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Flashcards in Sweatman Drugs to treat Anemia Deck (60):
1

erythrocyte factors

B12
folate
ESA's

2

granulocyte factors

Sargramostatin GM-CSF
Filgrastim G-CSF

3

Thrombocyte factors

IL-11 (Oprelvekin)

4

stimulates production of neutrophils specifically

Filgrastim-->G-CSF

5

stimulates all granulocytes

GM-CSF--> Sargramastin

6

seondary hemochromatosis is common in

beta thal

7

Megaloblastic anemia due to

B12 or folate

8

microcytic anemia

IDA
ACD
Sideroblastic anemia
Thalassemia

9

cause of pernicious anemia

defect in synthesis of Intrinsic factor to where you can't absorb b12
*either anti-parietal or anti IF ab's
*or surgical gastrectomy

10

regulation of totaly body iron is through

modulation of intestinal (duodenal) absorption HEPCIDIN
*no real good way to get rid of iron

11

only indication for iron administration

prevention or tx of Iron Deficiency Anemia
*overload is highly toxic
*bag of blood=bag of iron

12

IDA treated with dietary iron supplementation

ferrous sulfate, ferrous gluconate, ferrous fumarate

13

Special cases of IDA tx
Parenteral iron

iron dextran, sodium ferric gluconate, and iron sucrose
*colloid conatining a core of iron oxyhydroxide surrounded by core of carbohydrate

14

Iron intoxication

occurs most commonly via accidental ingestion of iron supplements by children

15

Describe the coure of iron inxication

necrotizing gastritis, shock, metabolic acidosis, and death

16

tx of acute iron intoxication

deferoxamine--> parenteral chelates circulating iron
*also remove undigested tabs and correct electrolyte abnormalities

17

iron overload occurs in
2 types

hemochromatosis
primary-> genetic defect in HFE gene--> cant turn off hepcidin
secondary--> chronically transfused as in beta thalassemia

18

symptoms of Hemochromatosis

free iron deposits in Heart, Liver and pancreas and other adrenal glands

gives you *cirrhosis and diabetes

19

tx of chronic iron overload

usually phlebotomy except if anemia
*deferasirox--> chelates free iron--> oral

20

With phlebotomy for Iron overload--> iron is first depleted from

ferritin stores first

then plasma iron

21

B12 defiency causes build up of

homocystein and methylmalonic acid

22

folate deficiency seen in

pregnancy
*lack of it causes NTD

23

causes CNS problems

b12--> methylmanolic acid build up

b12 required to conver methylmanolic acid into succinyl coa

24

Tx of megaloblastic anemia with folate only leaves the risk of

not getting rid of CNS defects--> you will correct the anemia and think the pt is doing better--> but not
--> must make sure it is a pure folate deficicneyc before you just administer folate

25

describe B12 absorption

first bound to haptocorin (r binder) present in salive which travels to the jejunum where B12 is released from haptocorin by degrdation of pancreatic proteases--> then it is bound to IF in the jejunum (but IF is produced by the pareital cells in the stomach--> them Cobalamin + IF travel to the distal illeum where they are taken up by transcobalamin II

26

tx of B12 deficiency

cyanocobalamin and hydroxocobalamin

27

which b12 tx has longer half life

hydroxocobalamin

28

B12 is stored in the

liver--> large reserve--> enough to last a vegan 5 years

29

b12 defiiency causes folate to accumulate as

N methyl THF
*folate is depleted over time
*production of RBC's slows

30

B12 replacement therapy should always be

parenteral--> bc lack of it is usally due to malabsorption such as in pernitious anemia

31

why is folate important-->

DNA SYNTHESIS--> converted to dTMP--> THYMINE eventually--> without it DNA synthesis stops and cell become megaloblastic

32

Folate is stored

modest amounts in the body--> run out in a few months

33

DHFR

converts folate to DHF-->THF

34

folic acid is different than dietary folate how?

dietary folate must be demethylated

35

toxicity associated with folic acid/ b12

none

36

ESA's used for anemias associated with

renal failure
primary bone marrow failure
anemia of cancer or chemo
HIV/AIDS
BMT

37

EPO is produced by the

kidney
*renal failure= anemia

38

list ESA's

Epoietin alfa (recombinant human EPO)
darbepoietin alfa
Methoxy polyethylene glycol-epoitein beta
-->long-lasting EPO adminstered 2 x monthly

39

ESA with longest half life

darbepoitein alfa
*glycosylated form of EPO

40

most common ADE's of ESA are

hypertension and thrombosis

41

HGB concentration of ppl undergoing ESA tx should not exceed

12--> any higher and you get adevrse CV events

42

Used to accelerate recovery of neutrophils after chemo

Gcsf- neutrophils specifically and majorly HSC's
GMCSF--> all granulocytes and minimally Hematopoietic Stem Cells

43

What should you give a pt who has just gotten autologous stem cell transplant

Gcsf--. reduces tim to engraftment and increases neutrophils

44

Hematopoietic stem cell mobilozer

plerixafor--> inhibitor of CXCR4
May be combined with GCSF in myeloma pt.s who do not respond well to just GCSF

45

used to mobilize HSC's prior to allogenic or autologous HSCT

GCSF

46

side effects of GSCF

minimal bone pain

47

side effects of GMCSF

fever, arthralgias, capillary damage

48

GCSF formulation with with longer

pegfilgrastim

49

Stimulates growth of megakryocytes

Oprevelkin IL-11

50

indications for Oprevelkin

pt.s with thrombocytopenia following chemo--> reduces need for platelet transfusions

51

TPO receptor agonist

romiplastin
eltrompobag

52

TPO receptor

c-MPL

53

ROute and indication for Romiplastin

Sub-Q
*pt's with ITP who have responded poorly to conventional tx

54

Route and indication for eltropobag

oral
*ITP with poor response to conv. tx

55

major toxicity of eltropbag

hepatotoxicity

56

TPO is made in the

liver and kidney

57

EPO WORKS THROUGH

jak2 signaling cascade

58

ESAs should be used only in patients with cancer

-->treating anemia specifically caused by chemotherapy, and not for other causes of anemia. Further, it states that ESAs should be discontinued once the patient's chemotherapy course has been completed.

59

ESA'S SHOULD NOT BE USED

for anemia that exists outside of the chemotherapy given to the pt.

60

darbepoietin contraindicated in

pt.'s with preexisting HTN