Which type of iron is used for therapy for iron malabsorption, intolerance of oral therapy, or non compliance?
Parenteral (colloidal) iron ---> iron dextran, sodium ferric gluconate complex and iron-sucrose complex
What is the urgent treatment for iron poisoning?
Parenteral deferoxamine (potent iron-chelating compound)
When would oral vs. parenteral therapy for Vit B12 supplementation be indicated to tx deficiency?
- Oral: generally effective, EVEN in pt's w/ pernicious anemia
- Parenteral therapy: used if neurological sx's are present
What are 3 types of iron supplements that can be taken orally; what should they be taken with?
- 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
Nitrous oxide inhaled for analgesia during surgey can have what effect on B12?
Inactivates cyanocobalamin (common form of B12)
What is the MOA of epoetin alfa?
- Stimulates erythropoiesis
- ↑ reticulocyte count ≤10 days
- ↑ RBC count, hemoglobin, and hematocrit in 2-6 weeks
What are the clinical uses of epoetin alfa?
- Anemia due to: CKD; cancer chemotherapy; and zidovudine tx for HIV
- ↓ allogenic RBC transfusions in pt's undergoing elective surgery
There is an increased risk for what serious AE's associated with epoetin alfa?
- Venous thrombo-embolism
- Thrombosis of vascular access and tumor progression or recurrence
How does darbepoetin alfa differ from epoetin alfa?
Has 3x longer half-life
What are the 2 MOA of Hydroxyurea?
- Targets ribonucleotide reductase, results in S-phase cell cycle arrest
- Somehow boosts levels of fetal hemoglobin (HbF, α2γ2)
What is the only disease modifying therapy for sickle cell anemia?
List 4 AE's associated with hydroxyurea used for sickle cell anemia.
- Cough or hoarseness
- Fever or chills
- Lower back or side pain
- Painful or difficult urination
What is the MOA of eculizumab?
- Monoclonal Ab that binds complement protein C5 and inhibits cleavage to C5a and C5b
- Prevents generation of the MAC (C5b-9)
What are the 2 effects of using eculizumab for paroxysmal nocturnal hemoglobinuria and atypical HUS?
- Inhibits terminal complement-mediated intravascular hemolysis in PNH
- Inhibits complement-mediated thrombotic micorangiopathy in pt's w/ atypical HUS
What must be given 2-weeks prior to using eculizumab?
List some common presenting sx's of neutropenia?
- Low-grade fever
- Sore mouth
- Gingival pain and swelling
- Perirectal pain and irritation
What is filgrastim and pegfilgrastin; how do they differ?
- Both are G-CSF
- Pegfilgrastim is longer lasting (PEGylated = conjugated to polyethylene glycol)
What are some of the serious AE's associated with Filgrastim (G-CSF)?
- Splenic rupture, sometimes fatal
What is sargramostim?
What are some of the serious AE's associated with the GM-CSF, Sargramostim?
- 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
Between Filgrastim and Sargramostim which has fewer AE's and should be used?
What is the MOA of Plerixafor?
Partial agonist at CXCR4 receptor, important for homing of hematopoietic stem cells to BM
What is Plerixafor used for?
In patient who do not mobilize sufficient stem cells for autologous transplant with just G-CSF
What is the main AE associated with Plerixafor?
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!
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)
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
What are the 2 clinical uses for Eltrombopag?
- Excess platelet destruction due to idiopathic thrombocytopenic purpura
- Cirrhosis due to hepatitis C
What is an AE associated with Eltrombopag?
Hepatotoxicity when used in combo w/ interferon and ribavirin in pt's with hepatitis C
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