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Why is the bio-availability of iron low
It is not very soluble in physiological Ph
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Where is most of the iron found in the body
In the Hemoglobin 60-70%
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What are some of the important functions that iron participates in
- Cellular respiration
- Krebs cycle
- Electron Transport chain
- Lipid metabolism
- Gene regulation
- DNA regulation and repair
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What is the recommended dietary allowance of iron for adults
- 18mg for women
- 8 mg for men
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What is the difference in the iron in meat and the iron in other organic substances during digestion
- The meat is more efficiently absorbed because it doesn't have to be disassociated from the Hb and myoglobin forms
- Non heme foods must be reduced before use
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What is the enzyme that reduces iron
Ferroreductase to the ferrous form
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Where is iron absorbed
In the small intestine
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How does the iron get to the bone marrow to be used for erythrocyte production
Via transferrin and the transferrin receptor
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What causes an increase in the amount of transferrin and its associated receptors
An increase in Erythropoiesis and a depletion of iron storage
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Where are some of the sites beyond the bone marrow that the iron can be stored
Macrophages in the liver, spleen, and bone as well as parenchymal liver cells
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Why is parenteral administration of iron used last
Because once it goes into the blood stream, there is no mechanism excreting it out of the body, once it is in the blood, it is in for good.
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What are the few conditions that iron is administered intravenously
- Patients on Dialysis in conjunction with erythropoietin
- Patients unable to absorb/tolerate the iron in the intestines
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What are the oral preparations of iron
- Ferrous sulfate
- Ferrous Gluconate
- Ferrous fumarate
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How much of the ferrous iron from salts can be absorbed
25%
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How long should the treatment of iron be continued
3-6 months after correction of the issue, this corrects, and begins storage
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What are the different parenteral administration options for iron and their routes of administration
- Iron Dextran (Muscle injection or IV)
- Sodium ferric gluconate (IV)
- Iron sucrose (IV)
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What are some of the adverse affects of oral iron
- GI complications
- Black stool
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What are some of the adverse affects of parenteral administration of iron
- Local pain
- Headache
- Light headed
- Fever
- Back pain
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What is done if a child has an overdose of iron
- Pump the stomach
- Administration of iron antidote
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Why is iron not given to patients with parkinsons disease
It appears to speed up the disease
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What effects can diets high in Ca+ have on iron
It interferes with iron absorption
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What is the effect of Deferoxamine
It is an iron chelator and therefore binds to iron in the body and pulls it out of circulation in the form of ferrin and tranferrin
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What drugs can be used for iron poisoning and their mode of administration
- Deferoxamine (IM, or IV)
- Deferasirox (oral)
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What are the two drugs used for B12 deficiency
- Cyanocobalamine
- Hydroxocobalamine
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What is the chief source of B12 in diets
- Meat
- Eggs
- Dairy products
- All require microbial breakdown
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Why is it okay if one was to go without B12 for an extended period of time
We have massive stores of it in the liver
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How is B12 transferred to various cells in the body
Transcobalamine
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What is a schilling test
It is a test designed to determine the cause of B12 deficiency by using a B12 radio labeled marker
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What is the preferred B12 drug when the patient has malabsorption
Hydroxycobalamine (Injections)
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What is another name for folic acid
Pteroylglutamic acid
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In order for Folic acid to be useful it must
Undergo a conversion by dyhydrofolate reductase
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How long would it take one to have the effects of no Folic acid intake to show symptoms of megaloblastic anemia
1-6 months due to the low storage and high demand
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What important functions are the cofactors of Folic acid required for
- Nucleotide synthesis
- DNA synthesis
- Glycine synthesis
- Methylation of B12 for use
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What is a drug used for Folic acid deficient patients
Leukovorin
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What is an important function of Leukovorin in cancer treatment
Some drugs in cancer treatment are used as folate antagonists, Leukovorin has the ability to get the folate to the native cells not the cancer cells.
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Why are higher doses of Leukovorin not helpful in cancer treatment
Because higher doses provides Folic acid for the cancer cells whereas the smaller doses prevents it
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What are the erythropoietin drugs
- Darbepoietin Alpha
- Epoetin Alpha
- Epoetin Beta
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What are the different dosages necessary for the different EPO drugs
- Darbepoietin once a week
- Epoetin alpha three doses a week
- Epoetin Beta once a month
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What normally produces EPO
The renal cortex
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What are some conditions that EPO drugs can be used for
- Aplastic anemia
- Myelodysplastic disordres
- Multiple myeloma
- Anemia from AIDS, HIV, and cancer treatments
- Hemochromocytosis
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EPO's should not be used with patients undergoing
Chemotherapy, there is a greater chance of death
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The administration of iron supplements interferes with the absorption of what drug
- Tetracycline
- Quinolones
- Thyroid Hormone
- Therfore, if taken, should be done at different times, seperated by at least two hours
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