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30 Cards in this Set

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Big Picture Question:
There are 4 major "drug" categories that can be used to treat anemia, what are they?
Iron preparations
Iron Antidotes
Vitamin B12 preparations
Folic Acid preparations
What iron preparations can you take orally?
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
What iron preparations can be taken parenterally (IV/IM)?
Iron Dextran,
Iron Sucrose, and
Sodium Ferric Gluconate Complex
Adverse effect(s) of oral administrations of Iron preparations include?
GI symptoms (Nausea, diarrhea, epigastric discomfort)

Black stools (No clinical significance, but can obscure diagnosis of GI bleeding)
Adverse effect(s) of parenterally administered iron preparations include?
1) Chronic tx REQUIRES monitoring Fe/Iron levels to avoid toxicity.
2) Anaphylaxis
3) Acute Fe toxicity (seen more with oral administration (children))
3a) Tx with Whole Bowel irrigation, and systemic administration of iron antidote
4) Chronic toxicity
4a) Tx with phlebotemy and iron antidote
Iron antidotes include which drug(s)?
Deferoxamine
Deferasirox
Deferoxamine is administered how and why?
Parenterally (IV/IM) because it has a low Foral (Oral bioavailabiilty).
Deferoxamine use(s) include?
Iron poisoning
Transfusional iron overload
Deferoxamine has a high affinity for which iron form?

After binding, is the complex active or inactive?
Ferric iron

Inactive complex
Ferric refers to what charge?
Fe+3
Ferrous refers to what charge?
Fe+2
Deferoxamine can remove Fe from what? (3 things)
Hemosiderin
Ferritin
Transferin
Iron chelator(s) include?
Deferoxamine
Deferasirox
This is a tridentate iron chelator.
Deferasirox
Deferasirox is administered how and why?
PO (per oral) because it has a high Foral (oral bioavailability).
Deferasirox is used for what?
Tx chronic iron overload due to transfusuions.
What is the more commonly used Iron chelator?

Is there a pharmacological advantage to explain this?
Deferoxamine is more commonly used.

Deferasirox can also be used for same indications though.
Vitamin B12 preparations include?
Cyanocobalamin
Hydroxocobalamin
The two active forms of B12 in humans are?
Deoxyadenosylcobalamin
Methylcobalamin
Pernicious anemia is what?
Vitamin B12 deficiency anemia, due specifically to no production of Intrinsic Factor (because the Gastric Parietal cells have been destroyed via autoimmune mechanisms)
How do you diagnose someone as having anemia due to Vitamin B12 deficiency, and not anemia due to folic acid deficiency for example?
Measure [serum] of the vitamins.
What are the folic acid preparations?
Folic acid
Leucovorin (Folinic acid)
Where is folic acid absorbed?
Proximal jejunum
Can folic acid be administered parenterally?
It's possible, but not usually required.
What kind of anemia is folic acid used to treat?
Megaloblastic anemia caused by folate deficiency.

Also used in prevention of neural tube defects.
Folic acid is also known as?
Pteroylglutamic acid
Leucovorin uses include? (3)
Methrotrexate rescue (rescues normal cells but not cancer ones (at normal doses))

Potentiation of 5-FU therapy (stabilizes binding of 5-FU to Thymidylate synthase complex)

Treat patients with congenital deficiency in dihydrofolate reductase (DHFR).
A pt presents to you with anemia. You give an oral dose of radioactive cyanocobalamin with and without intrinsic factor. 24 hours later you find that the pt excreted 16% of the one with intrinsic factor through his urine, but only 0.5% of the one without intrinsic factor.

What is the name of the test performed, and what type of anemia can you say this patient has based on this information?
Schilling test.
Pernicious anemia.
Reason: % excreted in urine means it had entered systemic circulation (otherwise it would be excreted as feces). So, if he absorbed 16% of the one with IF, but hardly any of the non IF one, it must mean he is unable to produce IF. Thus he has Pernicious Anemia.
How would you administer a vitamin B12 preparation to someone with Pernicious anemia?
Parenterally
(this goes for any other Malabsorption problems a patient might have, Pernicious anemia was just one example)
What test could you use to determine whether a patient has a vitamin B12 malabsorption problem, and to determine the specific cause for it?
Schilling test