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Terms in this set (45)
Oral Iron drugs?
Ferrous sulfate (hydrated or desiccated)
Parenteral Iron drugs?
Sodium ferric gluconate complex
Folic acid drugs?
Iron Chelator drugs?
Myeloid Growth Factor drugs?
Megakaryocyte Growth Factor drugs?
Erythropoietin, Epoietin and Darbapoietin (hematopoietic growth factors) MOA
stimulates cell-surface erythropoietin JAK/STAT receptors on RBC progenitor cells in the bone marrow to increase RBC production
Epoietin alfa similarities to erythropoietin?
identical to endogenous erythropoietin except for carbohydrate mods of the protein
Darbapoietin alfa similarities to erythropoietin?
similar except for 4 mutated amino acids that increase its half life
Physiological effect of Epoietin alfa and Darbapoietin alfa?
marrow progenitor cell survival & proliferation
production of hemoglobin
release of reticulocytes from marrow
Epoietin alfa, and Darbapoietin alfa therapeutic use?
cancer treatment (chemo and radiation therapy)
chronic kidney failure (decreased dose)
anemia of chronic disease
Epoietin alfa and Darbapoietin alfa adverse effects?
rapid rise in hematocrit causes HTN, thrombotic complications, polycythemia
N, V, D
increased risk of tumor growth and shortened survival in cancer patients
increased risk of MI, heart failure, stroke, blood clot
rarely causes allergic reactions and seizures
Myeloid growth factors Filgrastim, Pegfilgrastim, and Sagramostim MOA?
cytokines that bind to specific receptors on committed progenitor cells to increase the transcription of specific genes that enable granulocytes and monocytes to increase their proliferation and differentiation
G-CSF function (Filgrastim or Pegfilgrastim)?
stimulates neutrophil progenitors
prolongs neutrophil survival
increases concentration of hematopoietic stem cells in peripheral blood (used to BM transplant)
GM-CSF function (Sagramostim)?
broad action on erythroid, granulocyte progenitor cells and megakaryocyte progenitors
stimulates activity of neutrophils
Myeloid growth factors Filgrastim, Pegfilgrastim, and Sagromostim therapeutic use?
autologous stem cell transplantation (Filgrastim/Pegfilgrastim)
Filgrastim/Pegfilgrastim (G-CSF)side effects?
Bone pain (better tolerated)
Sagramostim (GM-CSF) side effects?
bone & muscle pain
increases proliferation and differentiation of megakaryocytes
(growth factor binds to IL-11 receptors on committed progenitor cells and through the JAK/STAT pathway)
Oprelvekin therapeutic use?
(increases GI lesion healing, inhibits adipogenesis, stimulates osteoclastogenesis)
Oprelvekin side effects?
fluid retention with edema -> dyspnea
rhinitis and pleural effusion
Causes of Microcytic hypochromic anemia?
inadequate iron ingestion
decreased iron absorption
-drug interactions (tetracyclines)
Increased iron requirements
Blood loss (iron loss)
what transports iron in the blood?
what state of iron is best absorbed?
ferrous iron Fe2+
How much iron can be utilized?
only 50 to 100 mg can be incorporated into hemoglobin
only 25% of the dose can be absorbed in the GI tract (so dose at 200-400mg elemental iron per day)
co-administration of what help iron absorption?
(decreased by as much as 1/2 if taken with food but will decrease the side effects)
Oral Iron side effects?
black stool and dark urine
(liquid iron stains dentures)
Treatment of microcytic hypochromic anemia?
test dose is needed with what iron supplement?
what is the advantage of parenteral iron?
correction of the iron deficiency in a shorter amount of time
Parenteral Iron side effects?
local pain and tissue discoloration
HA, light headedness, fever
hypersensitivity (flushing, urticaria, bronchospasm, anaphylaxis)
lethal iron dose?
1-2grams can be lethal but usually 2-10 grams associated with death (affects children more)
treatment of iron overdose?
Deferoxamine and Deferasirox (iron chelators)
Deferoxamine adverse effects?
tinnitus and reversible hearing loss
anaphylaxis is not uncommon
larger than normal RBC's due to inhibition of DNA synthesis (cells grow w/o dividing) normally as a result of Vit-B12 or folate deficiency
where is Vit-B12 stored?
liver (5 year supply)
Vit-B12 absorption requires what?
causes of Vit-B12 deficiency?
-pernicious anemia (lack of intrinsic factor)
manifestations of Vit-B12 deficiency?
initially anemia (fatigue, parasthesia, ataxia)
later neuropsychiatric abnormalities
Cyanocobalamin and Hydroxocobalamin MOA?
vit-B12 is a co-factor for the formation of THF (used for DNA synthesis)
cyanocobalamin and hydroxocobalamin side effects?
(anaphylaxis from impurities, very rare)
needed for synthesis of purines and thymidylates
needed for methylation of tRNA
needed for AA synthesis
Folvite side effects?
GI- nausea, flatulence, bitter taste
CNS - altered sleep patterns and confusion
anaphylaxis if used parenterally
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