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what is a hematinic agent?
drug that improves the blood
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heme is necessary for what fx's?
- RBC production
- o2 carrying
- cognitive fx in children
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Fe absorbed by what body system?
lymph, not blood
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Fe is best absorbed by body in what form?
ferrous (Fe2+), as opposed to ferric (Fe3+)
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Ca does what to Fe absorption?
decreases
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ascorbic acid (aka vitamin C) does what to Fe absorption?
increases
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why take iron supplements on empty stomach
ferric form coverts to ferrous form in the presence of stomach acid, which is readily absorbed in duodenum
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best dietary source of Fe
heme, found in meat, fish, and poultry
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protein complex that transports Fe throughout the body
transferrin
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iron dextran
- trade: Imferon
- parenteral
- (IM not used much b/c very painful and unreliable absorption from the muscle)
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iron drug interactions
- tetracyclines: decrease absorption
- antacids / Ca: decrease
- Vit C (ascorbic acid): ^
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iron SFX
- GI irritation
- anaphylaxis form imferon form - do small intradermal test dose first)
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what does PO Fe do to teeth? how to prevent this?
- stains teeth.
- dilute and give with straw or dropper on back of tongue
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type of anemia resulting from vit. b deficiency?
most common cause?
other possible cause?
- pernicious anemia (type of megaloblastic anemia)
- common cause: absence of intrinsic factor
- also seen in strict vegetarians b/c b12 comes from animal sources
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why is IF important? where does it come from?
- IF needed to absorb PO vit. b12.
- secreted by stomach
-
cyanocobalamin, hydroxocobalamin
- -tx for vit. b12 deficiency caused by absence of intrinsic factor
- -IM, SC (b/c non-PO forms don't require IF for absorption)
- -qmonth
- -life long
- -SFX: IM - allergic rxns, itching, diarrhea
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pernicious anemia FX which two body systems?
-
functions of b12 in the body
- normal cell growth
- DNA replication
- normal myelin (why there are neuro FX of deficiency)
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type of anemia that causes neuro complications
pernicious
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vitamin necessary to prevent neural / spinal cord birth defects?
folic acid
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type of anemia caused by folic acid deficiency?
how is this different than vit. b12 deficiency?
- megaloblastic
- different from b12 deficiency b/c no neurologic signs
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drugs to tx folic acid deficiency
- folate (aka folic acid, vit. b9) supplement
- folate sodium [Folvite]
- leucovorin [Wellcovorin] - IM
ususally given to pts who are taking folic acid antagonists, like chemo drugs
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folic acid drug interactions
- chemo drugs
- antimalarials
- some antiprotozoals
- dilantin - folic acid in large doses decreases its anticonvulsant FX
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epoetin
- trade: Epogen, Procrit
- SC 3x/wk (painful)
- used to tx anemia by stimulating differentiation of stem cells in bone marrow to become erythrocytes
- SFX: HTN, HA, arthralgia, edema, fatigue, pain, dizziness, seizures, thromboembolic events (MI, CVA), renal failure
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CSF given 1x/wk SC to tx anemia r/t chemo or renal failure, similar to epogen
Darbepoetin alfa [Aranesp]
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hormone primarily responsible for erythropoesis? secreted from where?
- erythropoeitin
- mostly from kidneys, also from liver
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epoetin alfa [Epogen, Procrit] functions just like which endogenous hormone?
erythropoetin
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why would CSF therapy be used for a pt receiving chemo?
- chemo leads to neutropenia
- CSF therapy causes rapid increase in neutrophils
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filgrastim
- [Neupogen]
- ther FX: ^ neutrophil production in bone marrow, enhance phagocytic and cytotoxic fx's of existing neutrophils
- SC, IV
- SFX: n/v/d, alopecia, fatigue, bone pain, leukemia
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pegfilgrastim
- [Neulasta] CSF to ^ neutrophil count
- sustained release version of filgrastim
- SC only
- used prophylactically in chemo pts
- same SFX, indications as filgrastim
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oprelvekin
- [Neumega]
- stimulates maturation of megakaryocytes into plts
- SC 1x/day
- SFX: fluid retention / peripheral edema (which can lead to HF), dyspnea, tachycardia
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primary side effect of oprelvekin [neumega]? pt education about it?
- fluid retention --> pulmonary edema, HF
- teach pt to weigh themselves qday. 1L water = 2.2#
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