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25 Cards in this Set
- Front
- Back
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How does normal erythropoietin work?
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Released from the kidneys, binds to BFU-E and CFU-E cells to stimulate maturation.
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What is darbopoetin used for? How is it different from erythropoietin?
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Stimulates erythropoiesis- only used in chronic kidney disease.
Contains two more carbohydrate chains to increase the half life. |
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What are the therapeutic uses of erythropoietin?
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Chronic renal failure
Anemia in AIDS or chemo treatment Surgery Chronic inflammatory conditions |
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How is EPO administered? What should be the goal of EPO?
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Given IV or SC (preferred)
Aim for hemoglobin of less than 11g/L |
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What causes resistance to EPO?
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Inflammation
Iron, B12, folic acid deficiency |
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What are the adverse effects of EPO?
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Hypertension
Iron deficiency Antibodies to EPO Risk for MI and stroke Decreased survival and increased risk of tumor progression in cancer. |
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What are the types of myeloid growth factors?
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G-CSF- filgrastim, pegfilgrastim
GM-CSF- sargramostim Interleukin-11 Romiplostim |
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What is the use of filgrastim? What is the difference between it and pegfilgrastim?
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Stimulate CFU-G to increase neutrophil production.
Pegfilgrastim has polyethylene glycol to increase half life. |
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What are the clinical uses for filgrastim?
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High dose chemo
Autologous bone marrow transplant Congenital neutropenia |
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What are adverse effects of filgrastim?
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Bone pain
Granulocytosis Splenomegaly |
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What are clinical uses for sargramostim?
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Autologous bone marrow transplant
Neutropenia or after chemo AIDS neutropenia Aplastic anemia, myelodysplasia |
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What are adverse effects of sargramostim?
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Flushing
Hypotension Nausea Vomiting Dyspnea Decreased arterial oxygen |
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What is the use of IL-11 therapeutically?
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Stimulates megakaryocytes to increase platelet production.
Treat high dose chemo |
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What is the use of romiplostim?
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Thrombopoietin receptor stimulating peptides.
Idiopathic thrombocytopenic purpura. |
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What vitamin deficiencies result in anemia?
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Iron
Vitamin B12 Folate |
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How should oral iron be given for anemia?
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Time released
Food and antacids reduce bioavailability Doses should be spread to provide uninterrupted supply. Increased dose does not correlate with increased absportion- need more frequent small doses. |
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What are the adverse effects of oral iron?
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Heartburn
Nausea GI discomfort Diarrhea/ constipation |
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What levels of iron are toxic? Who is susceptible?
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1-10g are fatal, particularly toddlers.
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When is parenteral iron given?
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Intolerance to oral iron
Iron malabsorption Supplement to total parenteral nutrition With EPO therapy for renal disease |
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What part of the folate cycle does vitamin B12 deficiency block?
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Blocks methyltetrahydrofolate to tetrahydrofolate, causing folate to back up at this step.
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What are the neurologic symptoms associated with vitamin B12 deficiency?
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Paresthesia of extremities
Decreased vibration and position sense Decreased deep tendon reflexes Confusion, moodiness, memory loss. Delusions, hallucinations. |
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What are the three causes of vitamin B12 deficiency?
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Insufficient digestive enzymes or gastric acid.
Insufficient intrinsic factor from parietal cells. Deficiency of transcobalamin II. |
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How is B12 administered?
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Mostly parenteral.
IM or deep SC. Effects usually seen quickly. Occasionally, high doses of oral B12 can be effective. |
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How is folic acid administered?
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Oral, if no absorption problems.
Folinic acid given to bypass DHFR if there is an enzyme deficiency. |
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Why does folic acid deficiency occur?
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Alcoholism, because there is no storage of folate in the body.
Small intestine diseases. Inhibitors of DHFR (folate reductase) Vitamin B12 deficiency. |
