pharmacology of anemia and hematopoietic growth factors

Question 1

treatment for hypochromic-microcytic anemia

Answer 1

iron (oral or parenteral)

Question 2

drugs for neutropenia

Answer 2

filgrastim G-CSF
pegfilgrastim
sargramostim GM-CSF`
plerixafor

Question 3

treatment for megaloblastic anemia

Answer 3

vitamin B12

folate

Question 4

drugs for thrombocytopenia

Answer 4

oprelvekin
romiplastin
eltrombopag

Question 5

drugs for anemia of chronic renal disease, etc

Answer 5

epoietin alfa
hydroxyurea
eculizumab

Question 6

oral iron dosing and toxicity

Answer 6

200-400 mg elemental ferrous iron/day in 2-3 divided doses with only water/juice

causes causea, constipation, anorexia, heartburn, vomiting, diarrhea, and dark stools

Question 7

names of oral iron sources

Answer 7

ferrous sulfate,
ferrous gluconate
ferrous fumarate

ideally not enteric-coated and not sustained release

Question 8

when is parenteral iron used

Answer 8

required if iron malabsorption, intolerance of oral therapy, noncompliance, etc

Question 9

names of perenteral iron sources

Answer 9

iron dextran
sodium ferric gluconate complex
iron-sucrose complex

ferumoxytol is new and faster and tolerated better than dextran

Question 10

iron therapy effect

Answer 10

expect reticulocytosis in a few days, increas in Hb in 2 weeks

Question 11

acute iron toxicity is seen in who?

Answer 11

almost exclusively in young children wo accidentally ingest iron tablets

10 tablets is fatal

Question 12

acute iron toxicity symptoms

Answer 12

necrotizing gastroenteritis with vomiting, abdominal pain and bloody diarrhea – > shock lethergy and dyspnea

suggestion of improvement followed by severe metabolic acidosis, coma, death

Question 13

treatment of acute iron toxicity

Answer 13

whole bowel irrigation and deferoxamine (potent iron chelating cmpd)

Question 14

Chronic iron toxicity sx and who is it seen in?

Answer 14

iron deposits in heart liver pancreas, etc. –> organ failure and death

seen in pts with hereditary hemochromatosis and pts who receive many red cell transfusions over a long period of time

Question 15

Causes of neutropenia

Answer 15

cancer
congenital disorders
viral infections
autoimmune disorders overwhelming infections
drugs that destroy neutrophils or damage bone marrow

Question 16

drugs causing hemolytic anemia

Answer 16

cephalosporins like ceftriaxone and cefotetan

penicillin and its derivatives like peperacillin

Question 17

Cause of immune drug induced thrombocytopenia

Answer 17

heparin

Question 18

cause of non-immune drug induced thrombocytopenia

Answer 18

quinidine and quinine

Question 19

drugs/toxins causing aplastic anemia

Answer 19

cancer chemotherapeutics
chloramphenicol
benzene

Question 20

clinical applications of epoetin alfa

Answer 20

used to treat anemia due to:
chronic kidney disease
cancer chemotherapy

Question 21

toxicity of epoetin alfa

Answer 21

increased risk of death, MI, stroke, venous thromboembolism, tumor progression or recurrence

Question 22

MOA and effects of epoetin alfa

Answer 22

erythropoiesis stimulating glycoprotein

stimulates erythropoiesis and increases reticulocyte count in 10 days or less

Question 23

Clinical applications of eculizumab

Answer 23

used to treat:
paroxysmal nocturnal hemoglobinuria
atypical HUS

Question 24

MOA of eculizumab

Answer 24

monoclonal antibody that binds to complement protein C5 and prevents its cleavage

Question 25

effects of eculizumab

Answer 25

inhibits terminal complement mediated intravascular hemolysis in PNH

inhibits complement mediated thrombotic microangiopathy in patients with atypical HUS

Question 26

toxicity of eculizumab

Answer 26

viral infections
meningococcal infections (GET VAX)
upper resp tract infections
msk pain
anemia
leukopenia
HTN
headache
insomnia, fatigue
UTI