Pharm4 - hematinics

  1. what is a hematinic agent?
    drug that improves the blood
  2. heme is necessary for what fx's?
    • RBC production
    • o2 carrying
    • cognitive fx in children
  3. Fe absorbed by what body system?
    lymph, not blood
  4. Fe is best absorbed by body in what form?
    ferrous (Fe2+), as opposed to ferric (Fe3+)
  5. Ca does what to Fe absorption?
  6. ascorbic acid (aka vitamin C) does what to Fe absorption?
  7. 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
  8. best dietary source of Fe
    heme, found in meat, fish, and poultry
  9. protein complex that transports Fe throughout the body
  10. iron dextran
    • trade: Imferon
    • parenteral
    • (IM not used much b/c very painful and unreliable absorption from the muscle)
  11. iron drug interactions
    • tetracyclines: decrease absorption
    • antacids / Ca: decrease
    • Vit C (ascorbic acid): ^
  12. iron SFX
    • GI irritation
    • anaphylaxis form imferon form - do small intradermal test dose first)
  13. what does PO Fe do to teeth? how to prevent this?
    • stains teeth.
    • dilute and give with straw or dropper on back of tongue
  14. 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
  15. why is IF important? where does it come from?
    • IF needed to absorb PO vit. b12.
    • secreted by stomach
  16. 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
  17. pernicious anemia FX which two body systems?
    • hematologic
    • neuro
  18. functions of b12 in the body
    • normal cell growth
    • DNA replication
    • normal myelin (why there are neuro FX of deficiency)
  19. type of anemia that causes neuro complications
  20. vitamin necessary to prevent neural / spinal cord birth defects?
    folic acid
  21. 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
  22. 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
  23. folic acid drug interactions
    • chemo drugs
    • antimalarials
    • some antiprotozoals
    • dilantin - folic acid in large doses decreases its anticonvulsant FX
  24. 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
  25. CSF given 1x/wk SC to tx anemia r/t chemo or renal failure, similar to epogen
    Darbepoetin alfa [Aranesp]
  26. hormone primarily responsible for erythropoesis? secreted from where?
    • erythropoeitin
    • mostly from kidneys, also from liver
  27. epoetin alfa [Epogen, Procrit] functions just like which endogenous hormone?
  28. why would CSF therapy be used for a pt receiving chemo?
    • chemo leads to neutropenia
    • CSF therapy causes rapid increase in neutrophils
  29. 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
  30. pegfilgrastim
    • [Neulasta] CSF to ^ neutrophil count
    • sustained release version of filgrastim
    • SC only
    • used prophylactically in chemo pts
    • same SFX, indications as filgrastim
  31. oprelvekin
    • [Neumega]
    • stimulates maturation of megakaryocytes into plts
    • SC 1x/day
    • SFX: fluid retention / peripheral edema (which can lead to HF), dyspnea, tachycardia
  32. 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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Pharm4 - hematinics