Pharmacology Of The Management of anemia Flashcards
Types of iron supplements
“Ferrous” with an anion (Iron salts)
Examples: ferrous gluconate, ferrous fumarate, ferrous lactate
vitamin B12 supplement MOA and pharmacokinetics
MOA: works with folate to promote increase synthesis of building blocks for DNA/RNA and is essential in maintaining the integrity of the neurological system and RBCs
Pharmacokinetics: IM, oral or nasal spray possible (spray is only used in patients that the IM injection failed on)
(Oral is only used in cases where B12 are only slightly low, very low = IM or nasal)
- not the greatest for pregnancy but is still safe “C”)
Folic acid vs Vit B 12 deficiencies
Usually requires blood test to determine for sure
HOWEVER, folic acid deficiency presents without neurological manifestations
- Vit. B12 will possess neurological manifestations to some degree
(Parasthesia, numbness/tingling sensation)
- both folate and Vit B12 are required to stimulate thymidylate synthase activity in DNA production*
Hydroxyurea MOA/ pharmacokinetics
Antimetabolite that is used to treat HbS by increasing HbF by blocking the division of HbS expressing erythroid precursors and triggers HbF expression
Renal and liver metabolism w/ 2-4 hr half life
- not recommended in pregnant patients*
3 agents used to treatneutropenia
Fligrastim
Pegfilgrastim
Sargamostim
“Stim’s”
Reasons for vitamin B12 deficiency
Decrease intake (vegans)
Impaired absorption
Increased requirement (pregnancy, hyperthyroidism)
Reasons for folic acid deficiency
Decrease intake (alcoholics)
Impaired absorption (oral contraceptives)
Increased loss (hemodialysis)
Increased requirement (pregnancy, infancy)
Folic acid antagonist (methotrexate)
Signs of vitamin B12 macrocytic anemia
MCV > 100
Vitamin B 12 deficiency levels
Bilateral parasthesia in extremities
Decreases proprioception
Neurological deficiencies
Reduced appetite
Beefy-red tongue
Low hematocrit
Folic acid deficiency signs
Bilateral parasthesia in extremities
Defects in proprioception
NO neurological deficiencies
Reduced folate levels with normal B12 levels
alcoholics and pregnant patients are the most common
Most common Types of hemoglobin
Hemoglobin A (HbA): adult hemoglobin with two alpha chains and two beta chains
Hemoglobin F (HbF): Fetal hemoglobin with two alpha chains and two gamma chains
Hemoglobin S (HbS): Adult hemoglobin similar to HbA except beta chains are dysfunctional (glu -> Val)
Thrombocytopenia
Decreased platelet counts and increases risk of bleeding significantly
uses TPO, IL-11 or direct platelet transfusion are the treatment options
Why is iron supplements in ferrous form rather than ferric form?
Ferrous form is the only form that can be absorbed by the GI system.
(If supplements are ferric form, lowers the absorption rate since there is an extra step now required)
Why is orange juice/ ascorbic acid indicated for patients that are taking iron supplements?
Naturally reduces ferric to ferrous which would further increase absorption of the supplement.
Why should eggs, milk, coffee and tea be avoided with iron supplements?
Reduce absorption due to forming insoluble complexes with iron making it challenging to move across GI mucosa and reducing it properly.
Most likely reasons for Vit B12 deficiency
Vegan diet
Proton pump inhibitors or GI malabsorption
Pregnant patients
Hyperthyroidism
