Kruse - Anemia Drugs Flashcards Preview

Heme/Lymph 2 > Kruse - Anemia Drugs > Flashcards

Flashcards in Kruse - Anemia Drugs Deck (50):
1

Symptoms of anemia

Pallor, fatigue, dizziness, exertional dyspnea, tachycardia, increased blood volume, vasodilation

2

Iron deficiency = ____ anemia

Microcytic, hypochromic

3

Iron must be in the ___ state to be absorbed

Ferrous (2+)

4

Oral iron is administered in what form? Why?

Drug names?

Ferrous (2+) salts - for easiest absorption

Ferrous sulfate, Ferrous gluconate, Ferrous fumarate

5

Adverse effects of oral iron

GI - nausea, epigastric pain, cramps, constipation, black stools, diarrhea

6

Who receives parenteral iron?

- Iron deficiency who can't tolerate or absorb oral iron
- Extensive chronic anemia who need more than oral (advanced renal disease w/ hemodialysis and EPO treatment, small bowel resection, IBD of small bowel, or malabsorption)

7

How to avoid iron toxicity since it's infused as ferric form?

Colloid containing core of iron oxyhydroxide around carbohydrates, thus released slowly after infusion

8

Ways to administer iron dextran?

- Deep IM injection
- IV infusion

9

Adverse effects of iron dextran

Headache, light-headed, fever, arthralgias, N/V, back pain, flushing, urticaria, bronchospasm, anaphylaxis

10

What should always be done first when giving iron dextran?

Give a small test dose, to rule out hypersensitivity

11

3 forms of parenteral iron

- Iron dextran
- Sodium ferric gluconate
- Iron-sucrose

12

Why would you give sodium ferric gluconate or iron-sucrose complexes, instead of iron dextran?

Less chance of hypersensitivity

13

Small child w/ vomiting, abdominal pain, bloody diarrhea, followed by shock and lethargy. Improves for a bit, then declines. Most likely?

Acute iron toxicity (accidental tablet ingestion OD)

14

How to treat acute iron toxicity?

Deferoxamine + whole bowel irrigation

15

Who is most likely to have chronic iron toxicity?

Hemochromatosis (excessive absorption), or those who receive many RBC transfusions over time

16

How to remove iron deposits from liver in chronic toxicity?

Deferasirox

17

Treatment of chronic iron toxicity

Intermittent phlebotomy + Deferasirox (liver)

18

B12 deficiency = ____ anemia

Megaloblastic, macrocytic

19

Most common causes of B12 deficiency

- Lack of intrinsic factor
- Deficient uptake mechanism in distal ileum
- Strict vegetarian (many years later)

20

B12 deficiency causes the accumulation of what 3 things?

N5-methyl-THF
Homocysteine
Methylmalonic acid

21

B12 deficiency causes the depletion of what important chemical?

THF

22

Characteristic findings of B12 or folic acid deficiency

Megaloblastic, macrocytic anemia w/ leukopenia or thrombocytopenia, and hypercellular BM w/ megaloblastic erythroid precursors

23

Most common symptoms of B12 deficiency

Paresthesias, weakness, spasticity, ataxia

24

Almost all cases of B12 deficiency are due to a lack of ___, thus all B12 must be administered via ____

Absorption; parenteral injections

25

Folic acid deficiency causes

- Alcoholics w/ poor diet and less hepatic storage
- Pregnant women w/ increased need
- Hemolytic anemics w/ increased need
- Malabsorption syndromes
- Renal dialysis

26

Drugs causing folic acid deficiency

- MTX
- TMP
- Pyrimethamine
- Phenytoin

27

What does folic acid deficiency NOT have, compared to B12 deficiency?

Neural symptoms

28

Epoetin alpha vs. Darbepoetin alpha

Darb = more glycosylated, thus much longer half life (less frequent dosing)

29

What to look for following EPO administration?

Risk in reticulocyte count, then rise in Hct and Hgb

30

Diseases requiring EPO administration?

- Chronic kidney disease (low endogenous EPO)
- BM disease (aplastic anemia, MPD, MDS, MM, AIDS, myelosuppressive chemo)

31

EPO is almost always coupled w/ administration of ___ in CKD?

Iron, and sometimes folate

32

Adverse effects of EPO

- HTN
- Thrombotic complications

33

Filgrastim...what is it?

Recombinant human G-CSF

34

How to give G-CSF less frequently than Filgrastim?

Pegfilgrastim (polyethylene glycol = longer 1/2 life)

35

Sargramostim...what is it?

Recombinant human GM-CSF

36

Plerixafor...what is it?

MoA

Mobilizer of hematopoietic stem cells and progenitor cells from BM into peripheral blood

Inhibits SDF-1-alpha (BM stromal cells) from binding CXCR4 (blood cells)

37

When and how is Plerixafor used?

When G-CSF alone does not work well

Used w/ Filgrastim

38

G-CSF does what? (2)

Stimulates proliferation of NEUTROPHILS, and increases hematopoietic stem cells in peripheral blood for transplantation

39

GM-CSF does what?

Stimulates proliferation of granulocytes, erythrocytes, and megakaryocytes

40

When is G-CSF (Filgrastim) used?

Chemo-induced neutropenia, other causes of neutropenia, myelodysplasia, and aplastic anemia, autologous stem cell transplantation

41

Side effect of Filgrastim

Bone pain

42

Side effects of Sargramostim

Fever, malaise, arthralgias, myalgias, peripheral edema, effusions

43

Oprelvekin...what is it?

Recombinant IL-11 (megakaryocyte growth factor)

44

Romiplostim...what is it?

MoA

Recombinant TPO

Activate Mpl TPO receptor

45

Oprelvekin causes increased _____

Platelets and neutrophils

46

After giving Romiplostim, when can the effects be seen?

5 days after administration

47

Use of Oprelvekin

Thrombocytopenia in non-myeloid cancer chemo

48

Use of Romiplostim

Thrombocytopenia in chronic ITP that hasn't responded to corticosteroids, Ig, or splenectomy

49

IL-11 toxicities

Fatigue, headache, dizzy, anemia, dyspnea, transient atrial arrhythmias

50

Romiplostim toxicities

Mild headache when administered