Pharmacology of Anemia Flashcards
What is the most common nutritional cause of anemia?
Iron deficiency Anemia
If Iron deficiency anemia is SEVERE, how do you treat it?
RBC transfusion
Is there a mechanism for elimination of excess iron?
No
What things can activate Hepcidin?
(Increased hepcidin = decreased absorption)
- Iron
- Inflammation
MCV < 80
Microcytic Anemia
Most common cause of Microcytic Anemia?
Decreased Iron
Diet items to increase iron?
Meat, fish, poultry
Oral treatment for Microcytic Anemia due to decreased iron?
200-400 mg of ferrous iron once a day with water/juice
200-400 mg of ____ once a day with water/juice treats Microcytic Anemia
Ferrous iron
What are the possible adverse side effects of oral treatment of iron for microcytic anemia?
Dark stools, nausea, constipation, heartburn, anorexia
Parenteral treatment for Microcytic Anemia due to decreased iron?
IV - LMW iron dextran or any complex with “ferric” or “iron”
IV - ______ can treat Microcytic Anemia
LMW iron dextran
What Parenteral treatment for Microcytic Anemia due to decreased iron can be given quickly?
Ferumoxytol
Is anaphylaxis common with Parenteral treatment for Microcytic Anemia?
No - similar side effects to the oral iron given
= heartburn, anorexia, dark stools, constipation, nausea
Who usually gets iron poisoning?
Children taking iron tablets
Cascade of symptoms for iron poisoning?
- Necrotizing gastroenteritis, abdominal pain, vomiting
- Shock, shortness of breath, lethargy
- slight improvement
- Coma/death
What is the treatment for iron poisoning?
Bowel irrigation and parenteral Deferoxamine
Parenteral Deferoxamine treats?
Iron poisoning
Deficiencies of _____ can cause Megaloblastic/Macrocytic Anemia
B12 and Folate
Sources of B12?
Meat products or fortified cereals
Your body stores this vitamin so that it takes years to develop a deficiency
B12
Causes of B12 deficiency?
Pernicious anemia
Gastrectomy
H. Pylori infection
What analgesic inhaled during surgery can inactivate vitamin B12?
Nitrous oxide
What are the symptoms of low B12?
Atrophic glossitis
NEURO - paresthesias, gait disturbances, weakness
Hyperpigmentation
Atrophic glossitis, NEURO - paresthesias, gait problems and weakness, hyperpigmentation in combo with Megaloblastic anemia indicate?
B12 deficient
Oral treatment (that works even for those with Pernicious anemia) for B12 deficiency that causes Megaloblastic anemia?
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
When do you give Parenteral treatment for B12 deficiency that causes Megaloblastic anemia?
When NEURO symptoms are present
Parenteral treatment for B12 deficiency?
Cyanocobalamin
- Adverse events rare
2 usual causes of Folate deficiency that can cause Megaloblastic anemia?
Inadequate dietary intake
Alcoholism
What are the symptoms of low folate?
Neural tube defects
Mouth ulcers
Neural tube defects and mouth ulcers in combo with Megaloblastic anemia indicate?
Folate deficiency
Treatment for Folate deficiency that causes Megaloblastic anemia?
Oral folate - 1mg/day for 4 months OR 1-5mg/day
Higher doses of Folate can cause what side effects?
Hypoglycemia and Hypotension
What is the treatment for Anemia of Chronic Disease?
Epoetin Alfa
How is Epoetin Alfa administered and what does it treat?
IV or subcutaneous
- Treats Anemia of Chronic Disease and Anemia caused by chemotherapy
How does Epoetin Alfa work?
Stimulates erythropoeisis and increases reticulocytes
What is a drug that has a 3X longer half-life than Epoetin Alfa?
Darbepoetin Alfa (21 hour half life)
The use of this drug was banned by the olympics
Epoetin Alfa
- Treats Anemia of Chronic Disease and Anemia due to Chemotherapy
What is the ONLY treatment for Sickle Cell Anemia?
Hydroxyurea
Hydroxyurea treats?
Sickle cell anemia
How does Hydroxyurea work and how is it given?
Given Orally
- Unknown mechanism = INCREASES Fetal Hemoglobin
This drug increased Fetal Hemoglobin
Hydroxyurea
What drug treats Paroxysmal Nocturnal Hemoglobinuria?
Eculizumab
Eculizumab treats?
PNH (paroxysmal nocturnal hemoglobinuria)
How is Eculizumab administered to treat PNH?
IV - once per week for the first 4 weeks; then every 2 weeks after that
How does Eculizumab work?
Blocks C5a from going to C5b and activating the complement MAC to lyse RBCs
Possible side effects of taking Eculizumab?
Viral, meningococcal and respiratory infections
Headache, hypertension
Pain, anemia
What are the possible side effects of taking Epoetin Alfa to treat Anemia of Chronic DIsease?
MI, tumor progression, death, stroke, VTE
