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Haem > Pharmacology for cytopenia > Flashcards

Pharmacology for cytopenia Flashcards

1
Q

Types of iron supplementation

A
  • Oral: ferrous sulfate
  • IV: iron sucrose
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2
Q

Elimination of iron

A
  • Minimal in feces, bile, urine, sweat
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3
Q

ADR of iron

A

Acute:
- Necrotising gastroenteritis with vomiting, abdo pain and bloody diarrhea
- May be followed by shock, lethargy, dyspnea, metabolic acidosis, coma & death

Chronic:
- Hemochromatosis
- Iron deposited in major organs –> failure

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4
Q

Treatment for iron toxicity

A
  • Parenteral deferoxamine
  • Oral deferasirox
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5
Q

Types of vit B12 supplementation

A

Parenteral hydroxocobalamin (preferred to cyanocobalamin)

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6
Q

Elimination of vit B12

A
  • Bile & urine
  • Excess stored in the liver
  • t1/2: 26-31 hours (IV)
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7
Q

ADR of vit B12

A
  • Photosensitivity
  • Injection site pain
  • Hypertension, flushing
  • Arrhythmias secondary to hypokalemia
  • GI disturbance
  • Dizziness, headache
  • Tremor, parasthesia
  • Chromatouria
  • Acneiform and bullous eruption
  • Rash, itch
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8
Q

DDI of vit B12

A

PPI (impede absorption)

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9
Q

Absorption of folic acid

A
  • Rapid following PO
  • F: 100%
  • Peak reached in 1 hour
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10
Q

Metabolism of folic acid

A
  • Liver & plasma
  • Converted to active metabolite (5 methytetrahydrofolate)
  • Enterohepatic recirculation
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11
Q

Elimination of folic acid

A

Urine

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12
Q

Contraindications of folic acid

A
  • Untreated cobalamin deficiency (including pernicious anemia)
  • Malignant disease
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13
Q

Precautions for folic acid

A
  • Patients with folate-dependent tumor, hemolytic anemia, alcoholism
  • Women with pre-existing DM, obesity, FH or previous pregnant history of neural tube defects
  • Not to be used as mono therapy for pernicious, aplastic, normocytic anemia (with B12 deficiency)
  • Children, pregnancy & lactation
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14
Q

ADR of folic acid

A
  • GI disturbance (bitter taste, nausea, abdo distension, flatulence)
  • Immune: allergy, sensitisation
  • Anorexia (rare)
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15
Q

DDI for folic acid

A
  • Reduce conc of anticonvulsants
  • Increase efficacy of lithium
  • Decrease effect of methotrexate
  • Elimination increased with aspirin
  • Absorption reduced with sulfasalazine & triamterene
  • Metabolism disrupted with chloramphenicol, bactrim
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16
Q

Absorption of ESA

A

IM: slow
SC: slow & incomplete
IV: rapid

17
Q

Distribution of ESA

A

Concentrated in liver, kidneys, bone marrow

18
Q

Metabolism of ESA

A

Limited protein degradation

19
Q

Elimination of ESA

A
  • Feces (main), urine (small amounts)
  • t1/2: epoetin alpha (4-13 hours), darbepoetin (20-25 hours)
20
Q

Cautions for ESA

A

Contraindication
- Uncontrolled hypertension

Caution
- Hypertension
- Ischemic vascular disease
- History of seizures
- Hepatic / renal impairment
- Sickle cell anemia
- Children, pregnancy, lactation

21
Q

ADR of ESA

A
  • Hypertension, edema
  • Increased platelet
  • Thrombosis, stroke
  • Hyperkalemia
  • Seizures
  • Myalgia, arthralgia, limb pain
  • GI (N,V)

Epoetin alpha: pruritus
Darbepoetin: dyspnea, cough, bronchitis

22
Q

Examples of myeloid GFs

A

G-CSF:
- Filgrastim
- Pegfilgrastim
- Plerixafor

GM-CSF
- Sargramostim

23
Q

ADR of myeloid GFs

A
  • G-CSF better tolerated

G-CSF:
- Bone pain (reversible)

GM-CSF:
- Fever, malaise
- Arthralgia, myalgia

Severe:
- Sickle cell crisis
- Capillary leak syndrome
- ARDS
- Splenic rupture (rare)

24
Q

Cautions for myeloid GFs

A
  • Pts with pre-malignant or malignant myeloid conditions
  • Acute myeloid leukaemia
  • Sickle cell diseases
  • Recent history of pneumonia or lung infiltrates
  • Osteoporotic bone disease
  • Not indicated for chronic myeloid leukaemia or myelodysplastic syndrome!!
25
Q

Megakaryocyte GFs

A
  • Oprelvekin (IL-11)
  • Romiplostim (Fc-peptide fusion protein thrombopoietin receptor agonist)
  • Eltrombopag (non-peptide thrombopoietin receptor agonist)
26
Q

ADR of megakaryocyte GFs

A
  • Thromboembolic events

Oprelvekin:
- Fluid retention, peripheral edema
- Dyspnea on exertion

27
Q

Cautions for megakaryocyte GFs

A
  • Pts with h/o cerebrovascular disease
  • Risk factors for thromboembolism
  • (Eltrombopag) Higher dose required for non-East Asian ancestry
  • (Oprelvekin) Heart failure pts or at risk of developing HF

Haem (5 decks)

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