IC3

Question 1

Aplastic anaemia: what are the 2 syndromes?

Answer 1

1) Dose-dependent direct drug toxicity
2) Idiosyncratic - by means of toxic metabolites

Question 2

Drugs that induce aplastic anaemia

Answer 2

1) Cancer chemotherapies, chloramphenicol
2) Carbamazepine, phenytoin

Question 3

Drug treatment for aplastic anaemia

Answer 3

• Immunosuppressants
• GM-CSF (sargramostim)
• G-CSF (filgrastim, pegfilgrastim)
• IL-14

Question 4

First step in management of drug-induced blood disorders

Answer 4

Withdraw causative drug where possible

Question 5

Drugs that induce immune thrombocytopenia

Answer 5

Heparin, sulfonamides, carbamazepine, phenytoin, GP IIb/IIIa inhibitors

Question 6

Drug treatment for immune thrombocytopenia

Answer 6

Immunosuppressants

Question 7

Agranulocytosis: what are the 3 syndomes?

Answer 7

1) Direct drug toxicity
2) Toxic metabolite
3) Immune (hapten or complement) mediated

Question 8

Agranulocytosis: causative drugs

Answer 8

Thiamazole, carbimazole, clozapine, beta lactams, propylthiouracil

Question 9

Agranulocytosis: drug treatment

Answer 9

G-CSF or GM-CSF

Question 10

Name for G-CSF

Answer 10

Granulocyte-colony stimulating factor

Question 11

Name for GM-CSF

Answer 11

Granulocyte-macrophage colony-stimulating factor

Question 12

Immune haemolytic anaemia: 3 syndromes

Answer 12

1) Drug-induced true autoantibody production
2) Innocent bystander (immune complex) autoantibody production
3) Hapten-induced haemolysis

Question 13

Immune haemolytic: causative drugs

Answer 13

1) Methyldopa
2) Quinine, quinidine
3) Penicillins, cephalosporins, streptomycin

Question 14

Non-immune haemolytic anaemia: syndrome

Answer 14

Protein adsorption

Question 15

Non-immune haemolytic anaemia: causative drugs

Answer 15

Cisplatin, oxaliplatin, beta lactamase inhibitors

Question 16

Haemolytic anaemia: drug treatment

Answer 16

1) Steroids and immunoglobulins have been used in serious cases
2) For autoimmune hemolytic anaemia, rituximab (human anti- CD20 monoclonal antibody) can be used

Question 17

Drugs used for neutropenia treatment

Answer 17

Myeloid growth factors e.g. G-CSF, GM-CSF

Question 18

Drugs used for thrombocytopenia treatment

Answer 18

Megakaryocyte growth factors / Platelet-Stimulating Agents (PSAs)

1) recombinant IL-11 (oprelvekin)
2) Fc-fusion protein thrombopoietin receptor agonist e.g.,
romiplostim
3) Oral nonpeptide thrombopoietin receptor agonists e.g., eltrombopag

Question 19

Features of RBC in iron-deficient anaemia

Answer 19

Few, small haemoglobin-poor RBC (paller)

Question 20

Features of RBC in VitB12/ folate-deficient anaemia

Answer 20

Very few, large Hb-rich RBC (redder)

Question 21

Acute adverse effects of iron supplements

Answer 21

Necrotizing gastroenteritis with vomiting, abdominal pain, and bloody diarrhoea followed by shock, lethargy, dyspnea, metabolic acidosis, coma and death

Question 21

Chronic adverse effects of iron supplements

Answer 21

Haemochromatosis with iron deposited in heart, liver, pancreas and other organs → organ failure, death

Question 22

Why is Hydroxocobalamin precursor preferred over cyanocobalamin?

Answer 22

Greater protein binding hence retained longer in circulation

Question 23

Why is vitamin B12 administered parenterally instead of orally?

Answer 23

Oral not usually effective as deficiencies are usually caused by GI malabsorption

Question 24

Adverse effects for hydroxocobalamin

Answer 24

1) Photosensitivity 2) Injection site pain 3) Hypotension, hot flushing

Question 25

DDI with hydroxocobalamin

Answer 25

PPI (reduce oral absorption)

Question 26

Adverse effects of folic acid supplements

Answer 26

* GI disorders: Bitter or bad taste, nausea, abdominal distension, flatulence * Immune system disorders: Rarely, allergic reactions (e.g.rash,pruritus, erythema, urticaria, dyspnoea, shock); allergic sensitization. * Metabolism and nutrition disorders: Rarely,anorexia.

Question 27

Contraindication for ESA

Answer 27

Uncontrolled hypertension

Question 28

ADR for ESA

Answer 28

* Hypertension, oedema; increased platelet count, thrombosis, stroke; hyperkalaemia; seizures; myalgia, arthralgia, limb pain; gastrointestinal effects including nausea and vomiting * Epoetin alfa: Pruritus * Darbepoetin alfa: Dyspnoea, cough, bronchitis

Question 29

ADR for G-CSF

Answer 29

bone pain, reversible when drug discontinued

Question 30

ADR for GM-CSF

Answer 30

fever, malaise, arthralgias, myalgias

Question 31

ADR for Megakaryocyte growth factors

Answer 31

Thromboembolic events

Question 32

ADR for IL-11 (Oprelvekin)

Answer 32

Fluid retention, peripheral oedema, dyspnoea on exertion