Anemia Pharmacology

Question 1

T or F: oral iron is the first line for iron deficiency tx.

Answer 1

True.

but … Compliance is very low.

Question 2

What is the least expensive oral iron supplement?

Answer 2

Ferrous sulfate (325 mg) 3/day (150 - 200 mg/day)
Also available in elixir

Question 3

When to D/C iron therapy

Answer 3

1. Stop when hgb normalizes.
2. Treat for 6 months after hgb normalizes
   - replenishes iron stores

Question 4

IV iron SE

Answer 4

Fever, arthralgias, myalgias, RA flares.

Premedicate with 125 mg Pred or solumedrol IV for Hx of asthma or RA

Question 5

IV Iron Indications

Answer 5

Chronic blood loss
Inability to tolerate SE
Inability to absorb
Kidney disease
Some cancers

Question 6

Folate Dosage

Answer 6

1 - 5 mg daily for 1-4 months. Be sure to R/O B12 deficiency, can mask symptoms.

Question 7

B12 Dosage

Answer 7

1000 mcg daily for a week, weekly for a month, monthly until cause is found and is reversible, or for life.

Question 8

Effects of folate/B12 therapy

Answer 8

Pt should feel better within a few days
Reticulocytosis in 3 - 4 days
Hgb rises in 10 days, normalizes in 8 weeks
Neuro abnormalities improve in 3 mo - 1 yr

Question 9

EPO dugs

Answer 9

Epoetin: Epogen and Procrit

Question 10

Indications for EPO therapy

Answer 10

Used to prevent blood transfusions

• Chronic Kindey disease
• Chemotherapy
• HIV complications
• Surgery scheduled
• Off label for myelodysplasitic syndrome

Question 11

If Epo produces no hgb response in 8-12 weeks, what should you do?

Answer 11

DC the med

Question 12

T or F: You should aim for an hgb increase of >1 g/dl in a 2 week period for patients using ESA (Epo).

Answer 12

False, If the hgb rises that much in a 2 week period, reduce dosage is ESA. Associated with cardiavascular and thromboembolytic events, stroke.

Question 13

ESA (Epo) risk factors

Answer 13

Decreases life span in cancer patients, tumors may grow more.
Cardiovascular events in gen pop, stroke, other bas stuff.

Question 14

CI for Epo

Answer 14

Uncontrolled HTN
Hx of pure red cell aplasia (due to ESA’s)
Allergy to drug (duh…)

Question 15

Red cell aplasia

Answer 15

Autoimmune rxn to ESA’s, bone marrow stops making RBC’s.