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57 Cards in this Set
- Front
- Back
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What is the difference among:
Macrocytic Anemia Normocytic normochromic Anemia Microcytic hypochromic Anemia |
What is the difference among:
Macrocytic Anemia- defective nuclear maturation; decrease production Normocytic normochromic Anemia- Acute blood loss, hemolytic, renal failure, chronic disease Microcytic hypochromic Anemia- Iron Deficiency |
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Decrease production of RBC is seen in which ... anemia
It consist of ... |
Macrocytic anemia
Folate and B12 deficiency |
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Name symptoms of Iron-Deficiency Anemia
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Fatigue
SOB Tachycardia Koilonychia (spoon nails) decreased cognitive function Pica (craving to chew on ice, chalk, crayon or even dirt) |
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What do all anemia have in common?
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dec Hct and Hgb
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What are other signs of Anemia?
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Dec O2, angina pectoris, CHF, pulmonary congestion
Ascites & Edema Incr. HR & stroke volume Systolic mumurs |
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What is the normal absorption of Iron?
What is the max? |
Normal: 1-1.4 mg/day
Max: 3-4 mg/day If you are iron deficient you are able to absorb more iron to compensate |
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Most commom anemia
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microcytic hypochromic, iron deficiency
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What is the Iron requirement for:
Infant Child Adult male Adult female Pregnancy |
What is the Iron requirement for:
Infant- 67 ug/kg Child- 22 ug/kg Adult male-13ug/kg Adult female- 21 ug/kg Pregnancy- 80 ug/kg |
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What stores iron?
Where |
Ferritin
In Reticuloendothelial system(lymph node & spleen) Liver muscle |
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Foods High in Iron?
Foods Low in Iron? |
High:
Meat Brewer's Yeast Wheat germ Egg yolks Oyster Dried beans and fruit Low: Milk Nongreen vegetables |
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How much iron is absorbed When person is deficient?
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40-60 mg/d
10 x more |
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Heme Iron vs. Inorganic Iron
which is more available? which is more important? |
Heme iron- more available
Inorganic iron- more important |
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Therapy of choice with oral iron
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Ferrous sulfate, very cheap
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Name 2 Facilitators of Iron Absorption
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1. Ascorbic Acid (Vitamin C)
2. Meats (stimultes gastric acid) |
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T or F
increase # of Fe is linear with absorption With anemia the iron absorpbs build for storage, for blood iron and for females within 1-2 mo |
No, it's not. It's less %
false, female is not accounted in this and it takes longer for storing |
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Tolerable doses of oral iron in people with iron-deficiency anemia, will deliver at most how much iron/day to the erythroid marrow?
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40-60 mg/day
increases RBC production by 2-3 times |
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Drugs that interact w oral iron are
What can u do? |
antacids: pepsid, prilosec, nexium, promeprisol
antihistamines: Cimetidine Tetracycline/antibiotics: alkylation w levothyroxine, Centrum Spacing, 1 hr prior or 4 hrs later |
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Which is absorbed better?
Ferrous or Ferric Salts Name some of theses |
Ferrous are absorbed 3x better
Gluconate Sulfate Fumarate Succinate |
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Oral cannot be used in pts w ileal disease &... for what?
What is New? |
... intrinsic factor (no intri = no absorp.)
what: B12 New: Intranasally gel |
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Name Ferrous Salts from highest percentage of Fe to least
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FEOSTAT= 33% (sulfate)
FEOSOL= 20% (fumarate) FERGON= 12% (gluconate) NIFEREX= (succinate) |
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T or F
folic acid + Vit B12 are not in need in elderly pts for blood transfusion B12 is not use off label |
F: They r, both r given immediately
F: it is used off label for neuropathies |
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Name Absorption enhancers for Fe
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increases absorption:
Ascorbic Acid (Vitamin C) Carbohydrates Amino Acids (meat) inorganic salts |
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How Folic acid is given to pregnant wo?
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5-6mg/d a mo before pregnancy and the 1rst trimes.
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What are the RDA of iron for:
Pregnant females lactating females males females >50 females 19-50 adolescent males >14 |
What are the RDA of iron for:
Pregnant females= 15mg, then 27 mg lactating females= 9-10 mg males= 8 mg females >50= 8 mg females 19-50= 18 mg adolescent males >14= 11 mg |
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Where is folic acid absorbed?
Where is B12 absorbed |
small intestine, liver, enterohepatic cycle
b) ileum with intrinsic factor |
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Oral Iron Doses for Iron Deficiency
Adults and Adolescents Neonates, Infants, Children Pregnant Women |
Oral Iron Doses for Iron Deficiency
Adults and Adolescents- 200 mg/day Neonates, Infants, Children- 3 mg/kg/ day Pregnant Women- 15-30 mg/day |
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a pt is suffering from hyperhomocysteinemia/ bile sequestrants, what does the diet need as a result?
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folate
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Oral Side Effects of Iron
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Heartburn
Nausea Upper gastric discomfort Constipation and Diarrhea |
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T or F
a pt is in chemo- related anemia can not get Folate a pt w cancer related anemia not on chemo can not get folate |
T: must give folate
b) true only to chemo pts |
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What is Hemochromatosis?
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Iron overload due to long-continued treatment (Iron Toxicity)
1-2 g in children (12-24months) can lead to death Symptoms: abdominal pain, diarrhea, vomiting, cyanosis, lassitude, drowsiness, hyperventilation |
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How are the following given?
Fe Co Folic |
Fe:PO, IV, IM
Co: PO, SQ, IM Folic: PO, aq injection |
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Under what conditions do you consider Parenteral Iron?
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Iron Malabsorption
Severe oral iron intolerance Patients with renal disease who are receiving erythropoietin |
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Where do you get naturally folate?
what is the daily intake? |
liver, yeast, fruits, fresh green veggies
400ug |
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What causes Megablastic Anemia?
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deficiency in:
1. Vitamine B12 2. Folic Acid results in defective synthesis of DNA |
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Name sources for Vitamin B12
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Animal
Bacteria |
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How is Vitamin B12 absorbed?
What test is performed to evaluate the absorption of B12? Is it okay to inject Cyanocobalamin I.V.? |
from the ileum
complex of Intrinsic Factor B12 Intrinsic factor produced by parietal cells (this is why PPI are contraindicated) Schilling test NO- IM or SC only |
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Name some Therapeutic Uses of Vitamin B12
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Trigeminal Neuralgia
Multiple Sclerosis Neuropathies Psychiatric disorders |
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What is the recommended daily requirement for Folic Acid?
What if pregnant or lactating? |
400 ug
500-600 ug |
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What are some drugs that can cause Folate Deficiency?
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anticonvulsants
methotrexate trimethoprim oral contraceptives alcohol |
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A deficiency in what may cause spina bifida, encephaloceles, and anencephaly?
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Folate Deficiency
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Treatment for Folate Deficiency
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Folic Acid (FOLVITE)
Folinic Acid (Leucovorin calcium, citrovorum factor) |
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Side Effects of high Folic Acid?
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decreases antiepileptic actions of:
phenobarbital phenytoin primidone |
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What is the maximum level for Hemoglobin?
What are some Erythropoiesis Stimulating Agents (ESA) |
Max: 12 g/L
Epoetin alfa Darbepoetin alfa (Aranesp) |
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What diseases cause an increase in atherogenic risk?
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coronary heart disease
Ischemic cerebrovascular disease Peripheral vascular disease |
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Talk about the w-6 FA family
a) chemical name b) ex. c) progeniture d) result |
a) linoleic
b)corn, sunflower, safflower OIL c) arachidonic acid: C20:4 d) more thrombotic & inflammatory metabolites (BAD) |
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Talk about the w-3 FA family
a) chemical name b) ex. c) progeniture d) result |
a) Linolenic
b) Flaxeed, Canola, Soybean oil c) ecicosapentaenoic (EPA), then docosahexaenoic (DHA) d) less thrombotic & inflammatory metabolites (fish oil/caps) |
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T or F
a) Sudden CARDIAC Death is increased w-6 level, it doesn't protect. w-3 is responsive to change in w-3 FA intake b) The more fried fish, the better your w-3 index. |
F
Sudden Cardiac Death is decreased by w-3 level, it protects by reduc. by 90%. it reduces susceptibility to fatal arrythmias b) F: The more NON-fried fish, the better your w-3 index c) T :by fish or caps |
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What is the w-3 FA good for?
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it decreases VLDL = dec TG
Good for RBC membranes inc B oxidation, apo B degradation, phospholipd synt. |
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What is LOVAZA main composition?
what is it? what is it best at treating? |
EPA 465 mg
DHA 375mg 90% w-3 FA, treat TG & VLDL |
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Define w-3 index
what is that #? what is a the proposed w-3 index risk zone? what does that mean? |
ratio of tot. EPA & DHA in RBC membranes per tot FA
3/64 = 4.6% 10% of your FA from the index should be w-3, it dec. the risk for death from CHD by 90% |
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How can you correct your w-3 index?
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S.E.A. : 1g/d by AHA, 3g/d by FDA
eat more fish or 1-3 caps/d cheap: 7cents/g/d |
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AHA recommendations for w-3 FA intake
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pts w/o doc. CHD: eat fish 2x a week
pts w doc. CHD: 1 g/d of Epa+DHA OR its supplements w a MD pt needing low TG: 2-4 g/d Epa+DHA Caps w a MD |
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Warning about combining which drug w w-3
Can't mix lovaza w... |
blood thinners: warfarin, aspirin clopidogrel = inc effect
incre. blood sugar levels w blood sugar lowering meds Cyclosporine, Nsaids, C-lowering med. |
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Ways to get 1 g/d
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2-3 oz /d salmon, sardines, mackerel
Cod liver oil: 1 tsp (RDA fot vit D & A) 1-3 caps: supplements: low = 300 mg e+d mid potency: 500-700 mg e+d drugs: 850 mg e+d |
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what 2 components may be measured at non fasting state
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TC & HDL
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what is apoB/ apoA-I
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<0.9
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what is tot C / HDL-C
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<4.5
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