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Pharm II > test 2 part 2 > Flashcards

test 2 part 2 Flashcards

1
Q

What is Anemia?

A

•Below normal plasma hemoglobin concentration

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2
Q

normal hemoglobin values for males and females

A
  • Males (Hgb)
    * 13.5 – 17.5 g/dL
  • Females (Hgb)
    * 12 – 16 g/dL
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3
Q

What is Hemoglobin (Hgb)?

A

• Iron-containing oxygen transport protein molecule inside RBCs

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4
Q

Symptoms of Anemia

A
  • Fatigue
  • Rapid heartbeat
  • Shortness of breath
  • Pale skin
  • Dizziness
  • Insomnia
  • Poor concentration
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5
Q

Causes of Anemia

A 
•Chronic blood loss
•Bone marrow
abnormalities
•Increased hemolysis
•Infections
•Malignancy
•Genetic
•Nutritional
•Renal failure
•Drugs
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6
Q

Erythropoiesis

A
  • Erythrocyte differentiation takes place in 8 stages
  • Stages 1 – 7 occur in bone marrow
  • After stage 7, reticulocyte is released into bloodstream, where it matures into an erythrocyte (stage 8)
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7
Q

Why Do You Care?

A
  • Lots of your patients will be anemic
    * Renal failure, cancer, trauma, “little old ladies”
  • YOU will cause anemia
    * Dilutional anemia, hemolysis
  • Some of your patients want only their blood
    * Jehovah Witness patients
  • Giving blood (because of anemia) is bad
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8
Q

Iron deficiency anemia causes

A

• Causes hypochromic (appear clear), microcytic (smaller) anemia

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9
Q

Symptoms: Iron Deficiency Anemia

A
  • Pica
    * Hunger for ice, dirt, paper, etc.
  • Upward curvature of finger and toe nails
    * koilonychia
  • Soreness and cracking at corners of mouth
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10
Q

Iron availability and dosage

A

•Oral and parenteral formulations available
• Amount absorbed depends on current body stores (if iron depleted and take an iron supplement you absorb 95%)
• Relative percentage of iron absorbed decreases with
increasing dose
• Divided into two or three doses
• 150 – 180 mg/day: recommended dose

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11
Q

Iron: Adverse Effects

A
  • Adverse effect is GI disturbances
    * Abdominal pain
    * Constipation
    * Diarrhea
  • Parenteral formulations: iron dextran
    * Fatal hypersensitivity reactions
  • Excessive iron toxicities
    * Reversed using chelators (deferoxamine)
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12
Q

most common iron supplement

A
  • ferrous sulfate
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13
Q

Iron

A
  • Essential metallic component of heme
  • Stored in:
    * Intestinal mucosal cells, liver, spleen, and bone marrow as ferritin
  • Delivered to marrow for hgb production
  • Iron deficiency anemia results from inadequate iron stores and/or intake
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14
Q

Folic Acid (Folate) used to treat

A

•Used to treat inadequate levels of the vitamin (B9)

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15
Q

Folate deficiencies may be caused by

A 
1. Increased demand
        • Pregnancy
        • Lactation
2. Poor absorption
        • Intestinal pathology
3. Alcoholism
4. Dihydrofolate reductase inhibitor drugs
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16
Q

Folic Acid Deficiency causes

A
  • Causes megaloblastic anemia

* Bone marrow produces unusually large, structurally abnormal, immature RBCs

17
Q

Folic Acid used as a drug

A
  • Oral and parenteral formulations available

* Minimal side effects

18
Q

Cyanocobalamin (vitamin B12) Deficiencies result from:

A
  • Low dietary intake
  • Poor absorption (pernicious anemia) due to:
    * Lack of intrinsic factor
    * Most common cause
  • Loss of receptor activity needed for uptake
19
Q

Cyanocobalamin (Vitamin B12)

A
  • Hydroxocobalamin (preferred)
    * IM formulation
    * Rapid response
    * Maintains higher plasma concentrations
  • Oral formulation
    * Dietary deficiencies
  • IM or SC formulations
    * Pernicious anemia
20
Q

Vitamin B12 Deficiency: Symptoms

A
  • Tingling (pins and needles)
    * Hands
    * Feet
  • Difficulty walking
  • Dementia
  • Hallucinations, paranoia, schizophrenia
    * Extreme cases
21
Q

Erythropoietin (EPO)

A
  • Released by the kidneys in response to hypoxia
  • Glycoprotein that stimulates stem cells to differentiate into proerythroblasts
    * Promotes release of reticulocytes from marrow
  • EPO regulates RBC proliferation and differentiation
22
Q

Erythropoietin or Epoetin Alfa (Epogen, Procrit) used to treat anemias caused by

A
  • End-stage renal disease
  • Bone marrow disorders
  • HIV induced anemia
  • Cancer induced anemia
  • Both are synthetic forms of epoetin alfa
23
Q

Darbepoetin

A

• Longer-acting version of epoetin alfa
• 3 times the half life of epoetin alfa
• Requires weeks to achieve steady state plasma
concentrations
• Not used in acute treatment of anemia
•Usually given with iron to ensure adequate response and support proper heme formation

24
Q

Epoetin alfa/Darbepoetin

A
  • Administered IV or SC
  • Side effects
    * Increased BP (because of increased viscosity)
    * Joint pain
  • Hgb > 11 g/dL (hgb below 10 it needs to be discontinued)
    * Stroke
    * Severe HTN
    * Embolic events
    * Death
  • High potential for drug abuse
  • Enhances endurance and recovery
25
Q

Neutropenia

A
  • Low levels of neutrophils

* Absolute neutrophil count (ANC) < 1500 neutrophils/ul blood

26
Q

Agents Used to Treat

Neutropenia

A 
- Myeloid Growth Factors
• Filgrastim, tbo-filgrastim, Sargramostim 
        • Dosed once daily
        • 24-72 hr after chemotherapy
• Pegfilgrastim 
        • Single dose
        • 24 hr after chemotherapy
• Sargramostim is Granulocyte-macrophage colony-stimulating factor (GM-CSF)
27
Q

how do the Myeloid Growth Factors work and what is the most common side effect

A
  • All stimulate granulocyte production in marrow to increase neutrophil counts
  • Bone pain is most common side effect
28
Q

Sickle Cell Disease

A
  • Inherited form of anemia
    * High levels of hgbS
    * HgbS red blood cells are sickle shape and are rigid and sticky
  • Sickle cells are destroyed rapidly in the bodies of people with the disease
  • Sickled cells block flow of blood through vessels causing tissue damage
29
Q

Hydroxyurea

A
  • Sickle Cell Drug
  • Increases fetal hgb levels which dilutes hgbS levels
    * Several month process
  • Reduces painful sickle cell crises
  • Side effects
    * Bone marrow suppression
    * Cutaneous vasculitis (inflammation of the blood vessels)
30
Q

Pentoxifylline (Trental)

A
  • Vasoactive drug that improves peripheral blood flow and enhances tissue perfusion
  • Increases flexibility of red blood cells
  • Decreases blood viscosity
  • Used to treat claudication (cramps due to blockage of vessels)
  • Side effects
    * GI disturbances

Pharm II (37 decks)

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