Agents Used In Anemias

Question 1

What are the symptoms of anemia?

Answer 1

Fatigue
Tachycardia 
Shortness of breath
Pale skin
Dizziness
Insomnia

Question 2

Where is iron stored?

Answer 2

In intestinal mucosal cells, liver, spleen and bone marrow as ferritin

Question 3

What is iron stored as?

Answer 3

Ferritin

Question 4

What is the usual cause of iron deficiency anemia?

Answer 4

Acute/chronic blood loss
Insufficient intake
Heavy menstruation
Pregnancy

Question 5

What are the typical lab findings in iron deficiency anemia?

Answer 5

Hypochromic, microcytic RBCs
High transferrin
Low ferritin level

Question 6

What are the different types of oral preparations that can be used in iron deficiency anemia?

Answer 6

Preparations containing ionic iron

Complex iron preparations

Question 7

What are the oral preparations containing ionic iron?

Answer 7

Ferrous sulfate
Ferrous fumarate
Ferrous gluconate

Question 8

What are the complex iron preparations?

Answer 8

Fe(III)-hydroxide-polymaltose

Question 9

What is the duration of treatment for iron deficiency anemia?

Answer 9

2-6 months

Question 10

What are the interactions of the agents used in iron deficiency anemia?

Answer 10

With chelate forming compounds

Question 11

What are the adverse effects of the oral preparations used in the treatment of iron deficiency anemia?

Answer 11

GI symptoms - nausea, abdominal pain, constipation

Question 12

What are the parenteral preparations used in iron deficiency anemia?

Answer 12

Iron dextran
Sodium ferric gluconate complex
Iron-sucrose complex
NEVER FERROUS!

Question 13

What are the clinical indications of using parenteral preparations in the treatment of iron deficiency anemia?

Answer 13

Severe absorption insufficiency

Very marked bleeding

Question 14

How are the parenteral preparations for the treatment of iron deficiency anemia administered?

Answer 14

IV bolus (slow) or infusion

Question 15

What are the adverse effects of the parenteral preparations in the treatment of iron deficiency anemia?

Answer 15

Anaphylactic shock

Question 16

What are the contraindications of using parenteral preparations in the treatment of iron deficiency anemia?

Answer 16

Hemosiderosis
Hemochromatosis
Acute hepatic problems
Non-iron-deficient-anemia

Question 17

What is the active form of Vitamin B12?

Answer 17

Methylcobalamine

Question 18

What are the causes of B12 deficiency?

Answer 18

Poor absorption (due to lack of IF: pernicious anemia)
Low dietary levels

Question 19

What are the other names of Vit B12?

Answer 19

Cyanocobalamine

Hydroxocobalamine

Question 20

What are the clinical indications of cyanocobalamine administration?

Answer 20

B12 deficiency anemia 
Megaloblastic anemia 
Neuropathy of diabetic and alcoholic patients
Spinal cord syndrome
Facial paresis
Herpes zoster
Bariatric surgery

Question 21

How is Vit B12 absorbed?

Answer 21

Absorption with IF

Question 22

Where is cyanocobalamine stored?

Answer 22

In the liver

Question 23

How is Vit B12 administered?

Answer 23

Oral

Parenteral (hydroxocobalamine)

Question 24

What are the side effects of Vit B12 administration?

Answer 24

Allergic symptoms (around the site of administration)
Risk of embolism
Worsening of psoriasis, eczema

Question 25

What are the contraindications of administering Vit B12?

Answer 25

Polycythemia

Question 26

What is the other name for Vit B9?

Answer 26

Folic acid

Question 27

What is the other name of folic acid?

Answer 27

Vit B9

Question 28

What are the indications of folic acid supplementation?

Answer 28

Prevention and treatment of folic acid deficiency Prevention of congenital neural tube defects General usage is controversial (masks B12 deficiency)

Question 29

What type of anemia is folic acid deficiency anemia?

Answer 29

Megaloblastic anemia

Question 30

What can cause folic acid deficiency?

Answer 30

Increased demand (e.g., pregnancy and lactation) Poor absorption Alcoholism Treatment with drugs that are dihydrofolate reducatase inhibitors (e.g., MTX, pyrimethamine, trimethoprim)

Question 31

How is Vitamin B9 eliminated?

Answer 31

Urine and feces

Question 32

How is folic acid administered?

Answer 32

Orally

Question 33

What are the adverse effects of folic acid administration at high doses?

Answer 33

``` GI problems Sleep disturbances Depression Allergy Abundant availability can enhance the development of pre-cancerous and cancerous tumors ```

Question 34

What are the contraindications of B9 supplementation?

Answer 34

Megaloblastic anaemia of unclarified origin | Folic acid dependent tumors (e.g., colon, hemopoietic)