Pharmacology of Anemia

Question 1

What is the most common nutritional cause of anemia?

Answer 1

Iron deficiency Anemia

Question 2

If Iron deficiency anemia is SEVERE, how do you treat it?

Answer 2

RBC transfusion

Question 3

Is there a mechanism for elimination of excess iron?

Answer 3

No

Question 4

What things can activate Hepcidin?

Answer 4

(Increased hepcidin = decreased absorption)

• Iron
• Inflammation

Question 5

MCV < 80

Answer 5

Microcytic Anemia

Question 6

Most common cause of Microcytic Anemia?

Answer 6

Decreased Iron

Question 7

Diet items to increase iron?

Answer 7

Meat, fish, poultry

Question 8

Oral treatment for Microcytic Anemia due to decreased iron?

Answer 8

200-400 mg of ferrous iron once a day with water/juice

Question 9

200-400 mg of ____ once a day with water/juice treats Microcytic Anemia

Answer 9

Ferrous iron

Question 10

What are the possible adverse side effects of oral treatment of iron for microcytic anemia?

Answer 10

Dark stools, nausea, constipation, heartburn, anorexia

Question 11

Parenteral treatment for Microcytic Anemia due to decreased iron?

Answer 11

IV - LMW iron dextran or any complex with “ferric” or “iron”

Question 12

IV - ______ can treat Microcytic Anemia

Answer 12

LMW iron dextran

Question 13

What Parenteral treatment for Microcytic Anemia due to decreased iron can be given quickly?

Answer 13

Ferumoxytol

Question 14

Is anaphylaxis common with Parenteral treatment for Microcytic Anemia?

Answer 14

No - similar side effects to the oral iron given

= heartburn, anorexia, dark stools, constipation, nausea

Question 15

Who usually gets iron poisoning?

Answer 15

Children taking iron tablets

Question 16

Cascade of symptoms for iron poisoning?

Answer 16

• Necrotizing gastroenteritis, abdominal pain, vomiting
• Shock, shortness of breath, lethargy
• slight improvement
• Coma/death

Question 17

What is the treatment for iron poisoning?

Answer 17

Bowel irrigation and parenteral Deferoxamine

Question 18

Parenteral Deferoxamine treats?

Answer 18

Iron poisoning

Question 19

Deficiencies of _____ can cause Megaloblastic/Macrocytic Anemia

Answer 19

B12 and Folate

Question 20

Sources of B12?

Answer 20

Meat products or fortified cereals

Question 21

Your body stores this vitamin so that it takes years to develop a deficiency

Answer 21

B12

Question 22

Causes of B12 deficiency?

Answer 22

Pernicious anemia
Gastrectomy
H. Pylori infection

Question 23

What analgesic inhaled during surgery can inactivate vitamin B12?

Answer 23

Nitrous oxide

Question 24

What are the symptoms of low B12?

Answer 24

Atrophic glossitis
NEURO - paresthesias, gait disturbances, weakness
Hyperpigmentation

Question 25

Atrophic glossitis, NEURO - paresthesias, gait problems and weakness, hyperpigmentation in combo with Megaloblastic anemia indicate?

Answer 25

B12 deficient

Question 26

Oral treatment (that works even for those with Pernicious anemia) for B12 deficiency that causes Megaloblastic anemia?

Answer 26

1-2 mg/day (500X daily need) that uses an alternative path for absorption so those with pernicious anemia can still take it even if they do not have intrinsic factor to absorb it

Question 27

When do you give Parenteral treatment for B12 deficiency that causes Megaloblastic anemia?

Answer 27

When NEURO symptoms are present

Question 28

Parenteral treatment for B12 deficiency?

Answer 28

Cyanocobalamin | - Adverse events rare

Question 29

2 usual causes of Folate deficiency that can cause Megaloblastic anemia?

Answer 29

Inadequate dietary intake | Alcoholism

Question 30

What are the symptoms of low folate?

Answer 30

Neural tube defects | Mouth ulcers

Question 31

Neural tube defects and mouth ulcers in combo with Megaloblastic anemia indicate?

Answer 31

Folate deficiency

Question 32

Treatment for Folate deficiency that causes Megaloblastic anemia?

Answer 32

Oral folate - 1mg/day for 4 months OR 1-5mg/day

Question 33

Higher doses of Folate can cause what side effects?

Answer 33

Hypoglycemia and Hypotension

Question 34

What is the treatment for Anemia of Chronic Disease?

Answer 34

Epoetin Alfa

Question 35

How is Epoetin Alfa administered and what does it treat?

Answer 35

IV or subcutaneous | - Treats Anemia of Chronic Disease and Anemia caused by chemotherapy

Question 36

How does Epoetin Alfa work?

Answer 36

Stimulates erythropoeisis and increases reticulocytes

Question 37

What is a drug that has a 3X longer half-life than Epoetin Alfa?

Answer 37

Darbepoetin Alfa (21 hour half life)

Question 38

The use of this drug was banned by the olympics

Answer 38

Epoetin Alfa | - Treats Anemia of Chronic Disease and Anemia due to Chemotherapy

Question 39

What is the ONLY treatment for Sickle Cell Anemia?

Answer 39

Hydroxyurea

Question 40

Hydroxyurea treats?

Answer 40

Sickle cell anemia

Question 41

How does Hydroxyurea work and how is it given?

Answer 41

Given Orally | - Unknown mechanism = INCREASES Fetal Hemoglobin

Question 42

This drug increased Fetal Hemoglobin

Answer 42

Hydroxyurea

Question 43

What drug treats Paroxysmal Nocturnal Hemoglobinuria?

Answer 43

Eculizumab

Question 44

Eculizumab treats?

Answer 44

PNH (paroxysmal nocturnal hemoglobinuria)

Question 45

How is Eculizumab administered to treat PNH?

Answer 45

IV - once per week for the first 4 weeks; then every 2 weeks after that

Question 46

How does Eculizumab work?

Answer 46

Blocks C5a from going to C5b and activating the complement MAC to lyse RBCs

Question 47

Possible side effects of taking Eculizumab?

Answer 47

Viral, meningococcal and respiratory infections Headache, hypertension Pain, anemia

Question 48

What are the possible side effects of taking Epoetin Alfa to treat Anemia of Chronic DIsease?

Answer 48

MI, tumor progression, death, stroke, VTE