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Pharm for Anemias

Pharmacotherapy-II

QuestionAnswer
75% of all anemia’s are accounted for what iron def, anemia chronic dz, associated w/ acute blood loss
Symptoms of acute onset anemia tachy, lightheadedness, breathlessness
Symptoms of chronic onset anemia fatigue, weakness, HA, vertigo, faintness, sensitivity to cold, loss of skin tone pallor
Initial lab evaluation for anemias CBC w/ RBC, retic count, FOB
Nl ranges for Hgb and hematocrit M14-17.5, 12.3-15.3 M42-50, F: 36-45
Nl MCV 80-100
Nl iron M: 45-160 F: 30-150
Nl ferritin <10-20
Nl retic count M: .5-1.5 F: .5-2.5
What is iron essential for Hgb synthesis therefore O2 transport
Causes of iron deficiency anemia inadequate dietary intake, inadequate aborption, ↑iron demands, blood loss, list some of each
What are signs of iron def koilonychias, angular stomatitis/glossitis, PICA
Koilonychias spooning of the nails
What happens w/ iron def in children and adolescents affects cognitive fxn and achievement
Lab findings with iron def anemia ↓serum iron, ferritin, High TIBC, low Hgb and Hct in later stages, microcytic anemia
What ↑ absorption on nonheme iron gastric and ascorbic acid
What iron is more easily absorbed iron in meat, fish, and poultry
What can ↓ iron absorption milk and tea
Tx of iron def anemia find underlying cause, dietary supplements, therapeutic iron preparations oral or paraenteral, transfusions
Where is iron absorbed max in duadnum, rest in small intestine ( don’t want extended release)
Recommended iron supplementation 200mg elemental iron/day, in 2-3 doses (best absorbed w/o food or other meds)
When is iron better tolerated smaller more frequent doses
MC iron supplementation ferrous sulfate 325mg tablet PO tid (20%iron)
AE’s iron supplementation GI, discoloration of feces (black), abd pain, heartburn, constipation, N/V
Absecence of AE’s may indicate what non adhearance
If SE’s intolerable,what can they do take iron w/ meals (↓daily dose to 110-120mg elemental Fe)
Monitoring of iron supplementation AE’, 3wks should raise Hgb 2g/dL
Why would tx fail nonadhearence, misdiagnosis, malabsorption, blood loss, anemia-inducing dz states
What is the gold standard for parenteral iron supplementation iron dextran 50mg IV/IM by Z-track
AE’s of Iron dextran arthralgias, myalgias,flushing, malaise, fever, allergic rxns (rarely anaphylaxis)
What should we do prior to giving full iron dextrose dose test dose, 25mg iv/im observe >1hr before administering remainder of dose, have IV epi ready
What is B12 water soluble vitamin, obtained by ingestion of meat and dairy products,
Fxns of B12 needed for DNA synthesis, metabolic rxns w/ folic acid,
Daily requirements of B12 2-2.6mg
3 causes of B12 def inadequate intake, ↓ absorption, inadequate utilization
s/s of B12 def neurologic sxs, glossitis, dysphagia, anorexia
lab findings of B12 def MCV >100, retic count, B12 levels and Hbg low
pernicious anemia Vit B12 def d/t intrinsic factor def
three ways to tx B12 def oral (1-2mg), parenteral:1000mcg q week , nasal spray: do not administer within 1 hr hot food/beverage
monitoring of B12 def tx retic count w/I 2-3days, CBC and B12 usually back w/I 1-2m
what may be greater during B12 initiation need for iron
AE’s ofB12 tx hyperuricemia, hypokalemia, rebound thrombocytosis, fluid retention, anaphalaxis
Where can we find folic acid fresh fruits, veggies, yeast, mushrooms, animal organs
What is folic acid heat-labile vit. Necessary for production of nucleic acids, proteins, amino acids, purines, and thymine
What are folate antagonists MTX, pentamidine trimethoprim, triamterene
What are drugs that ↓ folic acid inducers: phenytoin, phenobarbital, primidone
Sxs of folic acid def similar to B12 but NO neuro sxs (slow onset)
What is tx for folic acid def 1-5mg po qdx4m
What is pre contraception for folic acid 400-1000mcg qd
When will Hbg normalize w/ tx within 2m
What is the anemia mechanism with anemia of chronic dz w/ ↑ need of metabolism and other things, RBC life shortene
What do cytokines do may inhibit production or action of erythropoietin or inhibit RBC production
Lab findings w/ Anemia chronic dz serum iron ↓, ferritin nl or ↑, iron binding capacity nl or ↓
Tx of anemia chronic dz tx underlyin d/o erythropoietin stimulating agents,
AE’s of erthyropoeitin DBP elevation, fatigue, HA, fever, edema, CP, N/D/V
Created by: becker15
 

 



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