Therapeutics: Anemia 2

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  1. What can cause Cobalamin malabsorption?
    • Low Gastric acid secretion
    • Due to gastrecotmy or prolonged gastric acid suppression
  2. What can cause Decreased B12?
    • Pernicious anemia
    • Cobalamin malabsorption
  3. What drugs can cause Vitamin B12 deficiency?
    • Antibiotics
    • Anticonvulsants
    • Cytotoxic agents
    • Oral contraceptives
    • High dose Vitamin C
  4. What symptoms other than traditional pallor, SOB and fatigue, might you see in B12 deficiency?
    • Neuropsychiatric – May be irreversible
    • e.g. muscle weakness, dementia, mental status changes, ataxia
  5. What is the treatment for Vitamin B12 deficiency?
    • Dietary
    • Oral replacement with Cobalamin – 1 mg/day
    • PO unless having neuropsychiatric problems – then use IV or IM (cyanocobalamin)
  6. What is the intial dose for cyanocobalamin/cobalmain (B12)?
    1000 mcg
  7. What is the intranasal gel Vitamin B12 formulation used for?
    Mainenance only, because edose is only 500 mcg (half of what a repletion dose would be)
  8. What counseling needs to be done for intranasal Vit B12?
    Do not administer 1 hr before or after hot food/beverages
  9. What is the IV/IM form of B12?
  10. What is the PO form of B12?
  11. What are the SE for B12 therapy?
    • HYPERuricemia
    • HYPOkalemia
    • Thrombosis
    • Fluid retention
    • Anaphylaxis (IV/IM)
  12. What should you monitor on B12 therapy?
    • HgB – should normalize in 1-2 months
    • CBC and B12 levels after 1-2 months and then every 3-6 months
  13. What are the sources of folic acid?
    Fresh, green leafy veggies, citrus fruits, yeast, mushrooms, animal organs
  14. What groups are most at risk for folic acid deficiency?
    • Pregnant
    • Excessive alcohol intake
    • Elderly
  15. What are most cases of FA deficiency caused by?
  16. What are the four ways that FA deficiency usually develops?
    • Inadequate intake
    • Decreased absorption
    • Hyperutilization
    • Inadequate utilization
  17. Folic acid deficiency anemia has what signs and symptoms?
    • Normal: SOB, fatigue, pallor
    • Similar to B12 but with NO NEUROPHSYCOLOGICAL
  18. The lab values for FA deficiency would differ from B12 in what way?
    • Nomral B12 levels and normal MMA
    • Decreased Folate <3 ng/mL
  19. What is the treatment for FA deficiency?
    • 1 mg/day
    • Up to 5 mg/day for malabsorption causes
    • 4 month therapy, unless chronic
    • Increase dietary
  20. How much FA do pregnant women need?
    • 1 mg/day to prevent neural tube defects
    • Previous neural tube defects = 4 mg/day
  21. Increased Morbidity and Mortality for Anemia of Chronic disease, occurs in patients with what chronic diseases?
    HIV and CHF
  22. What are the causes of Anemia of Chronic Disease?
    • Shortened RBC lifespan
    • Decreased response to EPO
    • Disturbance of iron metabolism
    • Impaired proliferation of erythroid progenitor cells
  23. How is a diagnosis of Anemia of chronic disease made?
    By ruling out other causes
  24. What is the treatment for Anemia of Chronic disease?
    • Correct underlying disease if possible
    • Transfusion
    • Epoetin Alfa
  25. When can you initiate Transfusions for Anemia of Chronic DIsease?
    HgB <8
  26. When should you stop Epoetin alpha therapy?
    • If HgB goes over 11 g/dL
    • Should not go over 1 g/dL in 2 weeks
  27. What dosing of EPO is preferred for dialysis patients?
    3x/weekly dosing is preferred for dialysis patients as they have better response
  28. For non-dialysis patients what dosing of EPO is preferred?
  29. What needs to be monitored when giving EPO?
    Hgb rate of increase and total levels
  30. If Hgb increases by > 1 g/dL in 2 weeks on EPO therapy, what should you do?
    Decrease dose by 25-50%
  31. What is the risk of Hgb increasing by > 1 g/dL in 2 weeks on EPO therapy?
    Increased risk of HTN and seizures
  32. If Hgb increases above > 11 g/dL on EPO therapy, what should you do?
    Hold doses until Hgb falls below 11
  33. What is the risk of Hgb increasing by > 1 g/dL in 2 weeks on EPO therapy?
    Increased risk of Thromboembolism and mortality
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Therapeutics: Anemia 2
Therapeutics: Anemia 2
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