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75% of all anemia’s are accounted for what
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Symptoms of acute onset anemia
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Pharm for Anemias
Pharmacotherapy-II
| Question | Answer |
|---|---|
| 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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