B&l: Test 2: 4. Maloney : Treatment Of Anemias

Front 1

Which type of deficiency causes a microcytic, hypochromatic anemia?

Eryhtropoietin
Iron
Folic acid
Vitamin D
Vitamin B12

Back 1

Iron

Front 2

Low iron levels--> low hemoglobin--> ?

Back 2

Microcytic, hypochromatic anemia

Front 3

Low erythropoetin levels-->Reduced production of red blood cells --> ?

Back 3

Normocytic anemia

Front 4

Low folic acid levels/B12-->Reduced DNA synthesis --> ??

Back 4

Megaloblastic anemia

Front 5

Low vitamin B12 levels in addition to causing Megaloblastic anemia are responsible for what problem?

Back 5

Nerve demylenation and damage

Front 6

Blood loss
Increased requirement
Pregnancy
Inadequate intake

are causes of what?

Back 6

Iron Deficiency Anemia

Front 7

Tx for Microcytic hypochromatic anemia?

Back 7

200 mg elemental iron/day for 3-6 months

Front 8

why use only 200 mg elemental iron/day for 3-6 months?

Back 8

About 50-100 mg of elemental iron can be incorporated into Hb daily

About 25% of oral iron as ferrous salt can be absorbed

Front 9

Iron Dextran is what?

Back 9

a Parenteral Preparation of Iron

IM or IV

Front 10

when do you use Parenteral Preparations of iron?

Back 10

Oral iron ineffective
Noncompliance
Anemia of chronic kidney disease

Front 11

Why would you get anemia with chronic kidney disease?

Blood loss during hemodialysis
Reduced Erythropoietin
Reduced availability of stored iron
Reduced B12 stores
Reduced iron absorption
Multiple blood draws

Back 11

Reduced Erythropoietin

(lesser answers: Blood loss during hemodialysis, Reduced availability of stored iron, Reduced iron absorption, Multiple blood draws)

Front 12

Why would you use parental iron with anemia from CKD?

Back 12

Iron deficiency anemia is common with CKD, especially those on hemodialysis

Many patients do not respond adequately to oral iron

Front 13

biggest side effect of oral iron?

Back 13

GI irritation, nausea, diarrhea or constipation

Front 14

biggest side effect of IM iron?

Back 14

Skin discoloration, local inflammation, pain

Use z-track injection technique
--injection in the buttocks

Front 15

biggest problem about parental iron?

Back 15

Immediate hypersensitivity reaction
(or delayed)

usually give small test dose before full dose to test for this

Front 16

Acute Iron Toxicity occurs in what population? What does this do?

Back 16

Occurs in children

Due to its corrosive effects on the GI mucosa

GI toxicity followed by multiorgan failure

Front 17

There are Four stages of Acute Iron Toxicity:

Stage 1

Back 17

GI irritation, nausea, vomiting, diarrhea, lassitude, drowsiness, pallor, cyanosis, seizures, shock, coma (from all the diarrhea and vomiting).

Front 18

There are Four stages of Acute Iron Toxicity:

Stage 2

Back 18

Apparent recovery

Front 19

There are Four stages of Acute Iron Toxicity:

Stage 3

Back 19

Multiorgan Failure

CNS - lethargy, coma, convulsions
Metabolic acidosis
Hepatotoxicity - necrosis
Renal failure - acute tubular necrosis
Susceptibility to bleeding
Cardiovascular collapse - intractable hypotension, pulmonary edema

Front 20

There are Four stages of Acute Iron Toxicity:

Stage 4

Back 20

if the child survives stage 3-->Delayed Effects

Intestinal obstructions
Pyloric stenosis
Hepatic cirrhosis*
Severe gastric scarring

Front 21

Acute Iron Toxicity Tx?

Back 21

Induce vomiting
Gastric lavage
Deferoxamine (Desferal) Iron chelator
Supportive therapy

Front 22

Deferoxamine is what? Used for?

Back 22

Iron chelator

used to stop acute iron toxicity

Front 23

Chronic Iron Toxicity occurs in who? what can it do?

Back 23

adults

Excess iron deposits in the heart, liver, pancreas, pituitary and synovia
Organ failure & death

Front 24

causes of Chronic Iron Toxicity?

Back 24

rarely due to eating too much iron

more likely do to:

Hereditary hemochromatosis
Red cell transfusions (eg. With thalassemia major)

Front 25

Chronic Iron Toxicity Tx?

Back 25

Phlebotomy
Deferoxamine (Desferal) – IM or IV
Deferasirox (Exjade) – Oral

other 2 are iron chelators

Front 26

what 2 things are needed to adequately absorb B12?

Back 26

Need acid in the stomach and intrinsic factor to adequately absorb vitamin B12

Front 27

What type of things will most likely cause a B12 deficiency?

Pernicous anemia
Gastrectomy
Dietary Deficiency
Proton pump inhibitors
Pancreatitis
Ileal resection

Back 27

Pernicous anemia (no IF)
Gastrectomy
Proton pump inhibitors
Pancreatitis (need pancreatic enzymes)
Ileal resection (can't absorb)

Front 28

If you have adequate stores of B12 but you just had a gastrectomy, how long will it be before you have symptoms of B12 deficiency without treatment

months or years?

Back 28

Several years (up to 5)

Front 29

What type of things will most likely cause a folic acid deficiency

methotrexate
poor dietary intake
proton pump inhibitors
sprue
inflammatory bowel disease
pregnancy
chronic alcoholism

Back 29

methotrexate
poor dietary intake
sprue
inflammatory bowel disease
pregnancy
chronic alcoholism

Front 30

If your intake of folic acid suddenly stops, how long will it be before you develops symptoms of a folic acid deficiency?

few months or several years

Back 30

few months

you don't have that big of stores

Front 31

Folate and B12 are important for what?

Back 31

DNA synthesis

Front 32

Myelin sheath
of neurons is affected with what deficiency?

Back 32

Affected with B12 deficiency

Front 33

What type of anemia would you see with either a vitamin B12 or folic acid deficiency?

Back 33

Megaloblastic

Front 34

Why are RBCs very large with B12 deficiency

Back 34

making lots of RNA, but not much DNA

Front 35

What may happen if you treat a B12 deficiency with large doses of folic acid

Back 35

treat the anemia

BUT NOT TREAT THE NEUROLOGIC DAMAGE

Front 36

She ran out of time. Must go over slide 50 and on by yourself... i will fill these in

Back 36

later today

Front 37

what does Epoetin Alfa do?

Back 37

increases RBCs

Front 38

what does Darbepoeitn Alfa do?

Back 38

increases RBCs

Front 39

what does Sargramostim do?

Back 39

increases neutrophils

Front 40

what does Filgrastim do?

Back 40

increases neutrophils

Front 41

what does Filgrastim do?

Back 41

increases neutrophils

Front 42

what does Oprelvekin do?

Back 42

increases platelets

Front 43

possible tx for Anemia? 2

Back 43

Epoetin alfa
Darbepoetin Alfa

increase RBCs

Front 44

chemotherapy for neutropenia? 3

Back 44

Sargramostim
Filgrastim
Pegfilgrastim

Front 45

chemotherapy for thrombocytopenia?

Back 45

Oprelvekin

Front 46

hematopoietic drugs for AIDS?

Back 46

anemia--> Epoetin/Darbepoeitin

Neutropenia-->the stims

Front 47

a pt with chronic kidney disease may have what problem? What hematopoietic growth drugs could you use?

Back 47

Anemia

Epoetin/Darbepoetin alpha