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HL II Shuffle > Pharmacology Of Anemia & Hematopoietic Growth Factors > Flashcards

Pharmacology Of Anemia & Hematopoietic Growth Factors Flashcards

1
Q

Drug(s) used to treat microcytic hypochromic anemia

A

Iron (oral, parenteral)

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2
Q

Drug(s) used to treat neutropenia

A

Filgrastim
Pegfilgrastim
Sargramostim
Plerixafor

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3
Q

Drug(s) used to treat megaloblastic anemia

A

Vitamin B12

Folate

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4
Q

Drug(s) used to treat anemia of chronic renal disease

A

Epoetin alfa
Hydroxyurea
Eculizumab

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5
Q

Drug(s) used to treat thrombocytopenia

A

Oprelvekin
Romiplastin
Eltrombopag

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6
Q

Formulations of oral iron therapy given for microcytic anemia

A

Ferrous sulfate
Ferrous gluconate
Ferrous fumarate

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7
Q

AEs of orally administered iron

A 
Nausea/vomiting
Constipation
Diarrhea
Dark stools
Anorexia
Heartburn
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8
Q

Parenteral (colloidal) iron formulations used to tx microcytic anemia

A

Iron dextran, sodium ferric gluconate complex, iron-sucrose complex

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9
Q

With iron replacement therapy, when can you expect reticulocytosis and increase in Hb?

A

Reticulocytosis in a few days

Hb increases in 2 weeks

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10
Q

Acute vs. chronic iron toxicity

A

Acute — necrotizing gastroenteritis w/vomiting, abd pain, and bloody diarrhea —> shock, lethargy, and dyspnea —> severe metabolic acidosis, coma, and death

Chronic (hemochromatosis) — iron deposits in heart, liver, pancreas —> organ failure and death

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11
Q

Tx for acute iron toxicity

A

Whole bowel irrigation and parenteral deferoxamine (iron-chelating compound)

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12
Q

Oral vitamin B12 supplementation is generally effective, even in pts with pernicious anemia. When is parenteral therapy indicated?

A

If neurologic sxs are present

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13
Q

T/F: adverse events are rare with vitamin B12 therapy

A

True

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14
Q

Treatment of folate deficiency is oral folate. This is generally well-tolerated at recommended doses, but higher doses can cause ______ and/or ______

A

Hypotension

Hypoglycemia

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15
Q

Symptomatic outcome of megaloblastic anemia treatment (w/ Vit B12 or folate)

A

Should see reticulocytosis in 3-5 days

Hct increases in <2wks w/ folate, normalizes in 2 months

Hb increases in 1 wk with B12 therapy, and should normalize in 1-2 months

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16
Q

MOA and effects of epoetin alfa

A

Erythropoiesis-stimulating glycoprotein (basically EPO analog)

Stimulates erythropoeisis —> increased reticulocyte count in <10 days —> increased RBC count, Hb, and Hct in 2-6 wks

Note: iron and folate also often included in therapy

[administered IV or subQ — half life of 4-13 hrs]

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17
Q

Clinical applications for epoetin alfa

A

Anemia d/t CKD, cancer chemotherapy, zidovudine tx for HIV

Reduce allogeneic RBC transfusions in pts undergoing elective surgery

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18
Q

AEs of epoetin alfa

A

20-50% have DAP > 10 mm Hg despite keeping Hct in 30-35 range

Increased risk of death, MI, stroke, DVT

Minor AEs include cough, HA, myalgias, spasms, joint/bone pain, injection site pain, N/V, weight loss, insomnia, allergic rxns

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19
Q

Which has a longer half life — epoetin alfa or darbepoetin alfa?

A

Darbepoetin alfa has 3x longer half life

20
Q

Only disease-modifying therapy approved for sickle cell disease

A

Hydroxyurea

21
Q

MOA and effects of hydroxyurea therapy

A

Targets ribonucleotide reductase —> S-phase cell cycle arrest

Boosts levels of HbF [mechanism unknown]

[administered orally and readily absorbed; distributed widely but concentrated in erythrocytes and leukocytes. Excreted unchanged by kidney]

22
Q

Toxicities of hydroxyurea

A

Cough or hoarseness

Fever or chills

Lower back or side pain

Painful or difficult urination

23
Q

Indications for eculizumab

A

Paroxysmal nocturnal hemoglobinuria (inhibits terminal complement-mediated intravascular hemolysis)

Atypical hemolytic uremic syndrome (inhibits complement-mediated thrombotic microangiopathy)

[only available under Risk Eval and Mitigation to which prescribers must enroll]

24
Q

MOA of eculizumab

A

Monoclonal Ab that binds to complement protein C5 w/high affinity —> inhibits cleavage to C5a and C5b —> prevents generation of MAC (C5b-C9)

25
Q

AEs of eculizumab

A

Infection (HSV, Influenza-like)

Life-threatening meningococcal infections — must give vaccine prior to therapy

Immunogenic, URIs, MSK pain, anemia, leukopenia, HTN, HA, insomnia, fatigue, UTIs

26
Q

The following are clinical applications for what drug:

Decreases incidence of infection, as manifested by febrile neutropenia, in pts with nonmyeloid malignancies receiving myelosuppressive therapy or in those receiving bone marrow transplant

Also used to mobilize HSCs into PB for collection by leukophoresis, and in those with severe chronic neutropenia

A

Filgrastim (G-CSF)

27
Q

MOA of filgrastim

A

G-CSF — regulates production of neutrophils in bone marrow and enhances some end-cell functions like phagocytic ability, respiratory burst, and Ab-dependent killing

28
Q

______ is a longer lasting version of filgrastim (G-CSF) d/t conjugation with monomethoxypolyethylene glycol

A

Pegfilgrastim

29
Q

AEs of filgrastim (G-CSF)

A

Generally well-tolerated but can cause allergic reaction

Some experience mild to moderate bone pain — tx with NSAIDs

Rarely splenic rupture and ARDS

30
Q

The following are clinical indications for what drug:

Used to accelerate recovery of myeloid cells after autologous or allogeneic bone marrow transplant

Can be used to mobilize HSCs into PB for leukophoresis

Indicated for use following induction chemo in pts >55 w/ AML to shorten time to recovery/decrease incidence of infections

A

Sargramostim (GM-CSF)

31
Q

MOA of sargramostim

A

GM-CSF — acts in bone marrow to increase production of neutrophils, eosinophils, and monocytes

32
Q

AEs of sargramostim (GM-CSF)

A

Contains benzyl alcohol — can cause fatal “gasping syndrome” in premature infants

Causes fluid retention —> edema, pleural effusion, pericardial effusion

Sequestration of granulocytes in pulmonary circulation has caused dyspnea

Occasional transient SVT

Worsening pre-existing renal and hepatic dysfunction

33
Q

Drug used in the 15-20% of pts who do not mobilize sufficient HSCs for autologous transplant with just G-CSF; also approved for pts with lymphoma and multiple myeloma

A

Plerixafor

34
Q

MOA of plerixafor

A

Partial agonist of CXCR4 receptor, important for homing of HSCs to bone marrow

Acts to mobilize HSCs from bone marrow to plasma

35
Q

AEs of plerixafor

A

Hypersensitivity reaction

Potential to mobilize leukemia cells

36
Q

Drug that can be used to tx thrombocytopenia in pts undergoing myelosuppressive chemo for non-myeloid cancers, but does NOT have a major clinical use

A

Oprelvekin (IL-11)

37
Q

MOA and effects of oprelvekin

A

Recombinant form of IL-11; MOA unknown, but results in increases in platelets by promoting formation and maturation of megakaryocytes

38
Q

AEs of oprelvekin

A

Significant edema d/t volume expansion

Cardiac dysrhythmias

Severe allergic reactions

“Bloodshot” eyes

39
Q

Drug used to tx excess platelet destruction d/t idiopathic thrombocytopenic purpura, as well as its counterpart which can also be used to tx cirrhosis d/t hep C

A

Romiplostim — tx ITP

Eltrombopag — tx ITP and cirrhosis d/t hep C

40
Q

MOA and effects of romiplostim

A

Composed of 2 disulfide-bonded human IgG1 kappa heavy chain constant regions (an Fc fragment) that bind the TPO receptor

Leads to increased platelet count in healthy individuals, ITP pts, and pts with myelodysplastic syndromes

41
Q

AEs of romiplostim

A

Generally well-tolerated; most serious AE is allergic rxn

42
Q

MOA and effects of eltrombopag

A

Potent, orally available non-peptide TPO receptor agonist

Increases platelet count in healthy individuals, pts with ITP, and thrombocytopenia d/t hep C

43
Q

AEs of eltrombopag

A

May cause hepatotoxicity when used in combo with interferon and ribavirin in pts with chronic hep C

44
Q

Most common drug-related cause of hemolytic anemia

A

Cephalosporins (especially ceftriaxone and cefotetan)

Other drug causes include PCN derivatives (esp. piperacillin), dapsone, levodopa, levofloxacin, methyldopa, nitrofurantoin, NSAIDs, phenazopyridine, quinidine

45
Q

most common drug-related cause of immune thrombocytopenia

A

Heparin

46
Q

Classic drug-related causes of non-immune thrombocytopenia

A

Quinidine; quinine

Other causes include furosemide, NSAIDs, PCN, sulfonamides, ranitidine

47
Q

Drugs/toxins causing aplastic anemia

A

Cancer chemotherapeutics, esp alkylating agents, antimetabolites, and cytotoxic abx

Chloramphenicol (no longer used)

Benzene

HL II Shuffle (4 decks)

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