Heme Drugs

Question 1

In oral Iron Therapy, used to treat Iron deficiency, what are the three most common Iron supplements

Answer 1

Ferrous Sulfate, Ferrous Gluconate, Ferrous Fumarate

Question 2

What percentage of oral iron given as ferrous salt is absorbed ?

Answer 2

25%

Question 3

What are the major toxicities of Iron therapy?

Answer 3

Nausea, diarrhea, constipation, etc..

Question 4

What is the greatest challenge to parenteral iron therapy?

Answer 4

Serious dose dependent toxicities

Question 5

How is most parenteral Iron administered?

Answer 5

Colloid formulation containint a core of iron oxyhydroxide surrounded by a carbohydrate.

Question 6

Major parenteral Iron treatments?

Answer 6

Iron Dextran (IV and IM), Sodium Ferric Gluconate, Iron sucrose…both IV

Question 7

Do you give iron in cases of hemolytic anemia?

Answer 7

NO! Iron is elevated in these cases.

Question 8

How can you monitor patients taking iron supplements parenterally for iron overload?

Answer 8

Monitor ferritin levels and transferrin saturation

Question 9

Children who ingest iron tablets often are affected by

Answer 9

vommitting, abdominal pain, gastroenteritis, shock, initial improvement followed by coma, severe metabolic acidosis, death.

Question 10

For those suffereing from Iron overload, how is it treated?

Answer 10

Deferoxamine, Iron chelator

Question 11

How is defereroxamine excreted?

Answer 11

Urine and bile

Question 12

Can cuase:

Answer 12

Tachycardia, hypotension, shock

Question 13

Hemochromatosis is what?

Answer 13

Chronic iron toxicity

Question 14

Causes of hemochromatosis?

Answer 14

Either inherited or comes along with repeated blood transfusions (Thalassemia Patients)

Question 15

Chromic iron toxicity in pts who receive blood transfusions is treated with?

Answer 15

Defereasirox

Question 16

Vitamin B12 (Cobamalin) is needed for what?

Answer 16

DNA synthesis

Question 17

Vitamin B12 deficiency leads to what type of anemia?

Answer 17

Megaloblastic/ Macrocytic

Question 18

What are the neurologic defects that vitamin B 12 deficiency can cause?

Answer 18

Paresthesias in peripheral nerves, weakness, spasticity, etc…

Question 19

Common Causes of B12 deficiency

Answer 19

Partial or total gastrectomy, Pernicious anemia, conditions that affect the distal bowel.

Question 20

B12 deficient treatment?

Answer 20

B12 injections mostly (cyanocobamalin hydroxocobamalin

Question 21

Folic Acid does what?

Answer 21

Its a precursor for the synthesis of amino acids, purines, and DNA

Question 22

Folic Acid deficiency most common in:

Answer 22

Alcoholics and those with liver disease

Question 23

Maternal Folic Acid deficiencies can manifest in the fetus as:

Answer 23

Neural tube defects….spina bifida

Question 24

Drug Induced Folic Acid deficiencies include:

Answer 24

Methotrexate, Trimethoprim, Pyrimethamine, Phenytoin

Question 25

Incidence of depressive illness can be influenced by dietary intake of what three things?

Answer 25

zinc, magnesium, folate

Question 26

What the hell is Levomofolate?

Answer 26

The biologically active form of folate found in the circulation

Question 27

What is epoetin alfa?

Answer 27

Agonist of EPO receptors in the bone marrow, stimulates erythropoeisis and RBC production

Question 28

What is epoetin alfa used to treat?

Answer 28

Treatment of anemia associated with chronic renal failure, HIV infection, Cancer.

Question 29

Darbepoetin alfa?

Answer 29

Glycosylated form of epoeitin alfa. Longer half-life

Question 30

Methoxy polyethylene glycol-epoeitn beta

Answer 30

Long lasting form of epoeitin alfa

Question 31

What does the PEG prefix suggest?

Answer 31

That polyethylene glycol has been added to the drug to extend its PK and reduce the need for re-dosing

Question 32

Toxicity of Erythropoeisis stimulating agents in Chronic Kidney Disease patients?

Answer 32

Cardiovascular risk, stroke,

Question 33

Toxicity for ESA use in Cancer patients?

Answer 33

Potential enlargement of the tumor.

Question 34

Which ESA should no tbe used for treatment of anemia caused by cancer chemo?

Answer 34

Methoxy Polyethylene glycol epoeitin

Question 35

What does G-CSF promote

Answer 35

Proliferation and differentiation of progenitors committed to neutrophil lineage

Question 36

GM-CSF

Answer 36

Broader proliferative implications that G-CSF.

Question 37

What is Oprelvekin

Answer 37

Activates IL-11 receptors which stimulates the growth of multiple myeloid cells, including megakaryocyte progenitors. Inc number of circulating plateletts and neutrophils

Question 38

What is Oprelvekin used for

Answer 38

Prevents Thrombocytopenia in patients undergoing cytotoxic chemotherapy (By increasing platelett count)

Question 39

Symptoms of iron deficiency

Answer 39

pallor, fatigue, dizziness, exertional dyspnea

Question 40

Less iron to carry oxygen so what would you expect the body to do to make up for this?

Answer 40

tachycardia, vasodilation, increased output

Question 41

Major side effects of Deferoxamine

Answer 41

Tachycardia, hypotension, shock, some CV risk

Question 42

Of the drugs that induce folic acid deficiency, which is most severe?

Answer 42

Methotrexate because it is a folic acid analog and therefore inhibts dihydrofolate reductase. Trimethroprim and Pyrimethamine have a greater affinity for the bactrial and malarial dihydrofolate reductase enzymes therefore they are much less likely to cause deficiency. Phenytoin blocks intestinal uptake.

Question 43

Toxicities related to ESA pts with Chronic Kidney disease?

Answer 43

death, CV rxns, stroke when administered to reach a Hb level of 11 or higher. USE LOWEST DOSE POSSIBLE.

Question 44

What the hell is Romiplostin?

Answer 44

Activates TPO receptors to make more plateletts.

Question 45

G-CSF drugs?

Answer 45

Fligastrim, PEGfilgastrim has shown better results sometime in pts with sever neutropenia. PEG is polyethylene glycol

Question 46

GM-CSF durg

Answer 46

Sargramostim