Pharm II: Cases/Lecture info

Question 1

Why are tetracycline abx contraindicated with Iron?

Answer 1

They bind iron

Question 2

What to monitor with Iron?

Answer 2

Serum ferritin, transferin saturation (TSAT=(serum Fe/TIBC)x100), Hgb, reticulocytes

Question 3

What forms does deferoxamine come in?

Answer 3

PO (seldom), IV, IM, SQ

Usually IV!

Question 4

What do you not use deferoxamine not used to treat?

Answer 4

Hemochromatosis

Question 5

Wht drug depletes folic acid levels?

Answer 5

Methotrexate

Question 6

What to monitor with folic acid?

Answer 6

Serum folic acid, RBC folate level, variable drug dosing 1-5mg daily

Question 7

How is Iron transported in the body?

Answer 7

In the blood bound to transferrin

Question 8

Where is iron stored in the body?

Answer 8

Intestinal mucosal cells, macrophages in the liver, spleen, bone

Question 9

What is ferritin?

Answer 9

Iron + apoferritin

Question 10

What % of ferrous iron dose is absorbed daily?

Answer 10

25%

Question 11

Why is there a iron caution in children?

Answer 11

Iron overdose is lethal!

Question 12

What iron drugs are IV/IM?

Answer 12

Iron dextran (IM, IV)-test dose, sodium ferric gluconate complex, iron sucrose (IV)

Question 13

What is the daily elemental iron goal?

Answer 13

200-400mg

Question 14

What is the daily max incorporate iron rate?

Answer 14

50-100mg

Question 15

What is the storage pool of Vit. B12?

Answer 15

3000-5000mcg

Question 16

What is the amount of Vit. B12 needed daily?

Answer 16

2mcg

Question 17

What is the oral dosing for Vit. B12?

Answer 17

1000mcg daily (variable absorption at 500mcg or less)

Question 18

What is the IM dosing for Vit. B12?

Answer 18

100-1000mcg every 1 to 3 months

Question 19

What is tx for folate deficiency?

Answer 19

Folic acid 1mg daily

Question 20

What can deplete folic acid storage?

Answer 20

• Chronic alcoholism

- In end stage renal disease: dialysis removes folic acid

Question 21

What do you need to rule out before treating with folic acid?

Answer 21

Coexisting B12 deficiency

Question 22

What does erythrocyte stimulating agent (ESA) treatment do?

Answer 22

increases reticulocytes in 5-10 days and Hgb/Hct in 2-6 weeks

Question 23

What does a person have to also take with ESA tx?

Answer 23

Iron supplementation, may also meed increased anti-coagulation

Question 24

What are “white clots”?

Answer 24

Arterial clots form around activated platelets

Question 25

What are "red clots"?

Answer 25

Venous clots from around activated fibrin and RBCs

Question 26

What are the sources of UFH?

Answer 26

pork intestinal mucosa and bovine lung tissue source

Question 27

Does UFH have any fibrinolytic activity (can't lyse established clot)?

Answer 27

NO!

Question 28

How is LMWH Enoxeparin eliminated?

Answer 28

Renal elimination, no renal adjust CrCl >30mL/min

Question 29

Protamine sulfate drug class?

Answer 29

Indirect thrombin inhibitor antagonist

Question 30

Indications for protamine sulfate?

Answer 30

Excess heparin impact

Question 31

MOA of protamine sulfate?

Answer 31

Binds to heparin and neutralizes its anticoagulant effect

Question 32

How is protamine sulfate administered?

Answer 32

IV

Question 33

What is protamine sulfate composed of?

Answer 33

Mixture of polypeptides isolated from salmon sperm

Question 34

Which drug is protamine sulfate less effective with?

Answer 34

Less effective with LMWH then with HMWH

Question 35

What does protamine sulfate have no effect on?

Answer 35

fondaparinux

Question 36

How long will it take to see lab improvement with Ferrous sulfate for iron def anemia?

Answer 36

1-2 weeks

Question 37

How much Ferrous sulfate should you give to elderly?

Answer 37

1 325mg tab PO 1x daily and then maybe up to 2x daily if needed. 3x daily may be too much and will "bind" them up

Question 38

What is happening to anemia of chronic disease?

Answer 38

Not absorbing iron well

Question 39

What can be supplemented with Iron to help with absorption?

Answer 39

Vitamin C

Question 40

What is occurring with chronic disease anemia?

Answer 40

Decreased iron absorption

Question 41

What do you seen when you have anemia and heart failure?

Answer 41

Exacerbated symptoms

Question 42

What is the major cause for people to stop taking Iron supplements?

Answer 42

GI problems - nausea, vomiting

Question 43

What type of anemia is iron def?

Answer 43

Microcytic anemia

Question 44

Which iron supplement has the highest level of environmental iron per tablet?

Answer 44

Ferrous sulfate!

Question 45

What drug inhibits the absorption of B12 and folate?

Answer 45

Metformin!

Question 46

What may a patient complain of with B12 def anemia?

Answer 46

Numbness in lower extremities

Question 47

What don't you get patient's if there Hgb is above 11? Why?

Answer 47

Epogen, patient's at increased risk for stroke and MI

Question 48

What should you test before giving folate to patients?

Answer 48

B12 levels

Question 49

What is the Schillings test?

Answer 49

Test to measure intrinsic factor to see if GI is absorbing B12

Question 50

What happens if you don't catch B12 def?

Answer 50

Can cause permanent neurologic damage...YIKES!

Question 51

What is the most common cause of Iron def anemia in an otherwise healthy patient?

Answer 51

GI bleed or other blood loss!

Question 52

How long does iron treatment take to correct the anemia and fully replenish iron stores?

Answer 52

3-6 months