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Pharmacology > Anemias and Sickle Cell (Exam 1) > Flashcards

Anemias and Sickle Cell (Exam 1) Flashcards

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1
Q

Anemia

A

Too few RBCs, either by destruction or loss

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2
Q

Symptoms of Anemia

A

Fatique
Tachypnea & dyspnea
Tachycardia
Pallor & cold extremities

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3
Q

Hemoglobin (HgB) levels in Anemic Males

A

HgB <13.5 g/dL

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4
Q

Hemoglobin (HgB) levels in Anemic Females

A

HgB <12 g/dL

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5
Q

What causes anemia? (3)

A

Impaired erythrocyte production
Blood Loss
Increased erythrocyte destruction

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6
Q

How is anemia classified?

A

Effect on RBC size determined by mean corpuscular volume (MCV)

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7
Q

Microcytic Anemia

A

<80 fL MCV
Decreased hemoglobin production

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8
Q

Microcytic Anemia Subtypes (4)

A

Iron deficiency
Sideroblastic
Chronic Inflammation
Thalassemias

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9
Q

Normocytic Anemia

A

80-100 fL
Bleeding, hemolysis
Bone marrow suppression, chronic kidney disease

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10
Q

Normocytic Anemia Subtypes (2)

A

Loss of RBC
Decreased RBC production

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11
Q

Macrocytic Anemia

A

> 100 fL
Decreased DNA production

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12
Q

Macrocytic Anemia Subtype (2)

A

Megaloblastic
Non-megaloblastic

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13
Q

What is the most common type of anemia?

A

Microcytic, hypochromic anemia

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14
Q

Heme Iron

A

Absorbed by GI transporter
Found in meat

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15
Q

Non-Heme Iron

A

Exists as Fe3+
Trivalent, ferric state

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16
Q

Ferrireductase

A

Reduces Fe3+ to Fe2+ prior to absorbtion

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17
Q

What is the co-factor for ferrireductase?

A

Vitamin C

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18
Q

Relationship between non-heme iron and absorption

A

Lower pH = more absorption

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19
Q

What are the two most common routes of administration for iron?

A

Oral and IV

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20
Q

Why is Fe2+ used instead of Fe3+?

A

Higher bioavailability

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21
Q

Ferrous sulfate, hydrated

A

Size: 325mg
Iron: 65mg
Dosing: 2-4 tabs per day

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22
Q

Ferrous sulfate, desiccated

A

Size: 200mg
Iron: 65mg
Dosing: 2-4 tabs per day

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23
Q

Ferrous gluconate

A

Size: 325mg
Iron: 36mg
Dosing: 3-4 tabs per day

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24
Q

Ferrous fumarate

A

Size: 325mg
Iron: 106mg
Dosing: 2-3 tabs per day

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25
Why would one use ferrous gluconate over ferrous sulfate?
Patient has GI problems No differences in bioavailability so it's interchangeable
26
Why is it recommended to take oral iron supplements on an empty stomach?
Maximize absorption since gastric pH is lower before eating
27
DMT1 Transporter
Non specific transporter that binds iron
28
Relationship between DMT1 binding and absorption
Drugs that bind to DMT1 transporter can decrease absorption of Fe
29
GI ADRs (4)
Stomach cramping Heartburn Constipation Black tarry stools
30
What are GI ADRs from?
Free radical generation Changes to gut microbiota
31
Acute iron toxicity symptoms
Bleeding, vomiting, diarrhea, dyspnea, coma
32
Intravenous deferoxamine (DFO)
Antidote for iron overdose Iron chelator which increases iron excretion
33
What state is parenteral given?
The Fe3+ state Binds to transferrin
34
What is the challenge with giving iron through IV?
Unbound iron in the blood is toxic
35
ADR associated with IV iron
Hypersensitivity reactions
36
Vitamin B12
Cobalamin
37
What does vitamin B12 deficiency cause?
Macrocytic, megaloblastic anemia Reduces DNA synthesis
38
Reduction of DNA synthesis
Impairs cell division leading to megaloblasts
39
Vitamin B12 Absorption
Requires acidic environment and intrinsic factor
40
Pernicious Anemia
Defective absorption High gastric pH, antibodies against intrinsic factor
41
Symptoms of Vitamin B12 Deficiency
Paresthesia, weakness, cognitive impairment Due to myelin abnormalities
42
Why is parenteral injection of B112 the most common?
Deficiency is caused by poor absorption
43
What does folate (vitamin B9) deficiency cause?
Macrocytic, megaloblastic anemia Reduces DNA synthesis
44
Folic Acid
Synthetic form of folate used in supplements and fortified foods Used because it's heat and light stable
45
5-MTHF
Reduction and methylation turns folic acid into 5-MTHF
46
ADRs of Folic Acid
Mild nausea, abdominal pain, bloating
47
Erythropoietin stimulating agents (ESAs) mimic...?
Endogenous EPO
48
Chronic Kidney Diseases
Anemia occurs due to a reduction in EPO production
49
Drug Induced Anemias
Some drugs cause myelosuppression
50
Epoetin
Recombinant human EPO
51
Darbepoetin
Synthetic EPO analogue Prolongs half life
52
ESAs Mechanism of Action
Agonists at EPO receptors on hemopoietic cells in bone marrow resulting in increased RBC production
53
ESAs through subcutaneous administration
Increases half life Darbepoetin >> Epoetin
54
ADRs for ESAs
Increased risk for cardiovascular thrombotic events Increased blood pressure
55
When should ESAs be used?
Hgb <10g/dL with intent to prevent need for blood transfusion
56
ESA is not effective if...
Iron levels are low Iron is important cofactor
57
Sickle Cell Disease
Genetic disorder caused by DNA mutation leading to production of defective beta globin chains HbS
58
Sickling occurs when...
HbS is deoxygenated
59
Normal hemoglobin vs Sickle-cell
Normal: Negatively charged Glutamate Sickle-cell: Neutral Valine
60
Electrophoretic Patterns
Normal: BaBa Sickle-cell trait: BaBS Sickle-cell anemia: BSBS
61
Pathophysiology of Sickle-Cell Disease
1.) After deoxygenation, HbS molecules polymerize to form bundles 2.) Bundles result in sickling which leads to vaso-occulaion and promotes ischemia-reperfusion injury OR 3.) Hemolytic process enhanced to release heme from RBC breakdown 4.) Both 2 & 3 promote sterile inflammation
62
Medications preventing vaso-occlusion
Hydroxyurea L-glutamine Crizanlizumab Voxelotor
63
Mediactions for infection prevention and treatment
Penicillin prophylaxis Vaccinations
64
Hydroxyurea treatment
MoA increases gamma globin production and HbF
65
ADRs of hydroxyurea
Immunosuppression, myelosuppression, gastrointestinal issues
66
L-glutamine treatment
MoA decreases oxidative stress Improves ratio of NADH to NADtotal 5-15g Oral BID
67
Crizanlizumab treatment
Monoclonal antibody for P-selectin Blocks interaction with PSGL-1 and decreases vaso-occlusion 5mg/kg IV infusion Week 0, 2, then every 4 weeks
68
Voxelotor treatment
HbS polymerization inhibitor Binds reversibly to hemoglobin preventing polymerization and increasing hemoglobin affinity for oxygen 1500mg Oral QD
69
PK consideration for voxelotor
Drug interactions with CYP3A4 inhibitors and inducers

Pharmacology (18 decks)

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