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