Do I Make You Sweat(man)? Flashcards
(106 cards)
1
Q
what are the three irons administered for Fe deficiency?
A
ferrous sulfate
ferrous gluconate
ferrous fumerate
2
Q
what is the difference between ferrous and ferric iron?
A
ferrous is “just the 2+ of us”
ferric is 3+
3
Q
how much Fe is absorbed with oral supplementation?
A
25%
4
Q
how much Fe can be incorportated in Hgb per day?
A
50-100mg
5
Q
if you were wanting to correct a Fe def ASAP, how much would you admin? why?
A
200-400
absorb 25% :: will max out daily utilization at 50-100
6
Q
after you correct the deficiency, how much longer do you admin Fe?
A
3-6 mo to replete stores
7
Q
what are the related toxicities related to oral iron?
A
GI probs: nausea, epigastic discomfort, abdominal cramps, constipation, diarrhea
8
Q
what is the most common cause of chronic anemia?
A
iron deficiency
9
Q
what are the symptoms of anemia?
A
pallor fatigue dizziness exertional dyspnea generalized symptoms of tissue hypoxia
10
Q
what is a special adaption to chronic anemia?
A
CV adaptations
tachycardia, increased output, vasodilation
11
Q
what is an underlying disease to be aware of for iron-def pts?
A
CV issues - Fe def can exacerbate
12
Q
where is the Fe used for hematopoiesis from?
A
from senescent or damaged erythrocytes that are recycles
13
Q
where is the most common place of blood loss for men and p-m women?
A
GI
14
Q
adjustments you can make to try to avoid AE of oral iron
A
- dose-related :: lower daily dose
- take with or after meals
- try a different iron salt
15
Q
what is a special side effect of oral iron you need to be aware of?
A
turns stools black :: could obscure a GI bleed **
16
Q
what type of iron do you give orally? parenterally?
A
oral - ferrous
parenteral - ferric
17
Q
parenteral iron is indicated in what pts?
A
- cannot tolerate oral
- extensive chronic anemia
- renal disease 2* Epo admin, dialysis
- proximal bowel/duodenum involvement
18
Q
what is absorbed in the duodenum? jejunum? ileum?
A
duodenum - Fe
jejunum - folate
ileum - B12
19
Q
what is the important thing about parenteral iron? why?
A
serious dose-dependent toxicity
bypasses body’s innate regulation
20
Q
toxicity symptoms for parenteral iron?
A
- hypersensitivity Rx: headache, light head, arthalgias, N+V, back pain, flushing, urticaria, bronchospasm
- (!) : possible anaphylaxis and death **
- give small test dose
21
Q
what is the name of the iron that you admin parenterally?
A
Fe Dextran
22
Q
what values can you use to estimate iron stores?
A
- ferritin
- transferrin
- % sat’n
23
Q
what is the % sat’n?
A
(serum Fe)/ (TIBC)
24
Q
symptoms of acute Fe toxcitiy
A
shock, lethargy, dyspnea,
bloody diarrhea
vomiting, abdominal pain
initial improvement followed by severe metabolic acidosis –> coma –> death!**
25
which iron-overload Tx is given IV? orally?
IV - Deferoxamine
| oral - Defasirox
26
what is Deferoxamine? how does it affect other metals? how is it excreted?
- iron chelating for iron-overload
- doesn't chelate impt trace metals
- bile, urine (red!)
27
side effects of Deferoxamine
- tachycardia, hypotension, shock
| - could add to CV collapse from iron-toxicity**
28
what are types of chronic iron toxicity?
Hemochromatosis
| Thalassemmia Major 2* transfusions
29
what is Defasirox? how can it be admined?
- for chronic iron overload (e.g., due to multiple blood transfusions)
- also for iron ingestion overload/toxicity
:: for chronic and acute
- orally with OJ
30
why OJ with oral Fe?
vit C/ascorbate helps Fe absorb better
31
some side effects of Defasirox
- diarrhea, nausea, abdominal pain, headache
- pyrexia/fever, cough
- increased serum creatinine and liver enzyme levels **
- auditory + visual disturbances **
32
what is the best Tx for chronic iron overload without anemia?
bleeding
| 1 u/week
33
what is another name for vit B12?
cobalamin
34
give me some physical symptoms of B12 def
GI
| neurologic abnormalities
35
why do you get the crazies with B12 def?
because there is a buildup of proprionlyl CoA due to the buildup of me-malonic acid/me-CoA
36
what population is B12 def most likely in?
vegans
| olds
37
give me some hematologic symptoms of B12 def
- megaloblastic erythroid cells
- macrocytic (in ALL cells, not just RBCs)
- pancytopenia: leukopenia and/or
- thrombocytopenia
- hypercellular bone marrow
38
what are causes of B12 def if not from dietary def? what is the general mechanism?
- Pernicious Anemia
- involvement of distal ileum
gen mechanism: malabsorbtion
39
rare causes of B12 def
bacterial overgrowth
chronic pancreatitis
thyroid dis
children w/ congenital IF def or IFR
40
what is parenteral Tx for B12 def?
shots shots shots shot shot shotssss
errryyybody
41
what are the vitamin versions of B12? which one is preferred? why?
Cyanocobalamin
Hydroxycobalamin
Hydroxy > Cyano bc more protein bound :: remains in circulation longer
42
what form of folic acid do you need for biochemical reactions?
reduced
43
what is a more common def, B12 or folate?
folate
44
how long does it take to develop a folate def? a B12 def?
folate: 3-4 mo
B12: 2-4 years
45
what pop are at risk for folic acid def?
```
alcoholics
liver disease
pregnant women
hemolytic anemia pts
dialysis pts
certain skin diseases
```
46
is oral absorption of FA high or low?
high
| even in a pt with a malabs syndrome
47
what drugs cause a deficiency in FA?
Methotrexate
Trimethoprim (antimicrobial)
Pyrimethamine (antimalarial)
Phenytoin (antiepileptic)
48
how does Phenytoin cause FA def?
inhibiting intestinal uptake of FA
49
tell me about Leucovorin.
- Leucovorin is the knight that saves FA Princess from the evil folate antagonists
- he is also a do-gooder and modulates 5-FU/fluorouracil in his fight against the cancers
- he is a reduced folate
50
why are you more likely to get a FA def from Trimethoprim or Pyrimethamine rather than Phenytoin?
bc they have a higher affinty for the bacterial and malarial FA
51
tell me about folate and depression. why did they think that it might work to make the depressed happy puppies of sunshine?
- FA (in a different form) modulates formation of NT like serotonin, norepi, dopa
- study says: might work
52
the best enzyme, MTHFR, takes what to what? what pathway does this play a role in?
FA, DHF to Levomofolate
related to monoamine neurotransmitter synthesis
53
what is the biologically active form of folate found in the circulation?
Levomofolate
aka 6-5-MeTHF, L-MeFolate
54
what makes Levomofolate so special? how does it do this special thing?
it can cross the BBB
receptor-mediated endocytosis
55
what is the name of the hematopoietic growth factor med? what is it's mechanism?
rHuEPO aka Epo alfa
agonist of Epo receptors expressed by red cell progenitors
56
what does a PEG prefix mean?
PEG = polyethylene glycol
the original drug has had PEG added to it
57
what does adding PEG to a drug do?
1. extend the PK
| 2. reduce the need for so frequent re-dosing
58
what does Epo alfa do?
- stimulates erythroid prolif, diff
| - release of retics from bone marrow
59
what is Darbopoietin alfa?
long acting form
weekly vs. every few days
glycosylated
60
what is Methoxy polyethylene glycol also called?
Epo beta
long acting form
1-2x month
61
what is the toxcicity that comes with Epo alfa?
HTN
thrombotic complications
pure red cell aplasia (very rare) **
62
why the special concern with managing Hgb levels with Epo?
bc there are CV risks with >12 g/dL
63
what is Epo alfa used to treat?
- anemia (no shit)
- renal failure assoc anemia
- HIV
- infection
- Cx
- prematurity
64
how is Epo alfa used in the OR? what are the risks that come with this?
can be used instead of a blood transfusion
increased DVT risk :: DVT prophylaxis
65
what special receptor family are the hematopoietic growth factors involved with?
JAK/STAT cytokine receptor
| posphorylation, Tx factors to regulate cell function
66
what induces production of endogenous epo?
hypoxia
67
epo serum levels for helathy, mod severeanemia, and severe anemia
normal: <20 IU/L
moderate: 100-500
severe anemia: 1000s
68
what are epo levels in renal disease? on primary bone disorders? nutritional anemias? secondary anemias?
low
rest high
69
will a person with high or low epo be responsive to exogenous Epo?
low :: renal disease pts will respond
70
what are the two BBW for Epo?
chronic kidney disease **
| Cx **
71
why is chronic kidney disease a BBW for Epo?
- greater risk of death, stroke, serious CV AE **
| - no known dose or dosing strategy to reduce these risks **
72
why is Cx a BBW for Epo?
- shortened overall survival and/or **
| - increased risk of tumor progression **
73
when should an ESA be used?
- for anemia due to myelosupressive Tx **
| - DON'T use when pt is curable **
74
which Epo is better to use, alfa or beta?
alfa
beta had more deaths assoc with it when used for Tx of anemia from chemo **
75
what does Lance Armstrong use?
Epo :: why it's banned
76
what is Zidovudine?
- Tx for HIV pts
- can cause anemia
- Epo can offset this anemia
77
Epo can be used to treat what two specialized populations?
HIV anemics and preemies
78
what are the myeloid growth factors?
G-CSF/filgrastin
Pegfilgrastin
GM-CSF/sargramostim
79
what are the Fe-def drugs?
ferrous sulfate
ferrous gluconate
ferrous fumerate
Iron Dextran
80
what are the FA def drugs?
Folic Acid
Leucovorin
Levomofolate
81
What are the hematopoietic growth factors?
Epo alfa
Darbepoetin
Me-PEG Epo beta
82
what are the megakaryocyte growth factors?
Oprelvekin (IL-11)
| Romiplostin
83
what does G-CSF do?
- prolif, diff of neutrophil progenitors
- activates neutrophil phagocytotic activity
- extends survival of neutrophils
- mobilizes hematopoietic stem cells, i.e., inc their concentration in blood
84
what is G-CSF used for?
- neutropenias assoc myelodysplasia
- neutropenias assoc aplastic anemia
- chemo pts - secondary prevention of neutropenia
- stem cell transplant - mobilizes perpheral blood cells
85
what receptor family are myeloid growth factors in?
JAK/STAT
86
G-CSF v. GM-CSF
G-CSF: prolif, diff of progenitors already committed to neutrophil lineage
GM-CSF: early and late granulocytic progenitor cells
[think: GM-CSF acts earlier in the family tree]
87
which myeloid GF allows for use of peripheral blood stem cells in stem cell transplants? why is this beneficial?
G-CSF
| can use PBSCs rather than bone marrow stem cells
88
what is GM-CSF used for?
- prolif, diff of early AND late granulocytic progenitor cells
- erythrocyte and megalaryocyte progenitors
- function of mature neutrophils
- stimulate T cell prolif with IL-2
89
which cytokine does GM-CSF work with? what does it do?
IL-2
| stimulate T cell prolif
90
which mobilizes peripheral stem cells better, G-CSF or GM-CSF?
G-CSF
91
even though G-CSF accelerates the rate of nutro recovery, what can it NOT do?
increase pt survival
92
what is the benefit to Pegfilfrastim?
- admin'd less frequently
| - shorten the window of severe neutropenia > G-CSF
93
what happens first with admin of G-CSF, recruitment of mature neuto or new neutro production?
recruitment of the already exsisting
94
which myeloid GF are used more often? why?
G-CSF and Pegfilgastim
better tolerated
95
what is a side effect of discontinuing myeloid GF?
bone pain
96
toxic/side effects from myeloid GF?
- capillary leak syndrome (characterized by) **
- peripheral edema (and)
- pleural or pericardial effusion **
- splenic rupture, rare ** (in PBSC)
- rare Ax Rx
- more side effects with GM-CSF
- fever, malaise, arthalgias, myalgias
97
what is a rare, but serious side effect of PBSC?
splenic rupture
well, shit.
98
what is Oprelvekin?
rh-IL-11
99
what does Oprelvekin do?
- stim growth of megakaryocyte prgenitors
- stim growth of lymphoid, myeloid cells
- inc number of circulating platelets and neutrophils
100
what is Romiplostin?
- megakaryocyte GF peptibody
- 2 identical, single chain IgG1
- Fc of IgG1 covalently linked two identical copies of a peptide that stimulates thrombopoietin/TPO receptors
101
what is Romiplostin used to treat?
TPP
102
what family of receptors is Oprelvekin in?
a family that can all interact with gp130
103
what is a point of comparison between Oprelvekin and G-CSF?
G-CSF increases survival of neutrophils, whereas Oprelvekin-stimulated platelets have normal life expectancies
104
what is Oprelvekin used to treat?
thrombocytopenia, a secondary prevention in pts getting chemo for nonmyeloid Cx
105
what are some toxic effects of Oprelvekin?
- CV
- anemia 2* hemodilution **
- dyspnea 2* fluid accumulation in the lungs **
- transient atrial arrhythmias
- hypokalemia **
106
what is the benefit of the FcR in Romiplostin?
extends half life :: remains active in the circulation longer than endogenous tpo
