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Flashcards in Pharm 26 Objectives Deck (56):
1

What is the average daily maximum elemental iron absorption in both mg and %?

Mg: 3 – 4 mg/ day

%: 5 – 20% daily intake

2

Absorption of iron increases when?

- erythropoietic activity is high

- iron stores are depleted and iron absorption processes are intact

3

When does the iron absorption process become saturated?

The larger the dose of iron the more mg of iron is absorbed BUT the process becomes saturated and a smaller % of the dose is actually absorbed.

4

What is the primary factor that determines daily iron requirements?

Rate of erythrocyte production

5

Why it is important to consider the elemental iron dose within an oral iron product?

Elemental iron is the total amount of iron in the supplement available for absorption in the body. Each type of iron preparations has different percent of elemental iron so it is important to be aware of what iron preparation you are taking and what elemental iron % is listed to avoid iron toxicity

6

What is the RDA of iron in men and women?

- Men: 8-10 mg/day

- Women: 15mg/day

7

What dose of iron is used to treat iron deficiency anemia?

- 100 to 200mg/day

8

What is dose of Ferrous sulfate for IDA?

65mg elemental iron per 325mg tab
- 2 tabs/ day = 130 mg
- 3 tabs/day = 195mg

9

What is dose of Ferrous gluconate for IDA?

38mg elemental iron per 324mg tab
- 3 tabs/day= 114mg

10

What dose of an iron supplement is recommended to prevent IDA from occurring again.

27mg to 150mg

11

How much iron is contained in a prenatal vitamin?

27mg

12

List several foods or food groups that are naturally rich sources of iron and a cooking device (possibly) useful for preventing iron deficiency.

- Liver, egg yolk, brewer’s yeast, wheat germ, muscle meats, fish, fowl, cereal grains, beans, and green leafy vegetables

- Cook with cast-iron pan

13

List three general reasons that oral iron supplementation is preferred over the use of IV iron

- No need for test dose or observation period/safety consideration w/ oral

- Less toxicity risks

-Easily assessable and less expensive than IV

14

What components are needed to calculate an IV dose of iron dextran?

- Observed Hb

- Normal adult Hb

- Lean body weight

15

What is the procedure/safety considerations for administering IV dextran for the first time?

- Test dose: 0.5 mL IV over 30 seconds for 5 minutes

- 1 hr after test dose administer the balance of the dose if no hypersensitivity reaction occurs

- Observation includes: aware, trained personnel w/ resuscitation equipment and epinephrine on hand

16

What is the hormone that stimulates and commits the less differentiated blood cell progenitors to the RBC pathway?

Erythropoietin

17

What are the pharmacologic congeners that stimulates and commits the less differentiated blood cell progenitors to the RBC pathway?

ESAs/EPOs
- Epoetin alfa

- Epoetin beta

-Darbepoetin alfa

18

What is the MOA of ESAs/EPOs?

Inhibit apoptosis of erythroblast precursors which increases red blood cell mass

19

What are some clinical utilizations of ESAs/EPOs?

- Anemia associated with chronic renal failure

-Chemotherapy induced anemia

-HIV infected pts taking zidovudine

-Anemia in pts facing surgery

20

RBC production is stimulated by?

ESAs/EPOs

21

WBC production is stimulated by?

GM-CSF

22

Platelet production is stimulated by?

GM-CSF

23

What is the black box warning of ESAs/EPOs?

- CKD greater risk for death, CV rxns, and stroke when administered ESAs to target Hb levels of 11g/dL and above.

- Used in cancer pts: shortened overall survival and/or increased risk of tumor progression or reoccurrence.

24

Why we don’t we use folic acid for all patients with megaloblastic anemia?

- It can mask a vitamin B12 deficiency.

- Folic acid will reverse the disruption of hemopoiesis, but will not improve the neurologic deficits and will allow it to progress

25

What is the iron dose that is recommenced during pregnancy?

27mg/day

26

What is the folate acid dose that is recommenced during pregnancy?

- At least 400 mcg/day in addition to any dietary intake

- Parental vitamins 800 mcg (OTC) to 1000 mcg (rx)

27

What trimester is critical for folate acid supplementation?

First trimester

28

Name the preferred Rx product for rescue with methotrexate.

Leucovorin calcium

29

What is a cobalamin replacement product for megaloblastic anemia due to vitamin B-12 deficiency.

Cyanocobalamin (MC'ly used) or Methylcobalamin

30

What are the therapies that may be requires for the treatment of severe B12 deficiency?

- Correct the deficiency: IM injection of B12 (+/- folic acid)

- Administration of 2 to 3 units packed RBCs for severe anemia

- Platelet transfusion if bruising/bleeding due to thrombocytopenia

- Antibiotics if infection is present (due to leukopenia)

31

Clinical use of Cytotoxic: Methotrexate?

- High dose: cancer

- Low dose: autoimmune disorders such as RA.

32

Toxicities of Cytotoxic: Methotrexate?

- Elevated liver fxn test, nephrotoxicity, oral ulcerations, stomatitis, bone marrow suppression.

- Contraindicated in pregnancy (X cat)

33

Clinical use of Cytotoxic: Hydroxyurea?

Sickle cell anemia, chronic myeloid leukemia, head and neck cancer

34

Toxicities of Cytotoxic: Hydroxyurea?

Macrocytosis, infections, bacterial infection, neutropenia, eczema

35

Clinical use of Cytotoxic: Azathioprine?

Organ transplant rejection prophylaxis

36

Toxicities of Cytotoxic: Azathioprine?

Bone marrow suppression, pancreatitis, avoid use w/XO inhibitors (allopurinol)

37

Clinical use of Cytotoxic: Mycophenolate?

Long term after organ transplant rejection

38

Toxicities of Cytotoxic: Mycophenolate?

Block B and T lymphocyte proliferation -need to be monitored very closely.

39

What CYP 3A4 inhibitor drugs cause severe calcineurin inhibitor toxicity and immunosuppressant drug failure?

- Macrolides: clarithromycin and erythromycin

- CCB: Diltiazem and Verapamil

- Antifungals: Azoles

- Protease inhibitors for HIV

40

What is the half life of antibody therapies: TNF-alpha inhibitors?

1-2 wks

41

What is the half life of antibody therapies: Rho-D immune globulin?

give once or twice

42

What are the routes of administration of antibody therapies?

IV, IM, SQ

43

What are the cost of antibody therapies?

- EXPENSIVE $$$

- Palivizumab about $10,000 per season

- Adalimumab $65,00 per year

- Exulizumab $409,000 per year

44

Monoclonal antibody ending in -monab is a structure from?

Murine MAB - mouse

45

Monoclonal antibody ending in -imab and -ximab is a structure from?

Chimeric MAB - mouse and human

46

Monoclonal antibody ending in -zumab is a structure from?

Humanized MAB - humanized

47

Monoclonal antibody ending in -mumab is a structure from?

Human MAB - human

48

What antibodies inhibit immunity?

Polyclonal antibodies
- ALG and AGT

49

Clinical application of polyclonal antibody: ALG antilymphocyte globulin and ATG: antithymocyte globulin

Organ transplant rejection

50

Clinical application of Monoclonal: TNF-a inhibitors?

RA, psoriasis, Crohn’s disease

51

What antibodies aid in immunity?

Pooled human immune globulin
- IVIG, IMIG, Hyperimmune globulins, Palivizumab.

52

Clinical application of IVIG and IMIG?

Fight infection in pts who are unable to fight off an infection (ie immunosupressed pt)

53

Clinical application of Hyperimmune globulins?

- Rho (D): Hemolytic disease: newborn, blood infusions, and exposures via previous pregnancies

- Vaccines: Hep B

54

Clinical application of Palivizumab?

Severe lower respiratory track doses in children at high risk of severe RSV disease

55

Pt who are vegan but have megablastic anemia: B12 deficiency need to have a high intake of what?

Fermented foods: kombucha or kimchi

56

What is the MC organ transplant regimen?

Calcineurin inhibitor (cyclosporine or tacrolimus)
+
purine synthesis inhibitor (mycophenolate)
+
Corticosteroid (prednisone)