Agents used in Anemias and Hematopoietic Growth Factors Flashcards
(244 cards)
1
Q
Condition caused by a lack of RBCs which supply oxygen to different parts of the body
A
Anemia
2
Q
Possible causes of Anemia
A
- low iron
- low folic acid & vit. B12
3
Q
Essential component of hemoglobin
A
Iron
4
Q
Essential for the maturation of cells
A
Folic acid & Vitamin B12
5
Q
Formation of blood cells
A
Hematopoiesis
6
Q
Drugs involved in the formation of blood cells
A
Hematopoietic drugs
7
Q
Need growth factors or stimulating factors
A
Hematopoietic Stem Cells (HSC)
8
Q
Other term for HSC
A
Hemocytoblasts
9
Q
Capable of producing different types of cells which are pluripotent
A
Hematopoietic Stem Cells (HSC)
10
Q
Refers to the ability of HSCs to renew on its own
A
Pluripotent
11
Q
Cells that arise from HSC
A
- Lymphoid progenitor
- Myeloid progenitor
12
Q
Arise from lymphoid progenitor
A
Lymphoblasts
13
Q
Arise from lymphoblasts
A
- T-lymphocytes
- B-lymphocytes
- Natural killer cells
14
Q
Cells that arise from myeloid progenitor
A
- Erythrocyte
- Megakaryocyte
- Myeloblast
15
Q
Arise from myeloblast
A
- Monocyte
- Neutrophil
- Basophil
- Eosinophil
16
Q
Gives rise to Macrophage
A
Monocyte
17
Q
Fights bacterial infection
A
Neutrophil
18
Q
Carries oxygen
A
Erythrocyte
19
Q
Fights helminthic infection
A
Eosinophil
20
Q
Gives rise to platelets
A
Megakaryocyte
21
Q
Forms clots to stop bleeding
A
Platelets
22
Q
Release in response to worms and environmental threats
A
Basophil
23
Q
Deficiency in erythrocytes
A
Anemia
24
Q
Deficiency in platelet
A
Thrombocytopenia
25
Deficiency in neutrophil
Neutropenia
26
Normal color of RBCs
Normochromic
27
Paler than normal RBCs
Hypochromic
28
Normal sized RBCs
Normocytic
29
Smaller sized RBCs
Microcytic
30
Larger size RBCs
Macrocytic
31
Large and immature cells
Megaloblastic
32
Rate of cell destruction
Hemolysis
33
Normal range of WBCs
3,500-11,000 cells/mcL
34
Normal range of hematocrit for women
34.9%-44.5%
35
Normal range of hematocrit for men
38.8%-50.0%
36
Normal range of platelets count
150,000-450,000/mcL
37
Normal range of RBCs in women
3.9-5.1 million cells/mcL
38
Normal range of RBCs in men
4.3-5.7 million cells/mcL
39
Normal range of hemoglobin in men
13-17 g/dL
40
Normal range of hemoglobin in women
11.5-15.5 g/dL
41
5 Types of Anemia
1. Sickle cell
2. Iron deficiency
3. Aplastic
4. Thalassemia
5. Vitamin Deficiency
42
Genetic disorder wherein the erythrocytes is shaped like crescent moon
Sickle cell
43
Most common type of anemia
Iron deficiency
44
Occurs when the body stops producing enough new blood
Aplastic
45
Inherited blood disorder that causes the blood to have less hemoglobin
Thalassemia
46
Lack of healthy blood cell caused by a deficiency in Vitamin B12 and folate
Vitamin Deficiency
47
3 Possible causes of Anemia
1. malabsorption of RBCs
2. hemolysis of RBCs
3. increased demand for RBCs
48
Forms the nucleus of iron-porphyrin heme which together with globulin chains form hemoglobin
Iron
49
How is hemoglobin formed?
Fe-porphyrin heme + protein (globulin)
50
Indicated for the tx or prevention of IDA
Iron
51
Manifest as hypochromic, microcytic anemia
Iron Deficiency Anemia (IDA)
52
Commonly seen in infants, children during rapid growth, pregnant and lactating women and CKD patients undergoing dialysis
IDA
53
more absorbable source of iron in animals
heme
54
source of iron in plants
non-heme
55
Site of blood formation
bone marrow
56
produce the erythropoietin hormone needed for the formation of RBCs
kidneys
57
transported by heme carrier protein (HCP)
Heme
58
transported by divalent metal transporter (DMT)
Non-heme
59
Heme carrier protein (HCP) → Ferroportin (FP) → bloodstream
Heme Pathway
60
Divalent metal transporter (DMT) → Apoferritin (AF) will complex with ferrous → FP → bloodstream
Non-Heme Pathway
61
attach to the receptor in the bone marrow
Transferrin (Tf)
62
The following process occurs where?
Tf → release ferrous → mix to form hemoglobin
Bloodstream
63
stored in the liver
Ferritin
64
most efficiently absorbed iron in oral iron therapy
Ferrous (II) iron
65
Other types of oral iron therapy for anemia
Ferrous sulfate, Ferrous gluconate and Ferrous fumarate
66
About _____________________ given as ferrous salt can be absorbed
25% of oral iron
67
About 25% of oral iron given as ______________ can be absorbed
ferrous salt
68
Common ADRs of oral iron therapy
1. Nausea
2. Epigastric discomfort
3. Abdominal cramps
4. Constipation
5. Diarrhea
69
Major side effect of iron
Gastric toxicity
70
Patients unable to tolerate large amount of iron may be given _______________________
lower daily dose of iron
71
Absorbed iron
Elemental iron
72
Elemental iron content of Ferrous sulfate, hydrated
65 mg
73
Elemental iron content of Ferrous sulfate, desiccated
65 mg
74
Elemental iron content of Ferrous gluconate
36 mg
75
Elemental iron content of Ferrous fumarate
106 mg
76
Tablet size of commonly used oral iron preparations (ferrous sulfate, ferrous gluconate, & ferrous fumarate)
325 mg
77
Usual adult dose of tx using ferrous sulfate hydrated & desiccated
2-4 tablets per day
78
Usual adult dose of tx using ferrous gluconate
3-4 tablets per day
79
Usual adult dose of tx using ferrous fumarate
2-3 tablets per day
80
Reserved for patients with iron deficiency who can not tolerate oral iron
Parenteral Iron
81
Reserved for patients with advance CKD requiring hemodialysis & treatment with erythropoietin
Parenteral iron
82
Reserved for patients with various post gastrectomy condition and previous small bowel resection, inflammatory bowel disease
Parenteral iron
83
Can produce serious dose dependent toxicity
Parenteral iron
84
Types of Parenteral iron
Iron Dextran, Sodium Ferric Gluconate Complex, Iron Sucrose Complex
85
Stable complex or ferric oxyhydroxide and dextran polymer containing 50mg elemental iron/mL of solution
Iron dextran
86
Iron dose is also known as _________
Elemental iron
87
Iron dextran is composed of?
ferric oxyhydroxide and dextran polymer
88
Given by deep IM or IV infusion
Iron dextran
89
Colloidal Iron preparation with carbohydrate polymer
Ferric carboxymaltose
90
Superparamagnetic iron oxide nanoparticle coated with carbohydrate that may interfere with MRI
Ferumoxytol
91
Only given by IV route
Sodium Ferric Gluconate Complex and Iron Sucrose Complex
92
Monitoring iron storage level to avoid serious toxicity is done for _____________________
patients treated chronically parenteral iron
93
What must be done for patients treated with chronically parenteral iron?
Monitor iron storage level
94
Why must iron storage level be monitored for patients treated with chronically parenteral iron?
To avoid serious toxicity
95
Almost exclusive in young children
Acute Iron Toxicity
96
10 tablets can be lethal in young children
Acute Iron Toxicity
97
Children poisoned with oral iron may experience
Necrotizing gastroenteritis with vomiting, abdominal pain, bloody diarrhea
98
Flush unabsorbed pills
Whole bowel Irrigation
99
Antidote for iron toxicity
Deferoxamine
100
Potent chelating agent in which excess iron will combine with this drug and is excreted through urine
Deferoxamine
101
Hemochromatosis
Chronic Iron Toxicity
102
Excess iron may be deposited in the heart, liver, pancreas and other organs
Chronic Iron Toxicity
103
Most commonly occur in patients with inherited hemochromatosis
Chronic Iron Toxicity
104
Iron chelating therapy with parenteral deferoxamine or oral iron chelator is less efficient
Chronic Iron Toxicity
105
Antidote for Chronic Iron Toxicity
Phlebotomy
106
serves as a cofactor for several essential biochemical reaction
Cobalamin or Vit. B12
107
Vit. B12 deficiency leads to
1. Megaloblastic anemia
2. Gastrointestinal symptoms
3. Neurologic abnormalities
108
abnormal sensation, cause ataxia, weakness and spasticity
Paresthesia
109
disorder that affect coordination and balance
Ataxia
110
Active forms of the vitamin B12 in humans
Deoxyadenosylcobalamin and Methylcobalamin
111
Naturally-occuring forms of vitamin B12
Deoxyadenosylcobalamin and Methylcobalamin
112
Available for therapeutic use
Cyanocobalamin and Hydroxycobalamin
113
Synthetic forms of vitamin B12
Cyanocobalamin and Hydroxycobalamin
114
Stable and most effective form of vit. B12 but must be converted to the active form
Cyanocobalamin
115
Ultimate source of Vit. B12
microbial synthesis
116
needs to bind with intrinsic factor (secreted by GI) to be absorbed
Extrinsic factor
117
Average American Diet of Vit. B12
5-30 mcg of Vit. B12
118
Absorbed Vit. B12
1-5 mcg
119
Recommended daily allowance of Vit. B12
2-2.4 mcg
120
released by salivary glands to separate vit. B12 and dietary protein
Haptocorrin
121
a protein released by the stomach to bind with vit. B12, aiding its absorption
Intrinsic factor
122
Illium contains this receptor which specializes in the absorption of vit. B12 resulting in the separation of vit. B12 and IF
Cubam receptor
123
Transport vit. B12 to bloodstream of the cell
Transcobalamin
124
2 essential enzymatic reaction in humans associated with vit. B12
1. Methyltransfer from N5-methyltetrahydrofolate
to homocysteine
2. Isomerization of L-Methylmalonyl CoA
125
precursor of different biochemical reactions
Methyltransfer from N5-methyltetrahydrofolate
to homocysteine
126
Manifestation of Vit B12 deficiency
1. Megaloblastic, macrocytic anemia
2. Often associated mild or moderate leukopenia or thrombocytopenia
3. Neurological syndrome
127
low leukocytes
leukopenia
128
Correction of vit. B12 deficiency _________________________ of neurologic disease it may not fully reverse neurologic symptoms
arrest the progression
129
Correction of vit. B12 deficiency arrest the progression of neurologic disease it ____________________________ neurologic symptoms
may not fully reverse
130
measures the absorption & urinary excretion of radioactively labeled vit. B12
Schilling test
131
Defective secretion of intrinsic factor by the gastric mucosal cell
Pernicious anemia
132
available as cyanocobalamin or hydroxycyanocobalamin
Vitamin B12 parenteral injection
133
Initial dose of Vitamin B12 parenteral injection
100 – 1000mcg vit B12 IM daily or every other day for 1 – 2 weeks
134
Maintenance dose of Vitamin B12 parenteral injection
100 – 1000mcg IM once a month for life
135
Very important for pregnancy as it is needed for the baby's brain and spinal cord development
Folic acid
136
result of inadequate folic acid during pregnancy
Neural tube defect
137
required for essential biochemical reaction that provides precursors for the synthesis of amino acid, purine and DNA
reduced form of folic acid
138
cause of congenital malformation in newborns
Folate deficiency
139
Play an important role in vascular disease
Folic acid
140
undergoes reduction, catalyzed by the enzyme dihydrofolate reductase to give dihydrofolic acid
Folic acid
141
Enzyme that catalyzes folic acid, giving rise to dihydrofolic acid
dihydrofolate reductase
142
Average American Folic Acid diet
500-700 mcg folate daily
143
Folate absorbed
50-200 mcg
144
Folate absorbed by pregnant women
300-400 mcg daily
145
excreted in urine and stool
Folic acid
146
readily and completely absorbed in the proximal jejunum
Unaltered folic acid
147
Folate deficiency results in
Megaloblastic anemia
148
Patients with alcohol dependence and patients with liver disease can develop
folic acid deficiency
149
Folic acid deficiency can develop in pregnant women and patients with ________________________
hemolytic anemia
150
Folic acid deficiency can also develop in patients who require __________________
renal dialysis
151
Dose and frequency sufficient to reverse megaloblastic anemia, restore normal serum folate levels, and replenish body stores of folates in almost all patients
1 mg folic acid orally daily
152
Glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells in the bone marrow
Hematopoietic Growth Factor
153
Stimulate the growth of colonies of various bone marrow progenitor cells in vitro
Colony Stimulating Factor (CSF)
154
for neutrophil, basophil, and eosinophil
Granulocyte colony stimulating factor (G-CSF)
155
typically given for neutrophil deficiency
Granulocyte colony stimulating factor (G-CSF)
156
First human hematopoietic growth factor to be isolated
Erythropoietin
157
Originally purified from the urine of patients with severe anemia
Erythropoietin
158
Produced in a mammalian cell expression system
Recombinant human erythropoietin (rHuEPO, Epoetin Alpha)
159
Half-life after IV admin of rHuEPO in px with chronic kidney failure
4-13 hours
160
Not cleared by dialysis
Recombinant human erythropoietin (rHuEPO, Epoetin Alpha)
161
Administered thrice a week
Recombinant human erythropoietin (rHuEPO, Epoetin Alpha)
162
Given once a week
Darbepoetin alpha
163
Modified form of erythropoietin that is more heavily glycosylated as a result of changes in amino acid
Darbepoetin alpha
164
Has two-fold to three-fold longer half-life than epoetin alpha
Darbepoetin alpha
165
Isoform of erythropoietin covalently attached to a longer polyethylene glycol polymer
Methoxy polyethylene glycol – epoetin
166
Long lived recombinant product is administered as a single intravenous or subcutaneous dose at 2 week or monthly intervals
Methoxy polyethylene glycol – epoetin
167
Stimulates erythroid proliferation and differentiation by interacting with erythropoietin receptor on the RBC progenitor
Erythropoietin
168
Induces the release of reticulocyte from the bone marrow
Erythropoietin
169
Immature RBC from the bone marrow
reticulocyte
170
primarily produced in the kidney
Endogenous erythropoietin
171
In response to _______________, more erythropoietin is produced through an increased rate of transcription of the erythropoietin gene
tissue hypoxia
172
Low hematocrit, low hemoglobin, and high erythropoietic results in
Anemia
173
consistently improve the hematocrit and hemoglobin level, often the need for transfusion
Erythropoiesis – stimulating agents (ESA)
174
Used routinely in patients with anemia secondary to CKD
Erythropoietin-Stimulating agent
175
T/F: Erythropoietin-Stimulating agent dose should not exceed 10-12 g/dL
True
176
T/F: Erythropoietin-Stimulating agent increase the need for RBC transfusion in px undergoing myelosuppressive cancer chemotherapy who have hemoglobin of less than 5g/dL.
False; reduce the need...hemoglobin of less than 10g/dL
177
Most commonly observed HTN and thrombic complication
Erythropoietin-Stimulating agent toxicity
178
Myeloid Growth Factor drugs
1. Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
2. Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
3. Pegfilgrastim
4. Lenograstim
179
used for patients with neutropenia
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
180
Produced by bacterial expression system
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
181
Non-glycosylated peptide of 175 amino acid with a molecular weight of 18KDa
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
182
Stimulates the proliferation and differentiation of progenitor already committed to the neutrophil lineage
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
183
Activates the phagocytic activity of mature neutrophil and prolongs their survival in the circulation
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
184
Recombinant Human G-CSF (rHuG-CSF; Filgrastim) Dose
5 mcg/kg/day
185
Recombinant Human G-CSF (rHuG-CSF; Filgrastim) toxicity
Minimal but may cause bone pain
186
Given for cancer related disease(s) before chemotherapy
Recombinant Human G-CSF (rHuG-CSF; Filgrastim)
187
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim) Half-life of IV or SC
2-7 hours
188
Has broader biological activity that G-CSF
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
189
Stimulates the function of mature neutrophils
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
190
Less efficacious and more toxic than G-CSF
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
191
Reduces the duration of neutropenia after cytotoxic chemotherapy
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
192
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim) Dose
250 mcg/m2/day
193
May cause anaphylactic shock, arthralgias and capillary leak (causing peripheral edema)
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim)
194
Recombinant human GM-CSF (rHuGM-CSF; Sargramostim) at high doses
Severe effect
195
Covalent conjunction product of filgrastim and a form of polyethylene glycol
Pegfilgrastim
196
longer serum half-life than recombinant G-CSF
Pegfilgrastim
197
Can be injected once per myelosuppressive chemotherapy cycle instead of daily for several days
Pegfilgrastim
198
Alternative for G-CSF
Pegfilgrastim
199
for prevention of chemo induced febrile neutropenia
Pegfilgrastim
200
May shorten the period of severe neutropenia slightly more than G-CSF
Pegfilgrastim
201
Pegfilgrastim Dose
Single dose of 6 mg
202
Glycosylated form of recombinant G-CSF
Lenograstim
203
For patients with thrombocytopenia
Megakaryocyte Growth Factor
204
Commonly used to treat thrombocytopenia
Platelet transfusion
205
Thrombopoietin (TPO) and Interleukin-11
Megakaryocyte Growth Factor
206
Produced fibroblast and stromal cell of the bone marrow
Interleukin - 11
207
Acts through a specific cell surface cytokine receptor to stimulate the growth of multiple lymphoid and myeloid cell
Interleukin - 11
208
Acts synergistically with other growth factors to stimulate growth and proliferation of primitive megakaryocyte progenitor
Interleukin - 11
209
Half-life of Interleukin - 11 when administered SQ
7-8 hours
210
for secondary prevention of thrombocytopenia
Interleukin - 11
211
Reduces the number of platelet transfusion required
Interleukin - 11
212
Interleukin - 11 Dose
50 mcg/kg/day
213
Starts 6-24 hours after completion of chemo & continued for 14-21 days
Interleukin - 11
214
Recombinant form of IL-11
Oprelvekin
215
Produced by expression of E. coli
Oprelvekin
216
Recombinant thrombopoietin
Romiplostim
217
Peptide covalently linked to antibody fragment which extends the peptides T1/2
Romiplostim
218
After SQ, Romiplostim is eliminated by ___________________
reticuloendothelial system
219
Average half-life of Romiplostim SQ
3-4 days
220
Relationship of Romiplostim half-life and serum platelet count
inversely related
221
In patients with thrombocytopenia, Romiplostim has a _____________ (longer/shorter) half-life
longer
222
only oral preparation of Megakaryocyte Growth Factor
Eltrombopag
223
For chronic immune thrombocytopenia and thrombocytopenia in patients with Hepa C
Eltrombopag
224
Eltrombopag mode of administration
Oral
225
Eltrombopag half-life
26-35 hours
226
Eltrombopag peaks
2-6 hours
227
Potentially hepatotoxic
Eltrombopag
228
Increases the blast count and risk of progression to acute myeloid leukemia
Romiplostim
229
Increase risk of clot formation
Romiplostim
230
Recombinant G-CSF
Filgrastim
231
Recombinant GM-CSF
Sargramostim
232
Recombinant thrombopoietin
Romiplostim
233
Thrombopoietin Agonist
Eltrombopag
234
Recombinant human Erythropoietin
Epoeitin alpha
235
Epoeitin alpha Route of Admin
IV
236
Eltrombopag Route of Admin
Oral
237
Sargramostim Route of Admin
IV or SC
238
Filgrastim Route of Admin
IV or SC
239
Romiplostim Route of Admin
SC
240
Epoetin alpha Use
Anemia
241
Eltrombopag Use
Thrombocytopenia
242
Sargramostim Use
Neutropenia
243
Filgrastim Use
Neutropenia
244
Romiplostim
Thrombocytopenia
