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NAPLEX 25 > Chapter 35: Anemia > Flashcards

Chapter 35: Anemia Flashcards

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1
Q

What is anemia?

A

Anemia is a decrease in RBC, Hgb & Hct concentrations below the normal range.

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2
Q

Another name for immature RBCs

A

reticulocytes

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3
Q

What can cause anemia?

A

It can occur due to impaired RBC or Hgb production, increased RBC destruction (hemolysis)

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4
Q

What nutritional deficiencies can lead to anemia?

A

Nutritional deficiencies such as iron, folate, and vitamin B12.

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5
Q

What medical disorders can lead to anemia?

A

Anemia can occur as a complication of disorders such as chronic kidney disease (CKD) or malignancy.

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6
Q

What are classic symptoms of anemia?

A

fatigue, weakness, SOB, exercise intolerance, HA, dizziness, anorexia and/or pallor

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7
Q

What are the sign/symptoms of iron deficiency anemia?

A
  • Glossitis is an inflamed, sore tongue.
  • Koilonychias are thin, concave, spoon-shaped nails.
  • Pica is the craving and eating of non-foods.
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8
Q

What can Vitamin B12 deficiency present with?

A

Vitamin B12 deficiency can present with peripheral neuropathies.

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9
Q

What does a low MCV indicate about RBC size?

A

RBCs are smaller than normal
(microcytic anemia)

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10
Q

What does a high MCV indicate about RBC size?

A

RBCs are larger than normal
(macrocytic anemia)

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11
Q

Likely cause of MCV < 80 fL

A

iron deficiency

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12
Q

Likely cause of MCV 80-100 fL (normocytic)

A

acute blood loss, malignancy, CKD, bone marrow failure (aplastic anemia), hemolysis

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13
Q

Likely cause of MCV > 100 fL

A

B12 or folate deficiency

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14
Q

What does a reticulocyte count measure?

A

A reticulocyte count measures the production of RBCs.

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15
Q

When is the reticulocyte count low?

A

Reticulocyte count is low in untreated anemia due to iron, folate, or B12 deficiency and with bone marrow suppression.

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16
Q

What is the most common nutritional deficiency in the US?

A

The most common nutritional deficiency in the US is iron deficiency.

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17
Q

What are causes of iron deficiency?

A
  • Iron-poor diets (e.g., vegetarian)
  • Blood loss (heavy menses and PUD)
  • Decreased iron absorption (high gastric pH, GI disorder, gastric bypass)
  • Increased iron requirements (Pregnancy and lactation)
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18
Q

What are Lab findings in iron deficiency anemia?

A
  • ↓ Hgb, MCV < 80 fL, ↓ RBC production (low reticulocyte count)
  • ↓ serum iron, ferritin and TSAT
  • ↑ TIBC
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19
Q

How should oral iron be taken?

A

On an empty stomach

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20
Q

What should oral iron be avoided with?

A

H2RAs and PPIs, separate from antacids

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21
Q

What is the goal of oral iron therapy?

A

Increase in serum Hgb by 1 g/dL every 1-2 weeks; continue treatment for 3-6 months after anemia has resolved until iron stores return to normal.

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22
Q

What is the dosing for ferrous sulfate?

A

325 mg (65 mg elemental iron) PO daily or every other day

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23
Q

What is a boxed warning for oral iron?

A

Accidental overdose of iron-containing products which is the leading cause of fatal poisoning in children.

In the case of accidental OD, go to the ED or call a poison control center immediately (even if asymptomatic).

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24
Q

What is a common side effect of oral iron?

A

Constipation (dose-related), Dark and tarry stools

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25
What is the antidote for iron overdose?
deferoxamine (Desferal)
26
How does Antacids, H2RAs, and PPIs effect iron absorption?
Antacids, H2RAs, and PPIs decrease iron absorption by increase gastric pH.
27
Which supplement can increase the absorption of iron?
Vitamin C ## Footnote Giving iron with ascorbic acid may enhance the absorption to a minimal extent.
28
What effect does iron have on the absorption of other drugs?
Iron can bind with other drugs in the GI tract to form nonabsorbable complexes. ## Footnote This process is known as chelation.
29
How should iron be administered in relation to quinolone and tetracycline antibiotics?
Take iron 2 hours before or 4 - 8 hours after the antibiotic. ## Footnote This timing helps avoid interference with antibiotic absorption.
30
What is the recommended timing for taking iron after oral ibandronate?
Take iron ≥ 60 minutes after oral ibandronate. ## Footnote This ensures that iron does not affect the absorption of the bisphosphonate.
31
How long should you separate the administration of iron from levothyroxine?
Separate from iron by 4 hours. ## Footnote This prevents interaction that could impair the efficacy of levothyroxine.
32
Iron can decrease absoprtion of which drugs?
* Quinolone & tetracycline antibiotics * Bisphosphonates * Levothyroxine * INSTIs
33
Who are the patients restricted to IV iron?
* Patients with CKD on hemodialysis * Patients with CKD receiving erythropoiesis-stimulating agents (ESAs). * Patients unable to tolerate oral iron or those who have failed oral therapy.
34
Iron sucrose brand name
Venofer
35
Ferumoxytol brand name
Feraheme
36
IV iron BW
* Serious and sometimes fatal anaphylactic reactions with iron dextran or ferumoxytol; * all patients receiving iron dextran should be given a test dose prior to the first full therapeutic dose
37
What is the most common cause of vitamin B12 deficiency?
Pernicious anemia
38
What occurs due to a lack of intrinsic factor?
Pernicious anemia
39
What is required for pernicious anemia?
Lifelong parenteral vitamin B12 replacement
40
What are other causes of macrocytic anemia besides B12 and folate deficiency?
Other causes include alcoholism, poor nutrition, and GI disorders (e.g., Crohn’s disease, celiac disease).
41
What can decrease the absorption of vitamin B12 with long-term use?
Metformin, H2RAs, PPIs
42
What is considered long-term use for the medications that decrease vitamin B12 absorption?
>/= 2 years
43
What does folic acid deficiency cause?
Ulcerations of the tongue and oral mucosa
44
What is the diagnosis of macrocytic anemia?
Low Hgb and high MCV
45
What is the first-line treatment for macrocytic anemia?
B12 injections (caynocobalamin) - IM or deep SC
46
How is Cyanocobalamin nasal solution (Nascobal) used?
Once in one nostril once weekly.
47
What is EPO?
EPO is a hormone produced by the kidneys.
48
What is EPO mechanism of action?
EPO stimulates the bone marrow to produce RBCs.
49
What causes anemia of CKD?
Deficiency of EPO causes anemia of CKD.
50
What is the treatment for anemia of CKD?
Iron therapy and Erythropoiesis stimulating agents
51
What is first-line iron treatment for hemodialysis patients?
IV iron
52
Epoetin alfa brand names
Epogen, Procrit
53
Darbepoetin brand name
Aranesp
54
How many times per week is Epoetin alfa given in CKD?
3x/week
55
When is epoetin alfa initiated in CKD and cancer patients?
When Hgb < 10 g/dL
56
When should the dose of Epoetin alfa be decreased or interrupted?
When Hgb approaches or exceeds 11 g/dL (CKD or HD)
57
How is Darbepoetin for CKD administered?
Darbepoetin for CKD is given IV or SC.
58
How many times per week is Darbepoetin for CKD given?
Once weekly.
59
What are the boxed warnings for ESA?
Increases risk of death, MI, stroke, VTE, thrombosis
60
What is the risk associated with CKD when Hgb level is greater than 11 g/dL?
Increased risk of death
61
What side effects can ESAs cause?
Hypertension, arthralgia
62
What parameters are monitored for ESA treatment?
Hgb, Hct, TSAT, serum ferritin, BP
63
How should ESAs be stored?
in the refrigerator; do not shake
64
The darbepoietin half-life is __-fold longer than epoetin alfa.
3-fold (can be given once weekly for this reason)
65
What are the causes of hemolytic anemia?
Drug-induced or G6PD deficiency
66
Which test is used to detect antibodies that are stuck to the surface of RBCs in hemolytic anemia?
Direct Coombs test
67
Most people with G6PD deficiency should be instructed to avoid which high-risk medications?
1. Cephalosporins 2. Dapsone 3. Isoniazid 4. Levodopa 5. Methyldopa 6. Methylene blue 7. Nitrofurantoin 8. Pegloticase 9. Penicillins 10. Primaquine 11. Quinidine 12. Quinine 13. Rasburicase 14. Rifampin 15. Sulfonamides

NAPLEX 25 (21 decks)

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