Pharm: Anemia and Hematopoietic GF's Flashcards
(64 cards)
1
Q
Which type of iron is used for therapy for iron malabsorption, intolerance of oral therapy, or non compliance?
A
Parenteral (colloidal) iron —> iron dextran, sodium ferric gluconate complex and iron-sucrose complex
2
Q
What is the urgent treatment for iron poisoning?
A
Parenteral deferoxamine (potent iron-chelating compound)
3
Q
When would oral vs. parenteral therapy for Vit B12 supplementation be indicated to tx deficiency?
A
- Oral: generally effective, EVEN in pt’s w/ pernicious anemia
- Parenteral therapy: used if neurological sx’s are present
4
Q
What are 3 types of iron supplements that can be taken orally; what should they be taken with?
A
- Ferrous sulfate, gluconate, or fumarate that is ideally NOT enteric-coated and NOT-sustained release
- Pt should take with ONLY water/juice, not with food
5
Q
Nitrous oxide inhaled for analgesia during surgey can have what effect on B12?
A
Inactivates cyanocobalamin (common form of B12)
6
Q
What is the MOA of epoetin alfa?
A
- Stimulates erythropoiesis
- ↑ reticulocyte count ≤10 days
- ↑ RBC count, hemoglobin, and hematocrit in 2-6 weeks
7
Q
What are the clinical uses of epoetin alfa?
A
- Anemia due to: CKD; cancer chemotherapy; and zidovudine tx for HIV
- ↓ allogenic RBC transfusions in pt’s undergoing elective surgery
8
Q
There is an increased risk for what serious AE’s associated with epoetin alfa?
A
- MI
- Stroke
- Venous thrombo-embolism
- Thrombosis of vascular access and tumor progression or recurrence
9
Q
How does darbepoetin alfa differ from epoetin alfa?
A
Has 3x longer half-life
10
Q
What are the 2 MOA of Hydroxyurea?
A
- Targets ribonucleotide reductase, results in S-phase cell cycle arrest
- Somehow boosts levels of fetal hemoglobin (HbF, α2γ2)
11
Q
What is the only disease modifying therapy for sickle cell anemia?
A
Hydroxyurea
12
Q
List 4 AE’s associated with hydroxyurea used for sickle cell anemia.
A
- Cough or hoarseness
- Fever or chills
- Lower back or side pain
- Painful or difficult urination
13
Q
What is the MOA of eculizumab?
A
- Monoclonal Ab that binds complement protein C5 and inhibits cleavage to C5a and C5b
- Prevents generation of the MAC (C5b-9)
14
Q
What are the 2 effects of using eculizumab for paroxysmal nocturnal hemoglobinuria and atypical HUS?
A
- Inhibits terminal complement-mediated intravascular hemolysis in PNH
- Inhibits complement-mediated thrombotic micorangiopathy in pt’s w/ atypical HUS
15
Q
What must be given 2-weeks prior to using eculizumab?
A
Meningococcal vaccine
16
Q
List some common presenting sx’s of neutropenia?
A
- Low-grade fever
- Sore mouth
- Odynophagia
- Gingival pain and swelling
- Perirectal pain and irritation
17
Q
What is filgrastim and pegfilgrastin; how do they differ?
A
- Both are G-CSF
- Pegfilgrastim is longer lasting (PEGylated = conjugated to polyethylene glycol)
18
Q
What are some of the serious AE’s associated with Filgrastim (G-CSF)?
A
- Splenic rupture, sometimes fatal
- ARDS
19
Q
What is sargramostim?
A
GM-CSF
20
Q
What are some of the serious AE’s associated with the GM-CSF, Sargramostim?
A
- Contains benzyl alcohol, can cause fatal “grasping syndrome” in prematue infants
- Fluid retention —> edema; also pleural effusion and pericardial effusion
- Dyspnea from sequestration of granulocytes in pulmonary circulation
- Occsaional transient SVT
- May worse pre-existing renal and hepatic dysfunction
21
Q
Between Filgrastim and Sargramostim which has fewer AE’s and should be used?
A
Filgrastim (G-CSF)
22
Q
What is the MOA of Plerixafor?
A
Partial agonist at CXCR4 receptor, important for homing of hematopoietic stem cells to BM
23
Q
What is Plerixafor used for?
A
In patient who do not mobilize sufficient stem cells for autologous transplant with just G-CSF
24
Q
What is the main AE associated with Plerixafor?
A
Hypersensitivity rxn
25
What is the MOA of Romiplostim?
- A "**peptibody**" of human **IgG1** kappa heavy chain constant regions (an **Fc** fragment)
- **Binds TPO receptor**
- **Must** be given **SQ** because it's a **peptide!**
26
What is the effect and clinical use of Romiplstim?
- ↑ the **platelet count** in: healthy pt's, pt's with **ITP** and pt's with **myelodysplastic C syndrome**
- Use for **excess** platelet destruction due to **idiopathic thrombocytopenia purpura (ITP)**
27
What is the MOA of Eltrombopag; effects in pt's?
- Potent, **orally** available **NON**-peptide **TPO** receptor **agonist**
- ↑ **platelet count** in: healthy pt's, those with **ITP**, and **thromobocytopenia** due to **hepatitis C**
28
What are the 2 clinical uses for Eltrombopag?
- **Excess** platelet destruction due to **idiopathic thrombocytopenic purpura**
- **Cirrhosis** due to **hepatitis C**
29
What is an AE associated with Eltrombopag?
**Hepatotoxicity** when used in **combo** w/ **interferon** and **ribavirin** in pt's with **hepatitis C**
30
What is the most common drug class which causes hemolytic anemia; what is another common class?
- **Cephalosporins**, especially **ceftriaxone** and **cefotetan** = **most common**
- **Penicillin** and its derivative, especially **piperacillin**
31
Which drugs are the most common **immune** and **non-immune** causes of drug-induced thrombocytopenia?
- **Immune** = **heparin**
- **Non-immune** = **quinidine** and **quinine**
32
What are 3 major drugs/classes that may cause aplastic anemia?
- **Cancer chemotherapeutics**, especially **alkylating agents**, antimetabolites, and cytotoxic antibiotics
- **Chloramphenicol**, an Abx that is **no** longer used
- **Benzene**
33
**Parenteral (colloidal) iron** ---\> **iron dextran**, **sodium ferric gluconate complex** and **iron-sucrose** complex
Which type of iron is used for therapy for iron malabsorption, intolerance of oral therapy, or non compliance?
34
Parenteral **deferoxamine** (potent iron-chelating compound)
What is the urgent treatment for iron poisoning?
35
- **Oral**: generally effective, **EVEN in pt's** w/ **pernicious anemia**
- **Parenteral therapy**: used if **neurological sx's** are present
When would oral vs. parenteral therapy for Vit B12 supplementation be indicated to tx deficiency?
36
- **Ferrous sulfate, gluconate**, or **fumarate** that is ideally **NOT** enteric-coated and **NOT**-sustained release
- Pt should take with **ONLY water/juice**, not with food
What are 3 types of iron supplements that can be taken orally; what should they be taken with?
37
**Inactivates cyanocobalamin** (common form of **B12**)
Nitrous oxide inhaled for analgesia during surgey can have what effect on B12?
38
- **Stimulates** erythropoiesis
- ↑ **reticulocyte** count **≤10 days**
- ↑ **RBC count, hemoglobin, and hematocrit** in **2-6 weeks**
What is the MOA of epoetin alfa?
39
- **Anemia** due to: CKD; cancer chemotherapy; and zidovudine tx for HIV
- ↓ allogenic RBC transfusions in pt's undergoing elective surgery
What are the clinical uses of epoetin alfa?
40
- **MI**
- **Stroke**
- **Venous thrombo-embolism**
- **Thrombosis** of vascular access and **tumor progression** or **recurrence**
There is an increased risk for what serious AE's associated with epoetin alfa?
41
Has **3x** longer **half-life**
How does darbepoetin alfa differ from epoetin alfa?
42
- Targets **ribonucleotide reductase**, results in **S-phase cell cycle arrest**
- Somehow **boosts** levels of **fetal hemoglobin (HbF,** α2γ2**)**
What are the 2 MOA of Hydroxyurea?
43
Hydroxyurea
What is the only disease modifying therapy for sickle cell anemia?
44
- **Cough** or **hoarseness**
- **Fever** or **chills**
- **Lower back** or **side pain**
- **Painful** or **difficult urination**
List 4 AE's associated with hydroxyurea used for sickle cell anemia.
45
- **Monoclonal** Ab that binds **complement protein C5** and **inhibits** cleavage to **C5a** and **C5b**
- **Prevents** generation of the **MAC (C5b-9)**
What is the MOA of eculizumab?
46
- **Inhibits** terminal complement-mediated **intravascular hemolysis** in **PNH**
- **Inhibits** complement-mediated **thrombotic micorangiopathy** in pt's w/ **atypical HUS**
What are the 2 effects of using eculizumab for paroxysmal nocturnal hemoglobinuria and atypical HUS?
47
**Meningococcal vaccine**
What must be given 2-weeks prior to using eculizumab?
48
- Low-grade **fever**
- **Sore mouth**
- **Odynophagia**
- **Gingival pain** and **swelling**
- **Perirectal pain** and **irritation**
List some common presenting sx's of neutropenia?
49
- Both are **G-CSF**
- **Pegfilgrastim** is **longer lasting** (**PEGylated** = conjugated to **polyethylene glycol**)
What is filgrastim and pegfilgrastin; how do they differ?
50
- **Splenic rupture**, sometimes **fatal**
- **ARDS**
What are some of the serious AE's associated with Filgrastim (G-CSF)?
51
GM-CSF
What is sargramostim?
52
- Contains **benzyl alcohol**, can cause fatal **"grasping syndrome"** in prematue infants
- **Fluid retention** ---\> **edema**; also **pleural effusion** and **pericardial effusion**
- **Dyspnea** from sequestration of granulocytes in pulmonary circulation
- Occsaional transient **SVT**
- May worse **pre-existing renal** and **hepatic** dysfunction
What are some of the serious AE's associated with the GM-CSF, Sargramostim?
53
**Filgrastim** (**G-CSF**)
Between Filgrastim and Sargramostim which has fewer AE's and should be used?
54
**Partial** agonist at **CXCR4** receptor, **important** for homing of hematopoietic stem cells to BM
What is the MOA of Plerixafor?
55
In patient who **do not** mobilize sufficient stem cells for autologous transplant with just **G-CSF**
What is Plerixafor used for?
56
**Hypersensitivity rxn**
What is the main AE associated with Plerixafor?
57
- A "**peptibody**" of human **IgG1** kappa heavy chain constant regions (an **Fc** fragment)
- **Binds TPO receptor**
- **Must** be given **SQ** because it's a **peptide!**
What is the MOA of Romiplostim?
58
- ↑ the **platelet count** in: healthy pt's, pt's with **ITP** and pt's with **myelodysplastic C syndrome**
- Use for **excess** platelet destruction due to **idiopathic thrombocytopenia purpura (ITP)**
What is the effect and clinical use of Romiplstim?
59
- Potent, **orally** available **NON**-peptide **TPO** receptor **agonist**
- ↑ **platelet count** in: healthy pt's, those with **ITP**, and **thromobocytopenia** due to **hepatitis C**
What is the MOA of Eltrombopag; effects in pt's?
60
- **Excess** platelet destruction due to **idiopathic thrombocytopenic purpura**
- **Cirrhosis** due to **hepatitis C**
What are the 2 clinical uses for Eltrombopag?
61
**Hepatotoxicity** when used in **combo** w/ **interferon** and **ribavirin** in pt's with **hepatitis C**
What is an AE associated with Eltrombopag?
62
- **Cephalosporins**, especially **ceftriaxone** and **cefotetan** = **most common**
- **Penicillin** and its derivative, especially **piperacillin**
What is the most common drug class which causes hemolytic anemia; what is another common class?
63
- **Immune** = **heparin**
- **Non-immune** = **quinidine** and **quinine**
Which drugs are the most common **immune** and **non-immune** causes of drug-induced thrombocytopenia?
64
- **Cancer chemotherapeutics**, especially **alkylating agents**, antimetabolites, and cytotoxic antibiotics
- **Chloramphenicol**, an Abx that is **no** longer used
- **Benzene**
What are 3 major drugs/classes that may cause aplastic anemia?
