rbc disorders pharm

Question 1

severe

Answer 1

also = quick loss
blood transfusion

Question 2

vits and minerals

Answer 2

iron (ferrous sulfate)
b12
folic acid

Question 3

erythropoiesis stimulating agents

Answer 3

epoetin alfa

Question 4

iron deficiency pharm

Answer 4

most people do well with increasing consumption
preg and menstruation - need more
iron preparations
globulin: protein that binds heme groups together (heme contains iron)
liquid and parenteral (IV and IM) - form depends on severity

Question 5

ferrous sulfate
ferrous gluconate

Answer 5

ferrous sulfate and ferrous gluconate: oral, only 20% elemental and avail for abs
iron dextran = parenteral
I: treat and prevent fe deficiency anemia, treat blood loss
interactions: decreased abs w antacids, increase with vit c
SE: n, heartburn, c, metallic taste, stain teeth (straw), tox with overdose (liver fail) - death in kids, chelating agent (deferoxamine treat tox, bind iron and form insoluble complex excreted in skin), dark stool
GI effects esp with PO

Question 6

iron admin

Answer 6

empty stomach, dont crush or chew - enteric coated
at night for less GI SE
no antacids or Ca
can take with food at beginning
straw with liquid and dilute with OJ - teeth stain
parenteral: give test dose, black box: have epi for allergic rxn - not done at home (from dextran part); z track with IM bc stain skin

Question 7

treatment of b12

Answer 7

b12 injections
diet first!: meat, salmon, cod, milk, dairy, eggs

Question 8

treatment of folate

Answer 8

leafy green veggies, legumes, organ meats
multivits
OTC folic acid supplements
folic acid can fix anemia and mask b12 deficiency and may still be hurting neurologic system - make sure pt is on high enough b12

Question 9

cyanocobalamin

Answer 9

b12 replacement
I: low b12; perincious anemia, bariatric sx pt need 1 mg daily indefinitely - sx where all or part of stomach removed
oral: 1-2mg daily
IM: weekly until levels normal -> monthly, for pt with severe deficiency or neurological sx, well tolerated - pain and redness at site

Question 10

folic acid supplements

Answer 10

I: treat folic acid deficiency anemia, preg women for neural tube defects
rx strength = tablets or liquid, oral usually 1-5mg/day
otc: 400mcg/day
well tolerated

Question 11

epoetin alfa

Answer 11

CKD or kidney problem
moa: stim erythropoiesis -> increase hgb and reticulocyte counts
only use when hgb <10g/dL unless on dialysis
IV and SQ only
need adequate iron levels and bone marrow function or it wont do anything

Question 12

epoetin alfa I

Answer 12

anemia due to ckd, HIV pt on zidovudine, chemo for some cancer, autoimmune hemolytic anemia

Question 13

epoetin alfa: monitor

Answer 13

weekly blood test - monitor hgb with goal <11 to degrease risk for clotting
eval fe status before and during treatment - usually need supplement

Question 14

epoetin alfa: SE

Answer 14

htn and serious CV events (increased hct)
progression of certain cancers
injection site problems, bone pain, HA
black box: risk of death, serious CV, stroke
dont give if shaken or frozen, protect from light, dont dilute or mix with other drugs, CI in pt with uncontrolled htn - may worsen high BP, can be given IVP, hgb levels rise in ~2wk