Q4 Heme

Question 1

Which drugs can cause depression of the bone marrow and subsequent anemia?

Answer 1

Anti cancer drugs, clozapine.

Question 2

When is a good time to recheck labs after starting Iron supplementation?

Answer 2

1mo

Question 3

Non-pharmacological ways to increase iron intake/absorption?

Answer 3

Cast iron skillet cooking
Vit C or OJ with iron supps
No antacids or PPIs with iron
Diet high in iron.

Question 4

What is hemachromatosis?

Answer 4

Chronic iron overload. Damages heart liver, pancreas and other organs.

Question 5

What is Deferoxamine?
Preferred route?

Answer 5

Iron chelator (De-Ferous)

Preferred route IM or SC, but if IV, then go SLOW.

Question 6

Vit B12 (other names?) needed for? MOA?
Administration?
DI?

Answer 6

Cyanocobalamin, hydroxycobalamin
Needed for amino acid, fatty acid and DNA synthesis

Cofactor required for enzymatic reactions that form Tetrahydrofolate, convert homocysteine to methionine and metabolize l-methylmalonyl-CoA.

Administer PO only for dietary deficiency. If malabsorption issue suspected, administer IM or deep SC.

Do not take with acid suppressing meds. Protect from light.

Question 7

If your patient has low B12, what could be the cause?

Answer 7

Low oral intake
Malabsorption - PA
Medications that lower Vit B12:
Colchicine (gout)
Chlorramphenicol (bone marrow suppression)
Ethanol (alcoholics)
Histamine 2 Receptor Antagonists - increase gastric pH
PPIs (increase gastric pH)
Met Forman (DM)

Question 8

Which vitamin is BEST absorbed PO?

Answer 8

Folic acid (vit B9)

Question 9

If someone is taking folate supplements what could this mask?

Answer 9

A vit B12 deficiency.

Question 10

What is a severe SE of G-CSF?

Answer 10

Granulocyte colony-stimulating factor
Activates neutrophil progenitor proliferation, activates phagocytes activity of mature neutrophils and mobalizes hematopoietic stem cells.

Daily SC administration

SPLENIC RUPTURE!

Question 11

Which anticoagulant drugs have more bleeding risk in older adults (70-90s)? Why?

Answer 11

Oral Direct factor Xa inhibitors.
Vasculature changes with aging make vessels more atherosclerotic and friable.

Question 12

What category are aspirin, clopidogrel, glycoprotein IIb/IIIa antagonists and Cilostazol in?

Answer 12

Antiplatelets.

Question 13

What category are Warfarin, Xa inhibitors and direct thrombin inhibitors?

Answer 13

Anticoagulants.

Question 14

What is Heparin and LMWH MOA?

Answer 14

Bind to antithrombin and enhance it’s inactivation of factor Xa.

Question 15

HIT is a _________ state.

Answer 15

HYPERcoagulable.
Consumptive coagulopathy like DIC.

Question 16

Clinical considerations for patients on antiplatelet agents?

Answer 16

They always feel cold.

Question 17

Dipyridamole. Usually used in combo with ______. MOA?

Answer 17

ASA
Vasodilates AND inhibits platelet fxn by inhibiting adenosine uptake and cGMP phosphodiesterase activity.

Question 18

Hemophilia A+B are _______ traits

Answer 18

X-linked recessive.

Question 19

What is a very important wholistic concern with hemophilia patients?

Answer 19

Make sure to get Imms! They may have an alternate schedule from their heme doc

Question 20

How do clinical symptoms of TTP differ from ITP?

Answer 20

Both hav purpura, bleeding, low plt,
However TTP has HA, paralysis and numbness too.

Question 21

Both ITP and TTP can be _____ or ______

Answer 21

Hereditary
Acquired
ITP = autoimmune (primary) or infectious (secondary)
TTP = hereditary or acquired.