemia cause?
Bilateral parenthesis in extremities, proprioception deficits, dementia-like symptoms, sore beefy-red tongue, reduced appetite.
MCV elevated
Low B12
Low hematocrit
What does folic acid anemia present with?
No neurological manifestations, reduced appetite, red beefy tongue
Most common with excessive alcohol intake and pregnancy.
Nutritive Agent Folic Acid
Oral 1mg-5mg
Pregnancy A
Well tolerated
ADR: allergic reaction
Considerations: Don’t drink alcohol while taking this drug.
Erythropoietic Drugs
Epoetin Alfa, Darbepoetin Alfa
Same biological effects as endogenous EPO in the kidney. Stimulates RBC
Epoetin 1/2 life: 4-13 hrs
Darbepoetin Alfa: 74 hrs
Pregnancy C
Indications: Anemia due to chemotherapy, HIV, chronic kidney disease
ADR: Nausea, headache, HTN, increased cardiovascular event
Black Box: Increase risk of death, MI, stroke
Considerations: Use caution in patients with HTN
- Iron deficiency can occur
- **Monitor Hemoglobin don’t exceed 12 g/dL
- Does not rise greater than 1 g/dL every 2 weeks.
Antimetabolite Hydroxyurea
Induces HbF in RBC
1/2 life: 2-4.5 hrs
Renal excretion: 40% unchanged
Liver metabolism: 60%
Pregnancy: D
Indications: Sickle Cell, essential thrombocytopenia, chronic myeloid leukemia, squamous cell carcinoma
ADR: Myelosuppression, neutropenia, decreased platelet, ulcer of lower extremity, skin cancer
Black Box: May cause severe myelosuppression
Consiserations: Increases HbF to 20% or more
- Decreases painful crises by 50%
- Decrease need of transfusion
- Does not prevent end-organ damage or stroke
- Protect against sun
- Monitor the fetal hemoglobin every 3-4 months
Antineoplastic Agent
5-azacytidine, Decitabine
DNA demethylation agents reverse methylation of gamma globin and induce HbF
5-axacytidine 1/2 life: 4 hours renal excretion 50%, IV 85%
Decitabine 1/2 life: .5-.6 hrs excreted regally
Pregnancy: D
Indications: Myelodysplastic Syndrome, refractory anemia, chronic myelomonocytic leukemia
ADR: Constipation, diarrhea, Atrial fibrillation
Cytotoxic!!! Interfere with normal DNA so not used as therapy for Sickle Cell anemia
What group of drugs can you use to treat neutropenia?
Colony-stimulating factors (CSF)
Colony Stimulating Factor
Filgrastim, Pegfilgrastim, Sargramostim
Acts on hematopoietic cells and stimulating production of neutrophils
Filgrastim 1/2 life: 3.5 hrs. (G-CSF) specific
Pegfilgrastim: 15-80 hrs
Sargramostim: 3.85 hrs (GS-CSF) Non specific
pregnancy: C
ADR: Well Tolerated
-Rash, diarrhea, acute respiratory distress
Considerations: During first 4 weeks of therapy do a CBC and platelet count every 2 weeks. Move to once a month once on stable dose.
-Advise patient to report respiratory infection or distress.
Thrombopoietic Growth Factor
Oprelvekin
IL-11, to stimulate production of GM-CSF to stimulate Thrombopoiesis. Causes dose-dependent increase in platelet
1/2 life: 6.9 hrs
Pregnancy: C
Indications: Thrombocytopenia
ADR: Rash, nausea, vomiting, Atrial arrhythmia, fluid retention
Considerations: Report fever and infection signs as well as signs of fluid retention.
-Useful in patients with nonmyeloid malignancies form chemotherapy.
Thrombo poietin Receptor Agonist
Eltrombopag
Romiplostim
Eltrombopag: TPO receptor agonist
1/2: 21-35 hrs
Pregnancy: C
Indications: Thrombocytgopenia, aplastic anemia
ADR: Hepatoxicity, hemorrhage
Black Box: Pt. With chronic hep C, with interferon and ribavirin may increase risk of hepatic decompensation
Considerations: Monitor hepatic function, may need to discontinue
Romiplostim
Recombinant IgG Fc-peptide that activates the TPO receptor
1/2 3.5 days
Pregnancy: C
Indications: Thrombocytopenia’
ADR: Hemorrhage, acute myeloid leukemia
Considerations: May increase risk of bleeding
- Should avoid when pt takes medications that cause bleeding
- Monitor CBC with platelet count weekly to adjust dose
What is the difference between the intrinsic vs the extrinsic pathway of coagulation?
Intrinsic starts with 12 to activate 10, and extrinsic starts with 8 to get 10 going.
What factors does Prothrombin time test identify?
Activated partial thromboplastin time?
1, 2, 5, 7, 10
1, 2, 5, 8, 9, 10
What is hemophilia A associated with?
B?
C?
A: Factor 8
B: Factor 9
C: Factor 11
