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Pharmacology > Treatments for Anemia > Flashcards

Treatments for Anemia Flashcards

1
Q

what are the treatment options for anemia?

A 
• Iron Supplements        
oral: Ferrous Sulfate 
Ferrous Gluconate 
• Folic Acid 
• Vitamin B 12 (Cyanocobalamin) 
• Epoetin Alpha (Epogen, Procrit) 
• Darbepoetin (Aranesp)
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2
Q

what type of patients are treated prophylactically for anemia & why?

A

CKD patients

-prone to anemia d/t hemodialysis

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3
Q

what forms do iron supplements come in? which is the cheapest?

A

oral- cheapest
IM
IV

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4
Q

can patients with hemosiderosis or hemochromatosis

be given iron supplements?

A

No

Due to risk for iron overload syndromes

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5
Q

what are the most commonly used PO forms of iron supplements?

A

Ferrous Sulfate
> Elemental iron dose: 50-100mg PO TID
> Pure salt form: Ferrous Sulfate 320/324/325mg PO TID
Ferrous Gluconate

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6
Q

what is the dosing for ferrous salts in normal, healthy adults?

A

Ferrous Sulfate 320/324/325mg PO TID

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7
Q

what are the symptoms of iron supplements such as ferrous sulfate & ferrous gluconate?

A 
constipation- most common
nausea
epigastric pain
vomiting
diarrhea
black stools
anorexia
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8
Q

what types of medications interact w/ ferrous salts & how do they interact w/ them?

A

dec absorption and effectiveness of iron d/t required acidic environment for Fe

  • Calcium
  • Antacids
  • PPIs
  • levodopa
  • fluoroquinolones
  • Tetracyclines
  • PCNs
  • Vit E
  • Levothyroxine
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9
Q

when prescribing patients to take iron supplements, how should you instruct them?

A

take w/ food at night

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10
Q

what foods may impair oral iron absorption & can interact w/ iron supplements?

A

cheese, coffee, milk, yogurt, whole grain breads,

eggs

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11
Q

what vitamin increases the absorption of iron?

A

Vitamin C

-allows an acidic environment which enables iron to be absorbed

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12
Q

what are the benefits of using anhydrous ferrous sulfate & what are the disadvantages?

A

pro: once a day dosing d/t 30% elemental iron = extended release & increased compliance
con: expensive & higher cost than ferrous sulfate

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13
Q

what are the advantages of ferrous sulfate?

A

low cost w/ good effectiveness & tolerability

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14
Q

what iron supplement is given to patients w/ renal insufficiency & patients on dialysis?

A

Nu-Iron 150, Niferex -> polysaccharide-iron complex
pro: 100% elemental iron -> not dialyzed out as easily
tasteless, odorless
similar bioavailability to ferrous sulfate

con: VERY expensive

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15
Q

what does the amount of iron absorbed in the body depend on?

A

content of Heme/Fe (meats vs. veggies/legumes)

calcium

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16
Q

what are vegetarian sources of iron that increase absorption of Fe?

A
  • Legumes (lentils, chick peas, lima beans)
  • Grains (quinoa, brown rice)
  • Some Veggies (swiss chard, collard greens)
  • Nuts and Seeds (cashews, pinenuts)
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17
Q

why can’t ferrous sulfate tablets be crushed?

A

iron will not reach the stomach & it will eat stomach lining = decreased absorption d/t inactivation

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18
Q

why does PO iron require several months of administration?

A

Fe storage takes about 3-6 months to be restored

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19
Q

what are contraindications when giving iron?

A 
PUD
regional enteritis
ulcerative colitis
repeated blood transfusions
hemochromatosis
hemosiderosis
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20
Q

what are the advantages of administering IV iron?

A
  • rapid correction of anemia & resolution of sx
  • can administer large doses (up to 1000mg of elemental Fe) in single infusion
  • assured compliance
  • no GI side effects
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21
Q

what are the disadvantages of administering IV iron?

A
  • requires monitoring d/t anaphylaxis
  • equipment & medical personnel needed in case there are rxns
  • higher initial cost
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22
Q

if a pt that is taking iron supplements comes into the office reporting black stools, what can this indicate?

A

GI bleed

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23
Q

what type of iron supplement can be prescribed to pregnant patients?
what would you prescribe with it to optimize its effects?
what are adverse effects related to pregnancy with taking iron?

A
  • Ferrous Sulfate
  • neuro deficits in infants & children
  • Vitamin C
24
Q

what are the types of folic acid supplements & what is the OTC dosage? what is the Rx dose?

A

folic acid
folate
folvite

OTC: 400mcg
Rx: 1mg/day

25
Q

why are folate supplements given to pregnant patients?

A

prevention of neural tube defects (NTD)

26
Q

what is the MOA of folate deficiency?

A 
-decreased synthesis of:
amino acid
purine
pyrimidine
-results in decreased DNA & RNA synthesis
= macrocytic/megaloblastic anemia
27
Q

what vitamin must be given to patients that are prescribed methotrexate?

A

folic acid (vit B9)

28
Q

what is the MOA of folic acid?

A

Stimulates production of protein synthesis necessary for RBC, WBC and platelet formation

29
Q

where in the body is folic acid metabolized and how long is it stored?

A

Converted by the liver to an active metabolite,
dihydrofolate reductase
Stored in liver for 4 months

30
Q

what drugs inhibit folate synthesis, absorption, and/or metabolism?

A

macrolides:

  • erythromycin
  • fofsamycin

bactrim
ethanol
phenytoin (Dilantin)

31
Q

what conditions can lead to deficient B12 absorption?

A 
Crohn’s disease 
cystic fibrosis (malabsorption due to insufficient alkalinization of the duodenal contents)

*also- vegan diet x5 years

32
Q

What lifestyle habits/changes can lead to B12 deficiency?

A

Strict vegans
Vegetarian diet in pregnancy
Patients that have had gastric bypass surgery

33
Q

What agents block & inhibit absorption of B12?

A

Neomycin (aminoglycoside PO)
Metformin
PPIs such as omeprazole
H2 receptor antagonists such as famotidine (Pepcid)

34
Q

What is required for vitamin B12 to be absorbed?

A

Acidic environment in the stomach & intrinsic factor

35
Q

What is given to treat patients with pernicious anemia & why?

A

B12 shots due to lack of intrinsic factor from destruction of gastric parietal cells
Monthly shots = better compliance due to reduction of pill load

36
Q

Vitamin b12 is a _ soluble substance

A

Water

37
Q

If a patient on colchicine is b12 deficient, what should you do?

A

D/c colchicine → b12 absorption normalizes because colchicine reduces quantity of available B12 receptors

38
Q

What is the recommended oral dose for b12 deficiency?

A

1000 mcg PO qd

* not suitable for severe B12 deficiency

39
Q

What is the half life for B12 & where is it stored for how long?

A

6 days - 400 days in the liver

40
Q

What is the IM/SC dosage for vitamin b12 (Cyanocobalamin) shots?

A

1000 mcg per month

41
Q

What is the man made form of vitamin b12 & what is it available in?

A

cyanocobalamin

  • Tablets
  • Injection → pernicious anemia or lack of capacity for oral administration
  • Nasal Spray
42
Q

What is the most concerning adverse reaction for cyanocobalamin & how does this happen?

A

Hypokalemia with heavy dosing

B12 pushes potassium into cells reduction of serum potassium due to intracellular shift

43
Q

What is used for anemic patients with end stage renal disease & when is it given?

A

Erythropoietin & epoetin during dialysis

* also given to chemo & HIV patients on zidovudine

44
Q

When is erythropoetin contraindicated?

A

Nonspecific anemia & uncontrolled hypertension

45
Q

What are the two available products for erythropoietin & Epoetin?

A

Epoetin: epogen & procrit

Darbepoetin; aranesp

46
Q

What should be done before giving erythropoietin & what is the MOA?

A

Obtain retic count
Stimulates the release of reticulocytes
Dose dependent → retic count will first rise followed by H&H

47
Q

What is the half life of erythropoietin & why is this important for dialysis patients?

A

4-13 hours

Dialysis patients will not need continuous infusion → received once a week

48
Q

what is the most adverse reaction of erythropoietin & how does this happen?

A

Hypertensive crisis & seizures
> high doses given too quickly in patients w/ prior hx of uncontrolled HTN
> IV vs. IM/subq

49
Q

how is erythropoietin dosed and what is it based on?

A

Initial dose is weight based -> interval dosing d/t half life
» adjusted based on Hgb level

50
Q

what patients should be cautioned (risk vs benefit) before giving erythropoietin?

A

> patients with prior venous thrombosis or prolonged immobilization
cancer patients

51
Q

what is the long acting version of erythropoietin?

A

Darbepoetin IV or subcutaneously

52
Q

how often are patients w/ CKD (not on dialysis) given Darbepoetin?

A

IV or subq once every 4 weeks

53
Q

how often are dialysis patients given Darbepoetin?

A

once a week every 2 weeks (infusion of subq)

54
Q

why is Darbepoetin not intended for STAT or Emergency use?

A

-delayed onset of action

|&raquo_space;> patients should be given infusion for emergencies d/t expenses

55
Q

what substance is in greens & some grains which inhibits the absorption of nonheme iron? what are some examples that are common in diets?

A

oxalates
> spinach
> kale

56
Q

what are causes of folate (vitamin B9) deficiency?

A 
poor intake
pregnancy 
alcoholism
MTX use 
depression & nursing homes -> pts do not eat

Pharmacology (7 decks)

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