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SBL week 2 > Pharmacology of Anemia/growth factors > Flashcards

Pharmacology of Anemia/growth factors Flashcards

1
Q

If iron deficiency anemia is severe, what do you treat it with?

A

RBC transfusion

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2
Q

What is iron regulated by?

How can this be bypassed?

A

1) Hepcidin

2) Iron infusion

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3
Q

Microcytic anemia due to reduced heme synthesis is caused by?

Due to reduced globin production is caused by?

A

1) Lead poisoning

2) Thalassemic disorders

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4
Q

How much oral iron should be taking in a day?

What should you take it with and why?

A

1) 200-400 mg divided into 2-3 doses a day

2) With liquids because food inhibits absorption

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5
Q

What are examples of oral iron and ideally what features do you want it to not have so that you can avoid poor absorption?

A

1) Ferrous sulfate/gluconate/fumarate

2) Not enteric-coated and not sustained-release

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6
Q

Parenteral iron therapy such as iron dextran, sodium ferric gluconate complex and iron-sucrose complex all have?

A

An iron oxyhydroxide core surrounded by carbohydrate

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7
Q

What is a new nanoparticle-based iron preparation that can be administered quickly (time increased from 15 sec to 5 min) and is tolerated much better than iron dextran?

A

Ferumoxytol

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8
Q

No matter the form of iron therapy we can expect what results?

A

Reticulocytosis in a few days and an increase in Hb in 2 wks

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9
Q

Acute iron toxicity is seen almost exclusively in young children who accidentally ingest iron tablets, how many is considered to be lethal?

A

10 tablets

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10
Q

Urgent treatment for acute iron toxicity includes?

A

1) Whole bowel irrigation

2) Parenteral deferoxamine

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11
Q

With chronic iron toxicity (hemochromatosis), iron deposits in what organs leading to their failure?

When do we see this?

A

1) The heart, liver, pancreas

2) With hereditary hemochromatosis and patients who receive many red cell transfusions over a long period of time

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12
Q

How much vitamin B12 do we need a day?

How much does the body store and where is most stored?

A

1) 2 µg/day

2) 2 – 5 mg which about half is in liver

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13
Q

Why does it take years to develop vitamin B12 deficiency after normal absorption ceases?

A

Because the normal body stores greatly exceed the daily requirement

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14
Q

What effect does nitrous oxide have on vit B12 when inhaled for analgesia during surgery?

A

Inactivates cyanocobalamin (common form of vitamin B12)

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15
Q

What happens if vit B12 body stores are depleted?

A

Rapid onset neurological dysfunction (e.g., paresthesias, weakness, spasticity) that may not fully reverse

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16
Q

What does cobalamin form a complex with so that it can bind to the cubulin receptor in the ileum in order to be absorbed?

A

Intrinsic factor (IF)

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17
Q

What is the most common cause of vitamin B12 deficiency?

A

Pernicious anemia

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18
Q

Pernicious anemia can cause what two autoantibody formations that blocks what?

A

1) IF-Cbl interaction

2) IF-Cbl receptors in ileum

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19
Q

Chronic atrophic gastritis from vitamin B12 deficiency is due to autoantibodies directed against?

A

H-K-ATPase of the parietal cells

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20
Q

How is vitamin B12 deficiency treated if no neurological symptoms are present?

A

Oral supplementation of 500X the daily need

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21
Q

How is vitamin B12 deficiency treated if neurological symptoms are present?

A

Parenteral therapy

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22
Q

Why do you want to give twice the daily allowance of folate for pregnant and lactating women compared to normal adults (400 µg/day compared to 800)?

A

Prevent spina bifida/cleft palate

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23
Q

Folate is absorbed in the jejunum, enters plasma, rapidly cleared by hepatocytes and other cells where it is trapped by?

A

Polyglutamation

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24
Q

What are the usual causes of folate deficiency?

A

Inadequate dietary intake or alcoholism

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25
Q

How is folate deficiency treated?

A

Oral administration of folate

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26
Q

Nausea, constipation, heartburn, vomiting, diarrhea and dark stools are side effects of?

A

Oral iron administration

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27
Q

Necrotizing gastroenteritis with vomiting, abdominal pain and bloody diarrhea leading to shock, lethargy, and dyspnea are the initial symptoms for?

A period of improvement is often seen but only to be followed by?

A

1) Acute iron toxicity

2) Severe metabolic acidosis, coma, and death

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28
Q

Hyperpigmentation, glossitis, macrocytic anemia and neuro issues involving gait, cognition, paresthesia are some symptoms of?

A

Vitamin B12 deficiency

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29
Q

Neural tube defect in fetus, macrocytic anemia, and mouth ulcers are some symptoms of?

A

Folate deficiency

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30
Q

What is a 165-amino acid erythropoiesis stimulating glycoprotein?

A

epoetin alfa

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31
Q

What are the effects of epoetin alfa?

A

1) Stimulates erythropoiesis
2) Increases the reticulocyte count
3) Increases RBC count, hemoglobin, and hematocrit

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32
Q

What are the clinical applications for epoetin alfa?

A

Anemia due to chronic kidney disease and cancer chemotherapy

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33
Q

Why must Hct be kept in the 30-35 range when administering epoetin alfa?

A

It increases diastolic blood pressure

34
Q

What is the only disease modifying therapy approved for sickle cell disease?

A

Hydroxyurea

35
Q

What is the MOA for hydroxyurea?

A

Boosts the levels of fetal hemoglobin which lowers the concentration of HbS

36
Q

How is epoetin alfa administered?

How is hydroxyurea administered?

A

1) IV or subcutaneously

2) Orally

37
Q

Increased risk of death, myocardial infarction, stroke, and venous thromboembolism are potential toxicities of what drug?

A

Epoetin alfa

38
Q

Neutropenia, anemia, oral ulcers, hyperpigmentation, rash, and nail changes are potential toxicities of what drug?

A

Hydroxyurea

39
Q

What drug is a monoclonal antibody that specifically binds to the complement protein C5 with high affinity?

A

eculizumab

40
Q

What is the MOA for eculizumab?

A

It inhibits cleavage of C5 to prevent generation of C5b-9 complex

41
Q

What are the clinical applications of eculizumab?

A

1) Paroxysmal nocturnal hemoglobinuria

2) Atypical hemolytic uremic syndrome

42
Q

Viral infections, life-threatening meningococcal infections, upper respiratory tract infections, musculoskeletal pain, anemia, and hypertension are all potential toxicities of what drug?

A

eculizumab

43
Q

Low-grade fever, sore mouth, odynophagia, gingival pain and swelling, pneumonia, recurrent sinusitis and otitis are all symptoms of?

A

Neutropenia

44
Q

Damage to what tissue can cause neutropenia?

A

Bone marrow

45
Q

What is the drug filgrastim?

A

Human granulocyte colony stimulating factor (G-CSF)

46
Q

What is the function of G-CSF?

A

Regulates the production of neutrophils within the bone marrow

47
Q

Why is filgrastim indicated for patients receiving myelosuppressive anticancer drugs or in those receiving a bone marrow transplant?

A

To decrease the incidence of infection‚ as manifested by febrile neutropenia

48
Q

What is a longer lasting version of filgrastim due to conjugation with monomethoxy polyethylene glycol?

A

Pegfilgrastim

49
Q

What is the drug sargramostim?

A

Granulocyte macrophage colony stimulating factor (GM-CSF) made in yeast

50
Q

Sargramostim acts in the bone marrow to?

A

Increase production of neutrophils, eosinophils, and monocytes/macrophages

51
Q

When is sargramostim used in order to accelerate recovery of neutrophils?

A

1) Bone marrow transplants

2) Following chemotherapy in patients with AML

52
Q

How is sargramostim and filgrastim administered?

How long should you wait to administer filgrastim for patients on chemo?

A

1) IV or SubQ

2) Wait 24 hours after chemo

53
Q

Which drug is the better option to treat neutropenic fever from cancer chemotherapy?

Why?

A

Filgrastim because it has fewer adverse effects

54
Q

What drug is a partial agonist of the CXCR4 receptor?

A

Plerixafor

55
Q

What is the MOA of plerixafor?

A

Mobilizes hematopoietic stem cells from the bone marrow to the plasma

56
Q

Plerixafor is used in the 15- 20% of patients who do not mobilize sufficient stem cells for autologous transplant with just?

A

G-CSF

57
Q

Plerixafor is approved for patients with?

A

1) Lymphoma

2) Multiple myeloma

58
Q

Edema, dyspnea, exacerbate pre-existing renal and hepatic dysfunctions, and fatal “gasping syndrome” in premature infants are potential toxicities of?

A

Sargramostim

59
Q

Allergic reactions and moderate bone pain are potential toxicities of?

A

Filgrastim

60
Q

Hypersensitivity reactions, the potential to mobilize leukemia cells, and contaminate apheresis product are potential toxicities of?

A

plerixafor

61
Q

Both thrombopoietin and its PEG derivatized variant were withdrawn from the market due to autoantibodies that caused?

Why was stem cell factor (aka c-Kit) also not used clinically?

A

1) Severe thrombocytopenia

2) Found on mast cells and causes severe allergic reactions

62
Q

Oprelvekin is the recombinant form of?

A

IL-11

63
Q

What is the MOA of Oprelvekin?

A

Increases platelet levels by promoting megakaryocytes

64
Q

What can oprelvekin be used to treat in patients undergoing myelosuppressive chemotherapy for non-myeloid cancers?

A

Thrombocytopenia

65
Q

What is the route of administration for Oprelvekin?

A

SubQ injection

66
Q

What is the route of administration for plerixafor?

A

SubQ injection

67
Q

What can also increase platelet levels like IL-11, but are too toxic to use?

A

IL-3 and IL-6

68
Q

What drug is a peptibody composed of two disulfide bonded human IgG1 kappa heavy chain constant regions that bind to the TPO receptor?

A

romiplostim

69
Q

What is the clinical application for romiplostim?

A

Idiopathic thrombocytopenic purpura

70
Q

What is the route of administration for romiplostim ?

A

Subcutaneous

71
Q

Edema, cardiac dysrhythmias, severe allergic reactions, and “bloodshot” eyes are all potential toxicities of?

A

Oprelvekin

72
Q

What drug is a potent, orally available non-peptide TPO receptor agonist?

A

Eltrombopag

73
Q

What is the MOA for both eltrombopag and romiplostim ?

A

Increase the platelet count

74
Q

What is the clinical application for eltrombopag?

A

1) Idiopathic thrombocytopenic purpura

2) Cirrhosis due to hepatitis C

75
Q

What is the route of administration for eltrombopag?

A

Oral

76
Q

What drug is generally well tolerated with the most serious concern is allergic reactions?

A

Romiplostim

77
Q

What drug may may cause hepatotoxicity when used in

combination with interferon and ribavirin in patients with chronic hepatitis C?

A

Eltrombopag

78
Q

Romiplostim and eltrombopag are the 2nd/3rd line agents for ITP used if?

A

Glucocorticoids, immune globulin, rituximab and splenectomy did not work

79
Q

Cephalosporins such as ceftriaxone and cefotetan along with penicillin and its derivatives such as piperacillin are all drugs that cause?

A

Hemolytic Anemia

80
Q

Immune drugs such as heparin and non immune drugs such as quinidine and quinine are all drugs that cause?

A

Thrombocytopenia

81
Q

Cancer chemotherapeutics, chloramphenicol, and benzene are all drugs that cause?

A

Aplastic Anemia

SBL week 2 (10 decks)

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