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AnemiaFC Flashcards

1
Q

Anemia what are causes ?

A

low HGB or RBCs
Bleeding
(sickle cell)
bone marrow cant produce enough rbcs
Lack of nutrients (iron, vitamin B12, folate)

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2
Q

Signs & Symptoms anemia

A

Fatigue, malaise, weakness
shortness of breath, dizziness,fainting,
pale skin
Chest pain, angina, palpatations, tachycardia
-Glossitis (sore tongue), koilonychias (spoon-shaped nails), pica (craving and eating non-foods)

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3
Q

which patients most commonly get injected iron rather than oral iron?

A

those on hemodyalysis because they lose iron from dialysis

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4
Q

Lab Values to monitor and normal values

A

Anemia has low Hgb and low Hct, MCV, TIBC, Serum ferritin, transferring saturation

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5
Q

typical hgb

A

Hgb = 13-18 (males), 12-16 (females)

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6
Q

typical hct

A

-Hct = 39-49% (males), 36-46% (females)

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7
Q

typical mcv and what used for

A

-MCV is used to classify type of anemia (80-100)Microcytic means that MCV I low, Macrocytic means MCV is high, or normocytic when they have normal volume

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8
Q

what is the TIBC, normal? What does it indicate?

A

-Total Iron-Binding Capacity (TIBC) = 250-400 (high TIBC may indicate iron deficiency)

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9
Q

typical serum ferritin

A

-Serum Ferritin = 30-300 (males), 10-200 (females),

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10
Q

TSAT stand for? Normal? What is it usedfor

A

-Transferrin Saturation (TSAT) = 15-50% (males), 12-45% (females), >20% (CKD)

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11
Q

what is the most common type of anemia?

A

microcytic anemia,iron deficiency anemia

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12
Q

lab values assocated w/ iron deficiency anemia?

A

-Low Hgb (<80)

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13
Q

what is the difference betweein hem and non heme iron?

A

Heme iron (animal meat) vs. nonheme iron (plant/dairy)
nonheme iron: bioavailability requires gastric acid and differs depending on enhancers and inhibitors in the diet

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14
Q

Microcytic Anemia: Risk Factors

A

Pregnant women, pre-term and low birth weight infants, older infants and toddlers
Teenage girls
women with heavy menstrual periods
Renal failure patients (iron deficiency)

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15
Q

Treatment of Microcytic Anemia
first line
how long takes to return iron values to norm
food and effect on iron?

A

-Oral iron therapy is first-line (execpt w/ hemodialysis)
Ferrous iron is best absorbed
-May take 3-4 months for the iron stores to return to normal
Sustained release forms are not recommended for initial therapy
Absorption of iron is enhanced in an acidic enviroment
Food will Decrease Absorption of iron

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16
Q

what is the first line of therapy for microcytic anemai? What doses?

A

-1st line therapyFerrous Sulfate
-325mg PO daily (20%; 65 mg elemental iron)

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17
Q

how long does it take to restore iron levels if deficint?

A

3-4 months

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18
Q

should patients take iron with food?

A

no food = better absorption so rec, but if Nausea, then can take w/ food but dec absorption

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19
Q

percent elemental iron of each oral formulation

A

ferrous sulfate 20%, ferrous fumarate 33%, ferrous gluconate 12 %

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20
Q

what is DOC if pt has Iron type constipation?

A

give docusate as Doc

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21
Q

what is the BBW of ferrous sulfate?

A

-BBW: accidental overdose of iron is a leading cause of fatal poisoning in children under 6 (deferoxamine is antidote)

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22
Q

SE of ferrous sulfate?

A

SE: stomach upset, nauea, constipation, dark and tarry stoold

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23
Q

mx for ferrous sulfate?

A

Monitor: Hgb, Serum iron, TIBC, Ferritin

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24
Q

Ferretts

A

Ferrous fumarate

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25
Ferrous Fumarate doses
-324 mg PO daily (33%; 106 mg elemental iron)
26
BBW of ferrous fumarate
-BBW: accidental overdose of iron is a leading cause of fatal poisoning in children under 6 (deferoxamine is antidote)
27
SE of ferrous fumarate
SE: stomach upset, nauea, constipation, dark and tarry stoold
28
mx for ferrous fumarate
Monitor: Hgb, Serum iron, TIBC, Ferritin
29
Ferrous Gluconate (Fergon)
-324 mg PO daily (12%; 38 mg of elemental iron)
30
fergon
ferrous gluconate
31
hemocyte
ferrous fumarate
32
bbw for ferrous gluconate?
-BBW: accidental overdose of iron is a leading cause of fatal poisoning in children under 6 (deferoxamine is antidote)
33
SE for ferrous gluconate?
SE: stomach upset, nauea, constipation, dark and tarry stoold
34
mx ferrous gluconate
Monitor: Hgb, Serum iron, TIBC, Ferritin
35
ferralet
carbonyl iron
36
ferracap
carbonyl iron
37
Carbonyl Iron doses
-Highest amount of iron (100% elemental iron)
38
bbw for carbonyl iron
-BBW: accidental overdose of iron is a leading cause of fatal poisoning in children under 6(deferoxamine is antidote)
39
se carbonyl iron
SE: stomach upset, nauea, constipation, dark and tarry stoold
40
mx carbonyl iron
Monitor: Hgb, Serum iron, TIBC, Ferritin
41
Iron Patient Counseling
-Best taken on an empty stomach 1 hour before or 2 hours after meals -Avoid taking antacids, dairy products, tea, coffee, or wine 2 hours before or after this medication Can cause your stool to become dark may need docusate for constipation
42
Iron Drug Interactions
antacids and agents that raise pH Antiobiotics, mainly tetracycline and quinolones Food decreases Absorption decreases levels of levodopa, methyldopa, levothyroxine, mycophenolate
43
Indication for Parenteral Iron Therapy
hemodialysis Unable to tolerate Oral iron -Intestinal malabsorption (Crohn's) Donating large amounts of blood for autoinfusion
44
Intravenous Iron Supplementation, BBW ? SE, HGB, whats special about giving this IV?
iron dextran (INFeD, Dexferrum), sodium ferric gluconate (Ferriecit, Nulecit), iron sucrose (Venofer), ferumoxytol (Feraheme) BBW (iron dextran only): anaphylactic reactions, patients should be given a test dose, concomitant use of ACEi may increase risk SE: hypotension, Chest tightness, peripheral edema, risk of anaphylaxis (BBW for iron dextran) Monitor: Hgb, Serum Ferritin, Serum iron, Transferrin Saturation Give IV slowly to Decrease hypotension (less risk with ferumoxytol)
45
Macrocytic Anemia cause, diagnosis,?
Due to either vitamin B12 or folate deficiency, or both -Diagnosised by low hemoglobin and high MVC (>100)
46
macrocytic anemia : pericious anemia definition and test, neurological consecuencses?
Pernicious anemia: low B12 levels Due to a Lack of intrinsic factor which requiresLIFE LONG vitamin B12 replacement Schilling test Can diagnose vitamin B12 deficiency Due to Lack of intrinsic factor Neurological consequences: cognitive dysfunction and peripheral nerve damage
47
who should be gettign the injectible vitamin b12 injections?
if severe deficiency if neurological symptoms if cannot take medication orally
48
Cyanocobalamin (Vitamin B12)
CI: cobalt allergy
49
cyanocobalamin routes? Dosing? ADR?
IM or deep SC: daily or monthly. adr: itching, diarrhea, edema usualy given as an INJECTION b/c crappy oral absorption -Intranasal: 500 mcg in one nostril once weekly (Nascobal); each nostril daily (CaloMist) Do not use Sustained-release as the Absorption is not adequate
50
SE cyanocobalamin, mx, DI
SE: itching, diarrhea, edema Monitor: Hgb, Hct, vitamin B12, folate, iron DI: colchicine, ethanol, LONG-term treatment with metformin
51
vitamin b12 generic name
cyanocobalamin
52
Folic Acid (Folate) dosing
-0.4 & 0.8 mg tabs (OTC), 1 mg tabs (Rx)
53
Folate SE, Mx, DI
SE: bronchospasm, flushing, rash, pruritus Monitor: Hgb, Hct, folate, vitamin B12, iron -DI: phenobarbital, phenytoin, primidone, OC, cholestyramine, azathioprine, 6-MP, methotrexate, thioguanine
54
Anemia of Chronic Kidney Disease, how does CKD lead to anemia? Main treatment?
Renal disease causes anemia Due to Lack of erythropoietin erythropoietin stimulates the bone marrow to produce RBCs Treated with erythropoiesis stimulating agent (ESA)
55
Erythropoiesis Stimulating Agents (ESAs): BBW, What action to take regardign BBW
increase risk of death, MI, stroke, VTE, thrombosis of vascular access, and tumor progression or recurrence Chronic kidney disease Cancer -Use lowest possible dose and stop with Hgb is near 11
56
ESA Drugs names, routes , CI SE Mx
Epoetin alfa (Epogen, Procrit), darbepoetin (Aranesp), peginesatide (Omontys) All are IV or SQ CI: uncontrolled HTN, pure red cell aplasia (PRCA) that begins after treatment SE: HTN, arthralgia, muscle spasm, pyrexia, vascular occlusion, upper respiratory tract infection, thrombosis Monitor: Hgb, Hct, Transferrin Saturation, Serum Ferritin, BP
57
ESA Patient Counseling BBW, Ses, Storage/use
-Increase risk of life-threatening heart or circulation problems; including heart attack or stroke (increases the longer you use) less serious SE: dizziness, mild headache, fever, sore throat, body aches, nausea, vomiting, diarrhea HEADACHEE -Do not shake the medication vial; do not use if medication has changed colors or has particles Store in refrigerator and Do not freeze
58
where to inject the ESA's
recommended sites for injection include: outer area of upper arm, the abdomen, the front of the middle thighs, the upper area of the buttocks NO DELTOID- b/c IM locaiton
59
RBC has a life span of
120 days
60
iron duration
effect of supplementation may be seen in about 3 weeks and should be used for about 3-6 months AFTER storage has been replaced.
61
IV infusion of iron causes
HYPOTENSION- slow rate and greater intervals may help
62
ferric gluconate brand
Ferrlecit
63
iron sucrose brand
venofer
64
IM injection
go into DELTOID
65
erythropoetin is IM or SC?
SC
66
when do you start ESA and stop therapy
when hgb < 10 stop when near 11
67
dosage differences for epo ad aranasep
epo is dose weekly or everytime w/ hemodiaylysis, but darbepoetin is dosed every weekly or ever 2 weeks.
68
what is reqd for ESA's to work effectively
ALSO you need adequate IRON for these agents to work

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