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106 Cards in this Set
- Front
- Back
S&S Alcohol intoxications
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Euphoria
slurred speech ataxia sedation flushed face mood swings nystagmus |
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S&S Opiate Intoxication
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euphoria
slurred speech ataxia sedation motor retardation dysphoria miosis |
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S&S Cocaine Intoxication
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euphoria
grandiosity motor agitation hypervigilance elation sweating/chills mydriasis |
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S&S Alcohol W/D
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tremor
anxiety nausea vomitting hallucinations seizures hyperthermia |
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S&S Opiate W/D
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fever
diarrhea lacrimation rhinorrhea mydriasis insomnia piloerection muscle ache |
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S&S Cocaine W/D
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fatigue
sleep disturbances nightmares depression increased appetite |
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OTC Category I
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recognized as safe and effective, not misbranded
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OTC Category II
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not recognized as safe and effective
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OTC Category III
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insufficient data
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Most herbal meds are classified as OTC Class?
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II
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DSHEA- Dietary Supplement
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A product not intended to supplement the diet that bears or contains one or more of the following dietary ingrediants: a vitamin, mineral, amino acid, herb or other botanical
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Chamomile uses
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mild sedative
antispasmotic |
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Chamomile allergic rxn
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people also allergic to rag weed
itchy eyes hives tongue swelling and airway tightness |
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Chamomile also contains the chemical...
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coumarin which is a blood thinner
could increase the effects of warfarin must monitor closely |
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Echinacea is a
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purple cone flower touted as an immune system booster
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Echinacea used for more than 8 weeks
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increased risk of liver damage
Theoretically may counter the effects of immunosuppressants used in transplant pts, corticosteroids etc.. Not recommended in immunesupressed |
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Feverfew uses
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migraines
muscle aches |
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Feverfew beliefs
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block the synthsus of leukotrienes, prostaglandins and thromboxane
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Feverfew CI
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Pregnancy
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Feverfew blocks
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platelet activity...
use with caution if you are taking Coumadin or Heparin or ASA |
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Garlic beliefs
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dec BP
dec cholesterol (~10-15%) blocks ATP citrate lysase, an imp step in the process of converting carbs to fat |
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Garlic blocks
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platelet activity...
may inc INR and cause inc risk of bleeding |
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Ginger uses
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nausea
stomach upset |
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Ginger was proven to be effective in...
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post surgery nausea
morning sickness motion sickness |
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Ginger can
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prolong bleeding
avoid in pts on coumadin |
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Gingko biloba beliefs
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memory enhancer
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Gingko biloba activity
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Flavoglycosides act as free radical scavangers and inc cerebral blood flow
antiplatelet activity |
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Ginseng belief
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mood elevator
fatigue/stress reliever energy enhancer |
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Ginseng structure is similar to
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steroids
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Ginseng proven in study of 36 newly dx DM pts
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200mg-->
increased vigor increased feeling of well-being lower blood sugar |
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Ginseng Adverse Effects
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high doses cause HTN
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Ginseng drug interactions
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enhance effects of hypoglycemia agents and antihypertensives
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Glucosamine and Chondroitin beliefs
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symptomatic relief of OA
may stimulate cell growth and inhibit inflammation |
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Glucosamine and Chondroitin is derrived from
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crabs, lobster and shrimp
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Chondroitin is part of the...
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proteoglycan structure
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Chondroitins effects of cartilage
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elasticity and resilence
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Glucosamine cautions
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brittle diabetics
shellfish allergy |
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St Johns Wart name
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Hypericum perforatum
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St John Wart is licensed in Germany for tx of
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anxiety, depression and sleep disorders
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St Johns wart is similar to
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amitriptyline (Elavil)
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St Johns wart was disproved to be effective for...
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moderate to sever depression
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Dig and St Johns Wart
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Dig concentrations have been shown to decrease by 25% with administration of St Johns Wart
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MAOIs, TCAs, triptans, ergot alkaloids and SSRIs with St Johns Wart
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leads to serotonin syndrome
confusion agitation hyperthermia muscle spasms seizures |
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St Johns Wart with tetracycline and certain NSAIDs
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increased risk of sun burns
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Valerian and Kava Kava beliefs
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sleep aids
increases the risk for CNS depression when used with EtOH and barbs |
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Ephedra is a
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CNS stimulant
Cardiac stimulant Uterine stimulant PV constricter |
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Ephedra uses
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weight loss
stimulant enhanced althletic performance |
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Ephedra AEs
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nervousness
anxiety h/a insomnia dizziness palpitations tachyarrhythmias HTN cardiac arrest AMI sudden death TIAs strokes seizures |
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Black Cohosh tx of
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menopausal sx
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Black Cohosh is...
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Phytoestrogrens and contains small amounts of salicylate acid
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Black Cohosh is CI in...
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woman with a h/o estrogen-dependant tumors or endometrial cancers
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Black Cohosh effects
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antiplatelet effects similar to ASA
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White Willow Bark effects
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Antiinflammatory
1851= ASA- same CI |
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Hawthorn uses
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angina
HTN heart failure Acts as a vasodilator and a cardiotonic |
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Hawthorn cautions
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concomittant cardiovascular agents
elderly- inc risk for Hypotn |
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D/C these meds preoperatively
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ephedra
garlic gingko biloba ginseng kava St Johns Wart |
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Digoxin and Warfarin are of the leading causes of...
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drug incuded admission into the hospital
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Dig poisoning S&S
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stomach upset
nausea vomitting diarrhea blurred vision greenish yellow halos dec HR arrhythmias cardiac arrest |
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Siberian Ginseng and Motherwart are similar to
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Dig`
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Licorice uses
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PUD
affects K balance causes hypokalemia--> increases in the toxic effects of Dig= DO NOT USE TOGETHER |
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Warfarin OD
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easy bruising
bleeding gums nose bleeds blood in urine and or stool |
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Herbal interactions with Warfarin- inc bleeding
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feverfew
gingko ginseng garlic |
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Herbal interactions with Warfarin- dec Warfarin's effect
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gingeng
St Johns Wart Green tea |
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Do not use Zinc Lozenges with
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Immunosuppressants
i.e. steroids, cyclosporine, azathiprine, MTX |
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Tannin and Iron Supplements
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can lead to anemia
Black Cohosh feverfew St Johns Wart |
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Fluorine and metal cations
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chelated complex formed
decreases bioavailability when given concurrently with Iron, Zinc, Aluminum, Calcium |
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Tetracycline
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mineral insoluble chelated complexes
Ca (dairy), iron, aluminum, zinc decrease bioavailability |
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Grapefruit Juice
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Blocks the metabolism of certain drugs
IV meds are not affected Culprit Bioflavenoids quercetin and naringin |
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MAOI + tyramine containing foods
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NOT ALLOWED: cheeses, aged and fermented products
Nardil- phenelzine Marplan- isocarboxazid Parnate- tranycypromine |
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Decrease RBC production
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Iron
Folate B-12 Renal failure Bone Marrow Suppression ACD |
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Increase in RBC production
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hemolysis
abNL production |
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S&S of all Anemias
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fatigue
pallor icterus hepatosplenomegaly tachycardia wide pulse pressure pale mucous mb cardiac decompensation shortness of breath dizziness |
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S&S of B12 deficiency
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dysphagia
anorexia beefy red tongue psychosis paresthesia of hands and toes + Romberg + Babinski impared vibratory and position sense ataxia decreased DTR |
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S&S of Folate deficiency
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Same as B12 but no CNS effects
ecchymosis purpura loss of skin elasticity early graying of hair |
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S&S Iron deficiency
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spooning of nails
angular stomatitis glossitis achlorhydria craving for substances low in iron |
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S&S Hemolytic anemia
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painful crisis
abdominal pain hemoglobinuria jaundice leg ulcers |
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Iron deficiency parameter increased
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TIBC
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Iron deficiency parameter decreased
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MCV
Hb/Hct MCHC Ferritin Iron % transferrin saturation reticulocyte |
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B12 deficiency LAbs
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+ Shilling test
inc MCV inc indirect bilirubin dec B12 dec Hg/Hct dec WBC dec Platelet count |
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Folate deficiency Labs
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inc MCV
inc indirect bilirubin dec serum folate dec Hg/Hct dec reticulocyte count |
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renal failure labs
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dec hg/hct
dec retic count dec EPO |
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Hemolytic Anemias labs
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inc retic count
inc unconjugated bilirubin dec hg/hct |
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ACD labs
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inc ferritin
dec hg/hct dec serum iron dec TIBC |
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What is the most common cause of macrocytic anemia?
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Alcoholism
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Iron Def Anemia Tx
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Tx cause...
blood cause inc requirement dec absorption |
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Prevent Iron def in
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Infants and Pregnancy
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Ferrous Sulfate
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Feosol- Elixir
Fer-in-sol- Drops Fer-in-sol- Syrup |
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Ferrous Gluconate
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Fergon- Elixir
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Increase required doses of Iron in Folate Deficiency
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Pregnancy
Infancy Infection Malignancy Hemolytic Anemia NL Dose= 200mcg/day |
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Decrease intake in Folate deficiency
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decreased absorption with drugs
decreased intake with malnutrition altered metabolism |
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Tx of Folate Deficiency
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Folic Acid 1mg daily 2-3weeks
Continue if risk factors continue |
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Tx of Folate Deficiency in Childbearing women
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400mcg/day- NTD
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B12 sources
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oysters
clams liver dineys muscle meats milk products egg yolks |
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B12 def types
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pernicious
vegan |
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Triad of B12 def
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weakness
sore tongue numbness/neuropathies i.e. peripheral neuropathies tinnitis neuritis vertigo h/a |
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B12 tx
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B12 30-100mcg/mL for 2-3 weeks
then 100mcg q2-4weeks for life |
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Monitoring with B12
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retic count in 5 days
h/h should normalizein 1-2 months neurologic sx may improve but some may stay for life |
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Anemia of Chronic Disease...
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Functional iron deficiency
Decrease life span of EBC or RBC Destruction Inadequate marrow response to EPO |
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What causes ACD
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Chemotherapy
Radiation Disease |
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ACD affects qual of life when
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Hb falls below 10g/dL
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ACD S&S
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pallor
fatigue SOB DOE |
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Interventions for ACD
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blood transfusions
exogenous EPO |
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Therapy for ACD
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Inprove QOL
decrease transfusions 60% of pts respond SE: pain at inj site, thrombosis, HTN |
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Dose for ACD
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Procrit 40,000units SC q week or Aranesp 200mcg SC q2weeks
Should get 0.5-1.0g/dL increase Hb in 4 weeks Increase dose if no response D/C use if no response with inc doses in 4 weeks transfuse if Hb <8g/dL |
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EPO Therapy tests
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H/H
Iron studies Folate B12 def Treat with iron supplementation during tx if iron def or not responding |
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Over responders to EPO therapy
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Stop once Hb >12g/dL
Hold until Hb drops below 11g/dL restart EPO at reduced dose or delayed interval If Hb rise too quickly >2g in 4 weeks--> reduce Hb >13g/dL can increase the risk of thrombosis Some evidence that maintaining Hb>12g/dL can decrease survival |