Flashcards in Pharm 26 Objectives Deck (56):
What is the average daily maximum elemental iron absorption in both mg and %?
Mg: 3 – 4 mg/ day
%: 5 – 20% daily intake
Absorption of iron increases when?
- erythropoietic activity is high
- iron stores are depleted and iron absorption processes are intact
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.
What is the primary factor that determines daily iron requirements?
Rate of erythrocyte production
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
What is the RDA of iron in men and women?
- Men: 8-10 mg/day
- Women: 15mg/day
What dose of iron is used to treat iron deficiency anemia?
- 100 to 200mg/day
What is dose of Ferrous sulfate for IDA?
65mg elemental iron per 325mg tab
- 2 tabs/ day = 130 mg
- 3 tabs/day = 195mg
What is dose of Ferrous gluconate for IDA?
38mg elemental iron per 324mg tab
- 3 tabs/day= 114mg
What dose of an iron supplement is recommended to prevent IDA from occurring again.
27mg to 150mg
How much iron is contained in a prenatal vitamin?
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
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
What components are needed to calculate an IV dose of iron dextran?
- Observed Hb
- Normal adult Hb
- Lean body weight
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
What is the hormone that stimulates and commits the less differentiated blood cell progenitors to the RBC pathway?
What are the pharmacologic congeners that stimulates and commits the less differentiated blood cell progenitors to the RBC pathway?
- Epoetin alfa
- Epoetin beta
What is the MOA of ESAs/EPOs?
Inhibit apoptosis of erythroblast precursors which increases red blood cell mass
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
RBC production is stimulated by?
WBC production is stimulated by?
Platelet production is stimulated by?
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.
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
What is the iron dose that is recommenced during pregnancy?
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)
What trimester is critical for folate acid supplementation?
Name the preferred Rx product for rescue with methotrexate.
What is a cobalamin replacement product for megaloblastic anemia due to vitamin B-12 deficiency.
Cyanocobalamin (MC'ly used) or Methylcobalamin
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)
Clinical use of Cytotoxic: Methotrexate?
- High dose: cancer
- Low dose: autoimmune disorders such as RA.
Toxicities of Cytotoxic: Methotrexate?
- Elevated liver fxn test, nephrotoxicity, oral ulcerations, stomatitis, bone marrow suppression.
- Contraindicated in pregnancy (X cat)
Clinical use of Cytotoxic: Hydroxyurea?
Sickle cell anemia, chronic myeloid leukemia, head and neck cancer
Toxicities of Cytotoxic: Hydroxyurea?
Macrocytosis, infections, bacterial infection, neutropenia, eczema
Clinical use of Cytotoxic: Azathioprine?
Organ transplant rejection prophylaxis
Toxicities of Cytotoxic: Azathioprine?
Bone marrow suppression, pancreatitis, avoid use w/XO inhibitors (allopurinol)
Clinical use of Cytotoxic: Mycophenolate?
Long term after organ transplant rejection
Toxicities of Cytotoxic: Mycophenolate?
Block B and T lymphocyte proliferation -need to be monitored very closely.
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
What is the half life of antibody therapies: TNF-alpha inhibitors?
What is the half life of antibody therapies: Rho-D immune globulin?
give once or twice
What are the routes of administration of antibody therapies?
IV, IM, SQ
What are the cost of antibody therapies?
- EXPENSIVE $$$
- Palivizumab about $10,000 per season
- Adalimumab $65,00 per year
- Exulizumab $409,000 per year
Monoclonal antibody ending in -monab is a structure from?
Murine MAB - mouse
Monoclonal antibody ending in -imab and -ximab is a structure from?
Chimeric MAB - mouse and human
Monoclonal antibody ending in -zumab is a structure from?
Humanized MAB - humanized
Monoclonal antibody ending in -mumab is a structure from?
Human MAB - human
What antibodies inhibit immunity?
- ALG and AGT
Clinical application of polyclonal antibody: ALG antilymphocyte globulin and ATG: antithymocyte globulin
Organ transplant rejection
Clinical application of Monoclonal: TNF-a inhibitors?
RA, psoriasis, Crohn’s disease
What antibodies aid in immunity?
Pooled human immune globulin
- IVIG, IMIG, Hyperimmune globulins, Palivizumab.
Clinical application of IVIG and IMIG?
Fight infection in pts who are unable to fight off an infection (ie immunosupressed pt)
Clinical application of Hyperimmune globulins?
- Rho (D): Hemolytic disease: newborn, blood infusions, and exposures via previous pregnancies
- Vaccines: Hep B
Clinical application of Palivizumab?
Severe lower respiratory track doses in children at high risk of severe RSV disease
Pt who are vegan but have megablastic anemia: B12 deficiency need to have a high intake of what?
Fermented foods: kombucha or kimchi