Week 1 pharmacology

Question 1

What type of iron is used in oral iron therapy?

Answer 1

ferrous salts

Question 2

How is ferrous sulfate administered?

Answer 2

oral

Question 3

What are the types of orally administered iron therapy drugs?

Answer 3

ferrous sulfate, ferrous gluconate, ferrous fumarate

Question 4

What is the indication for oral iron therapy?

Answer 4

iron deficiency anemia, common in growing children and menstrating/pregnant women when iron demands are higher

Question 5

What are adverse effects of oral iron therapy?

Answer 5

black stools, nausea, cramps, constipation

Question 6

What are indications for parenteral iron therapy?

Answer 6

those unable to tolerate oral dosing, extensive anemia not maintained with oral dose alone, chronic renal disease with hemodialysis, gastrectomy conditions, bowel resection, IBS, malabsorption

Question 7

What are the treatment challenges for parenteral iron therapy?

Answer 7

inorganic free ferric iron produces serious dose dependent toxicity

Question 8

What are the 2 forms of parenteral iron therapy?

Answer 8

1. colloidal

2. Iron dextran

Question 9

How is iron dextran administered?

Answer 9

IV and IM

Question 10

Toxic effects of iron dextran

Answer 10

headache, light-headedness, fever, arthralgias, N/V, back pain, flushing, urticaria, bronchospasm, anaphylaxis and death, iron overload

Question 11

What are the effects of acute iron toxicity in young children?

Answer 11

necrotizing gastroenteritis, V and abdominal pain, bloody diarrhea, shock, lethargy, improvement followed by severe acidosis, coma, death

Question 12

What is the drug mechanism of deferoxamine?

Answer 12

iron chelating agent

Question 13

How is deferoxamine administered?

Answer 13

IV

Question 14

How is deferoxamine excreted?

Answer 14

bile and urine, red discoloration

Question 15

What are the adverse effects of deferoxamine?

Answer 15

tachycardia, hypotension, shock, add to CV collapse caused by iron toxicity, abdominal discomfort, N/V, diarrhea

Question 16

What is the indication for deferoxamine?

Answer 16

acute iron toxicity (ingestion)

Question 17

What are the ways to detoxify due to ingestion of iron?

Answer 17

whole bowel irrigation (NOT CHARCOAL), deferoxamine

Question 18

How is deferasirox administered?

Answer 18

oral in OJ

Question 19

How is deferasirox exreted?

Answer 19

feces

Question 20

What are indications for deferasirox?

Answer 20

Chronic iron toxicity due to inherited or acquired hemochromatosis or pt that recieve lots of transfusions

Question 21

Deficiency of ____ causes megaloblastic anemia and neurological syndromes

Answer 21

B12

Question 22

Symptoms of b12

Answer 22

megaloblastic, macrocytic anemia, neurological syndromes, hematologic abnormalities

Question 23

Common causes of b12

Answer 23

pernicious anemia, gastrectomy

Question 24

What type of B12 therapy is usually used?

Answer 24

IM, because most cases are due to malabsorption

Question 25

What are the 2 ways B12 is available?

Answer 25

cyanocoblamin, hydroxocobalamin

Question 26

What is the preferred B12 vitamin?

Answer 26

hydroxocobalamin: more highly protein bound, remains in circulation longer

Question 27

Who is considered high risk for folate deficiency?

Answer 27

pregnant women, pt with alcohol dependence, hemolytic anemia, liver disease, skin diseases, patients on renal dialysis

Question 28

____ folic acid orally daily is sufficient to reverse megaloblastic anemia.

Answer 28

1mg

Question 29

Which drugs induce folate deficiency?

Answer 29

methotrexate, trimethoprim, pyrimethoprim, pyrimethamine, phenytoin,

Question 30

How does phenytoin produce folate deficiency?

Answer 30

inhibits intestinal uptake process

Question 31

Of the drugs that induce folate deficiency, which are less likely to do so because of affinity?

Answer 31

trimethoprim, pyrimethamine

Question 32

What is the relationship between folate and depression?

Answer 32

more folate, less depression

Question 33

What is the indication for leucovorin?

Answer 33

reduced folate

Question 34

What is the mechanism of leucovorin?

Answer 34

rescues cells from the effects of folate antagonists

Question 35

What is the biologically active form of folate found in the circulation

Answer 35

levomefolate

Question 36

_____ readily crosses the blood brain barrier where it modulates the formation of monoamines serotonin, norepinephrine, dopamin.

Answer 36

levomefolate

Question 37

How is leucovorin administered

Answer 37

oral, IM, IV

Question 38

mechanism of epoetin alfa

Answer 38

agonsit of EPO resceptors, stimulates RBC proliferation and differentiation, retic release from bone marrow

Question 39

Administration of epoetin alfa

Answer 39

IV or SC 1-3 x a week

Question 40

Treatment use of epoetin alfa

Answer 40

anamia (esp associated with chronic renal failure), prevention of need for transfusion, offset anemia produced by zidovudine

Question 41

What are the more common effects of epoetin alfa?

Answer 41

HTN, headache, arthralgias, nausea

Question 42

What are less likely adverse effects of epoetin?

Answer 42

edema, fatigue, diarrhea, vomiting, asthenia, chest pain, dizziness, skin reaction, seizures

Question 43

What are the black box warnings for epoteins?

Answer 43

CKD: increase risk of death, Cancer: shortened survival, increase risk of tumor progression

Question 44

How is darbepoietin alfa administered?

Answer 44

IV or SC once weekly

Question 45

How is darbepoietin alfa different from epoietin alfa?

Answer 45

it is a long lasting, glycosylated form

Question 46

How is methoxy peg-epoietin administered?

Answer 46

IV or SC 1-2x a month

Question 47

Mechanism of G-CSF filgrastim

Answer 47

stimulate G-CSF receptors on mature neutrophils and their progenitors; stimulates proliferation, differentiation, activates phagocytic activity, extends survival, mobilize SC

Question 48

_____ permits use of PBSC rather than bone marrow SC for stem cell transplant.

Answer 48

G-CSF

Question 49

Indications of G-CSF

Answer 49

neutropenia, prevention of neutrpenia, mobilization of SC for PBSC transplant

Question 50

Adverse effects of G-CSF (filgrastim)

Answer 50

bone pain, splenic rupture

Question 51

GM-CSF acts with ____ to stimulate T cell proliferation

Answer 51

IL-2

Question 52

Mechanism of GM-CSF

Answer 52

stimulates proliferation and differentiation of early and late granulocytic progenitor cells, erythroid, and megakaryocyte progenitors. Stimulates function of mature neutrophils, mobilizes PBSC

Question 53

Is GM or G-CSF better at mobilizing PBSC

Answer 53

G-CSF

Question 54

____ appears to be a locally active factor at the site of inflamation

Answer 54

GM-CSF

Question 55

How is G-CSF (filgrastim) administered?

Answer 55

SC

Question 56

How is GM-CSF (sargramostim) administered?

Answer 56

SC

Question 57

Adverse effects of GM-CSF

Answer 57

like G-CSF (bone pain, ruptured spleen), fever, arthralgia, myalgia, capillary leak syndrome