Exam I, Linger, anemia Tx, lec Part I Flashcards Preview

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Flashcards in Exam I, Linger, anemia Tx, lec Part I Deck (53):
1

What are the oral preparations for iron

ferrous sulfate
ferrous gluconate
ferrous fumarate

2

what are the parenteral preparations for iron

iron dextran
iron-sucrose complex
sodium ferric gluconate complex

3

What are the iron chelators

deferoxamine
deferasirox

4

what are the Vit B12 preperations

cyanocobalamin

5

what are the erythrocyte stimulating agents

epoetin alpha
darbepoetin alpha

6

what are the myeloid growth factors that are granulocyte colony stimulating factors

filgrastim(neupogen)
pegfilgrastim

7

what are the myeloid growth factors that are granulocyte macrophage colony stimulating factors

sargramostim

8

what are the megakaryocyte growth factor stimulants

oprelevekin (IL-11)
romiplostim

9

Sx of anemia

pallor fatigue, dizziness, exertional dyspnea
tissue hypoxia, tachycardia, increased CO and vasodilation

10

what do RBC look like in iron deficiency

microcytic hypochromic anemia

11

where does most iron absorption occur

duodenum and proximal jejunum

12

which iron has to be broken down by ferroreductase to be absorbed

nonheme iron

13

what occurs when iron stores are high

absorbed iron is diverted into ferritin in the intestinal epithelial mucosal cells for storage

14

what transports iron into the plasma

transferrin, beta globulin

15

how is ferrous iron transported

divalent metal transporter 1 into cell and enteres Hb synthesis pathway or stored as ferritin

16

how does iron uptake change in situations of increased erythropoiesis

increase in # of tranferrin R n developing etythroid cells

17

where is iron stored

intestinal mucosal cells in macrophages in liver, spleen and bone and in the parenchymal liver cells

18

how does low level of iron change apoferritin levels

inhibits its synthesis

19

What is the ONLY clinical indication for use of iron preparations

Tx or prevention of Fe deficient anemia

20

when giving patient ferrous sulfate or any other iron supp what should you tell them to do when taking the medicine

take with water or juice on empty stomach
with food to prevent irritation if need be

21

adverse effects of oral iron therapy

nausea, epigastric discomfort, abdominal cramps, constipation, black stools and diarrhea

22

when do you use parenteral iron therapy

patient cannot tolerate oral iron or patients with advanced chronic renal disease requiring hemodialysis and Tx with erythropoietin, small bowel resection etc

23

how does pareneteral iron avoid severe toxicity from free ferric iron at administration

colloid particles with core of oxyhydroxide surrounded by carbohydrate
Fe is released slowly
Need to monitor iron storage levels

24

how is iron dextran administered and side effects?

IM or IV (usually IV)
HA, light headedness, fever, arthralgias nausea, vomiting, back pain, flushing, urticaria, bronchospasm, anaphylaxis and death

25

how is sodium ferric gluconate complex administered

IV
HS reactions

26

which parenteral iron is less liley to cause HS reacions

iron sucrose
IV

27

Sx acute iron toxicity

necrotizing gastroenteritis, vomiting and abdominal pain, bloody diarrhea, shock, lethargy and dyspnea

28

what is Tx acute iron toxicity

whole bowel irrigation and parenteral deferoxamine

29

what occurs in chronic iron toxicity? who is it seen in

Fe deposits in Heart, liver, pancreas
toxicity is most common in patients with inherited hemochromatosis( excessive iron absorption) and patients with many RBC tranfusions

30

Tx for chronic Fe toxicity

intermittent phlebotomy
deferasirox reduces liver Fe [ ] but not sure if reduce Fe in heart

31

what is cobalamine

B12

32

deficieny in B12 can lead to what

megaloblastic anemia, GI Sx and neurologic abnormalities

33

where is B12 found in diet

meat, eggs and dairy products

34

where is B12 stored

liver

35

what is needed for absorption of B12

intrinsic factor

36

where is B12 absorbed

distal ileum

37

what cause B12 deficiencys

lack of IF
loss or malfunction of absorptive mech in distal ileum

38

how is B12 transported in body

glycoproteins transcobalamin I II and III

39

what reactions in human body require B12

synthesis of methionin and synthesis of succinyl CoA

40

why does folic acid help with B12 deficinecy

because B12 deficinecy causes accumulation of N5 methyltetrahydrofolate and depletion tetrahydrofolate

41

folic acid does not prevent what Sx of B12 deficiency

neurologic

42

accumulation of homocysteine is characteristic of what deficiency

Vit B12

43

What are Dx for B12 defieicny

increased serum lvels homocysteine
increased serum and urine levels methylmalonic acid

44

common causes Vit B12 deficiency

pernicious anemia, partial or total gastrectomy and conditions that affect distal ileum

45

what are the common clinical manifestations of B12 deficiency

megaloblastic macrocytic anemia
mild or moderate leukopenia or thrombocytopenia
hypercellular bone marrow with accumulation of megaloblastic erythroid and other precursor cells

46

what are the neuro Sx B12 deficiency

paresthesias in peripheral nerves and weakness and progresses to spaxticity ataxia and other CNS dysfunctions

47

Tx B12 deficiency

parenteral injections

48

what are the richest dietary sources of folic acid

yeast, liver, kidney and green vegetables

49

where is folic acid abosrbed

proximal jejunum

50

what type of anemia is caused by folic acid deficiency

megaloblastic anemia that looks like B12 deficiency anemia

51

what can cause folic acid deficiency

inadequate intake of folates like alcoholics with porr diet and pregnant women and patients with hemolytic anemia with icnreased folate requirements

52

what drugs can cause folic acid deficiency

methotrexate, trimethoprim and pyrimethamine
long term therapy with phenytoin

53

how much folic acid is given to resverse megaloblastic anemia

1 mg/day