Treatement of Anemia Flashcards
First line therapy of IDA?
oral iron
Drawbacks of oral therapy
2
- Absorption is limited in malabsorptive states and in chronic kidney disease
- May not be able to keep up with the bleeding in cases of ongoing blood loss
70% non-compliance rate due to GI side effects. What are they?
7
Constipation Nausea/vomiting Diarrhea Metallic taste Thick green/black stool May exacerbate inflammatory bowel disease
Where are iron supplements absorbed?
Is not absorbed in the stomach but best in the duodenum and proximal jejunum
How do you decrease the degree of side effects?
decrease the dose
What are the kinds of formulas for oral iron administration?
Avoid enteric coated or sustained release
When should we eat with iron supplementation?
What are the worst offenders?
- Give on an empty stomach as most foods impair the absorption 2. (worst offenders are calcium containing foods, cereals, fiber, tea, coffee, eggs, milk)
What meds should we avoid or take at a later time when taking oral supplementation?
2
- Give 2 hours before or 4 hours post antacids
- Calcium significantly impairs absorption
- To increase absorption give with Ascorbic acid or orange juice
What could you try if lowering the dose of the pills doesn’t work before going to IV therapy?
Ferrous sulfate elixir 44mg/5mL may be better tolerated than the tablets if patients have significant GI upset on the tablets
-rinse mouth out
How much of elemental iron is recommened a day for adults?
150-200mg/day of elemental iron
Whats the best option and how much elemental iron does it have?
Least expensive is ferrous sulfate 325mg tabs contain 65mg of elemental iron (varies from 300-325 iron salts and 60-65 elemental iron)
HOw much elemental iron is in Ferrous fumerate?
67-106 mg
How much elemental iron is in ferrous sulfate (325mg) ?
60-65 mg
How much elemental iron is in ferrous gluconate 325mg?
How much elemental iron is in Elixir (ferrous sulfate)?
28-37 mg
44 mg/5mL
Duration of therapy?
2
Some stop treatment when the Hgb normalizes
Others treat for 6 months after the Hgb has normalized
Whats the advantages and disadvantagses of stopping when it normalizes?
could still have a low iron even though the HgB has normalized
If youre giving the iron for pica or RLS how long will it take to go away?
often disappears right away
May feel better in a few days
When will reticulocytosis go away with iron treatment?
7-10 days