Anemia

Question 1

Sx of anemia

Answer 1

Fatigue, weakness, SOB, exercise intolerance, HA, DZ, pallor

Glossitis, koilonychia, pica

Question 2

Complication of B12 deficiency

Answer 2

Peripheral neuropathy

Question 3

Classifications of anemia

Answer 3

MCV >100: Macrocytic (folate or B12 deficiency)
MCV 80-100: Normocytic (blood loss, CKD, malignancy, bone marrow failure, hemolysis(
MCV <80: Microcytic (iron-deficiency)

Question 4

Labs to determine anemia

Answer 4

Low iron
Vit B12 and folate
Reticulocyte is low in iron, folate, B12 deficiency or bone marrow suppression
High reticulocyte → acute blood loss or hemolysis

Question 5

What is in a CBC

Answer 5

Hgb
Hit
RBC
Reticulocyte

Question 6

What is in a RBC indices

Answer 6

MCV
MCH
MCHC
RDW

Question 7

What is in an iron study

Answer 7

Serum iron
Serum ferritin
TIBC
TSAT

Question 8

Causes of iron deficiency

Answer 8

1. Low iron intake (vegetarian, vegan, malnutrition)
2. Blood loss (heavy menses, PUD)
3. ↓ iron absorption (High gastric pH, GI disorder, Gastric bypass)
4. Increased iron requirements (Pregnant, lactation, infants)

Question 9

Elemental iron in ferrous gluconate

Answer 9

12%

Question 10

Elemental iron in ferrous sulfate

Answer 10

20%

Question 11

Elemental iron in ferrous sulfate dried

Answer 11

30%

Question 12

Elemental iron in ferrous fumerate

Answer 12

33%

Question 13

Elemental iron in carbonyl iron, polsaccharide iron complex, and ferric manitol

Answer 13

100%

Question 14

Treatment of iron deficiency anemia

Answer 14

1 tablet QD or every other day

Take on empty stomach
Avoid H2RAs and PPIs; separate from antacids
SR or EC → less GI irritation

Goals: increase hgb 1-2 wks → treat 3-6 months or until normal

Question 15

BBW of iron

Answer 15

Accidental overdose in children

Question 16

ADR of iron products

Answer 16

Constipation (dose-related), dark and tarry stool

Question 17

Antidote for iron OD

Answer 17

desferoxamine (Desferal)

Question 18

Doing of ferrous sulfate

Answer 18

325 mg (65 EI)

Question 19

Design of ferrous sulfate dried

Answer 19

160 mg (50 mg EI)

Question 20

How to separate drugs from iron

Answer 20

FQ and tetracycline: 2 hrs before or 4-8hr after
Bisphosphonates: ≥60 min (Boniva), ≥30 min (Fosamax)
Levohyroxine: 4 hrs

Question 21

Indication forIV iron

Answer 21

CKD on HD recieving ESA
Unable to tolerate PO iron
Severe anemia Hgb <7
Patients who will not accept an RBC transfusion

Question 22

Iron sucrose

Answer 22

Venofer

Question 23

Ferumoxytol

Answer 23

Feraheme

Question 24

BBW of IV iron

Answer 24

Iron dextran and ferumoxytol: serious anaphylaxis

Iron dextran requires a test dose

Question 25

ADR and warning of IV iron

Answer 25

All IV iron → hypersensitivity risk Hypotension → give slowly to avoid All agents are stable in NS

Question 26

What is pernicious anemia

Answer 26

Vitamin B12 deficiency

Question 27

Drugs that can cause Vit B12 deficiency

Answer 27

Metforin, H2Ra, Pais,

Question 28

Signs of folate deficiency

Answer 28

Ulcerations in oral mucosa

Question 29

Doing of Cyanocobalmin

Answer 29

IM or deep SC: 100-1000 mcg QW Nascobal: 500 mcg one nostril QW

Question 30

ADR of cyanocobalmin

Answer 30

Rash, polycythemia vera, pulmonary edema CI: allergy to cobalt or vitamin B12

Question 31

ADR of folate

Answer 31

Bronchospasm, flushing, rash, malaise, pruirtis

Question 32

Drugs that are decreased by folate

Answer 32

Phenytoin, fosphenytoin, primidone, phenobarbital

Question 33

When can ESA be initiated

Answer 33

HgB <10 Iron has been corrected by IV

Question 34

When to DC ESA

Answer 34

Hgb approaches or exceeds 11

Question 35

ESA products

Answer 35

Epoetin alfa (Epogen, Procrit, Retacrti) Darbepoetin alfa (Aranesp)

Question 36

How often to administer ESA

Answer 36

Epoetin: 3x weekly Darbepoetin: Weeklt

Question 37

BBW of ESA

Answer 37

Increased risk for death, MI, stroke, VTE, thrombosis CKD: increased risk of death and Hbg >11 Not indicated if there is anticipated cure in select cancers

Question 38

ADR of ESA

Answer 38

HTN, Arthralgia

Question 39

Storage of ESA

Answer 39

Refrigerator Don't shake

Question 40

Describe forms of drug-induced hemolytic anemia

Answer 40

Immune-mediated: Postive Coombs test G6PD deficiency → ↑ oxidant injury

Question 41

Drugs that require the Coombs test

Answer 41

Penicillins cephalosporins Isoniazid Levodopa/Methyldopa Riffampin Quinidine Quinine Sulfonamides

Question 42

Drugs that require G6PD deficiency screening?

Answer 42

Dapsone Methylene blue Nitrofurantoin Pegloticase Rasbuicase Primaquine Quinidine Quinine Sulfonamides