Drug for Anemia and Myeloid Growth Factors

Question 1

ferrous sulfate

Answer 1

oral iron
patients develop black stools: may obscure Dx of continued GI blood loss
SE: nausea, epigastric discomfort, abominal cramps, constipation, diarrhea
Decrease dose/ take with meals/ switch to different oral iron

Question 2

ferrous gluconate

Answer 2

oral ironpatients develop black stools: may obscure Dx of continued GI blood loss
SE: nausea, epigastric discomfort, abominal cramps, constipation, diarrhea
Decrease dose/ take with meals/ switch to different oral iron

Question 3

iron dextran

Answer 3

IV and IM iron
Use: unable to tolerate oral, malabsorption, IBS, small bowel resection, gastrectomy, renal disease req. hemodialysis and EPO
Problem: dose dependent toxicity limits dose
SE: anaphylaxis, flushing, bronchospasm, uticaria, back pain, headache, fever, arthralgia, N/V
monitor: iron overload

Question 4

cobalamin

Answer 4

Vit. B12

Question 5

cyanocobalamin

Answer 5

IM Vit. B12

Question 6

hydroxycobalamin

Answer 6

IM Vit. B12

more highly protein bound: Remains in circulation longer than cyanocobalamin

Question 7

folic acid

Answer 7

oral absorption high even with malabsorption

consider in: pregnancy, alcoholics, hemolytic anemia, liver disease, dialysis

Question 8

epoetin alfa

Answer 8

erythropoietin receptor agonist (IV or SC)
Tx: anemia due to chronic renal failure, HIV infection (offset ZDV Tx), cancer, and prematurity
prophylaxis for surgery to prevent transfusion (must give DVT prophylaxis)
SE: HTN, thrombosis, arthralgia, headache, nausea
RARE: pure red cell aplasia
Give lowest dose sufficient to reduce need for RBC: reduce CV event risk in chronic kidney disease
increase tumor progression: discontinue after chemo and not indicated for chemo anticipated to cure the cancer
1-3x/week

Question 9

darbopoietin

Answer 9

same as epoetin alfa
glycosylated: administer weekly
unchanged in renal failure

Question 10

Filgrastim

Answer 10

G-CSF: neutrophil proliferation and differentiation
activates phagocytic activity of mature neutrophils and prolongs survival
mobilizes hematopoietic stem cells
Use: permits use of peripheral blood stem cells (PBSC) for autologous and allogenic hematopoietic stem cell transplantation
Use: myelosuppresive chemo recovery (reduce febrile neutorpenia, antibiotics, infections and days of hospitalization)
Tx: neutropenia, myelodysplasia, aplastic anemia
NO effect on patient survival
SE: bone pain upon discontinuation
Drug interaction: 1 day before/after cytotoxic chemo

Question 11

Pegfilgrastim

Answer 11

polyethylene glycol addition to filgrastim
dose less frequently
shorten period of sever neutropenia more than filgrastim

Question 12

Sargramostin

Answer 12

GM-CSF: granulocytes, erythroid, megakaryocyte proliferation and differentiation
acts with IL-2: T cell proliferation
mobilizes PBSC less effectively that G-CSF
SE: splenic rupture, allergic rxn, capillary leak syndrome (peripheral edema and pleural/pericardial effusion), fever, malaise, arthralgia, myalgia
Drug interaction: 1 day before/after cytotoxic chemo

Question 13

oprelvekin

Answer 13

IL-11 receptor agonist: thrombopoietin
Use: prevention of thrombocytopenia in cytotoxic chemo therapy
SE: fatigue, headache, dizzy, CV effects, anemia, dyspnea, atrial arrhythmia, hypokalemia (all reversible)
Drug interaction: thiazide > loop diuretics: severe hypokalemia

Question 14

acute iron toxicity

Answer 14

necrotizing gastroenteritis, vomiting, abdominal pain, bloddy diarrhea, shock, lethargy dyspnea
initial improvement followed by severe metabolic acidosis, coma, death

Question 15

deferoxamine

Answer 15

IV iron chelator
red urine
SE: tachycardia, hypotension, shock, add to CV collapse of iron toxicity
Other SE: N/V, abdominal discomfort, diarrhea
excreted in urine rather than feces

Question 16

chronic iron toxicity

Answer 16

hemochromatosis
iron deposits: heart, liver, pancreas
excessive absorption or people that receive lots of transfusions
Tx: intermittent phlebotomy

Question 17

methotrexate

Answer 17

DHFR inhibitor
causes folate deficiency
(more likely)

Question 18

trimethoprim

Answer 18

antimicrobial

causes folate deficiency but much greater affinity for bacterial form

Question 19

pyrimethamine

Answer 19

antimicrobial

causes folate deficiency but much greater affinity for malarial form

Question 20

phenytoin

Answer 20

antiepileptic

inhibits intestinal uptake of folate producing folate deficiency

Question 21

leucovorin

Answer 21

reduced folate
rescues from folate antagonists
modulates 5-FU and capecitabine

Question 22

methoxy polyethylene glycol-epoetin beta

Answer 22

same as epoetin alfa

long-acting form administered 1-2 times per month

Question 23

romiplostin

Answer 23

thrombopoietin mimetic (IgG1 Fc domain + peptide that binds TPO receptor)
Fc component: extends T1/2: lasts much longer that endogenous TPO

Question 24

Why are hematopoietic growth factor drugs administered by injection?

Answer 24

acid instability

Question 25

most likely reasons for poor response to EPO

Answer 25

folate or B12 deficiency

Question 26

What effect will renal dysfunction/ failure/dialysis have upon EPO and EPO drugs?

Answer 26

none