Pharmacology - Exam 4 - 6.1 Blood

Front 1

Hematopoietic factors can be subdivided into three groups. What are they?

Back 1

1. Erythrocyte factors
2. Platelet factors
3. Granulocyte factors

Front 2

The erythrocyte factors can be subdivided into yet another three groups. What are they?

Back 2

1. Iron
2. Vitamins (B12, folate)
3. EPO

Front 3

Platelet factor?

Back 3

Oprelvekin (IL-11)

Front 4

Granulocyte factors?

Back 4

1. Filgrastim (G-CSF)
2. Sargramostim (GM-CSF)

Front 5

What is cobalamin?

Back 5

Vitamin B12

Front 6

dTMP synthesis?

Back 6

A set of biochemical reactions that produce dTMP, an essential component of DNA synthesis. The cycle depends on the conversion of dihydrofolate to tetrahydrofolate by the enzyme dihydrfolate reductase

Front 7

Folate trap?

Back 7

The accumulation of N-methyltetrahydrofolate and the resulting deficiency in tetrahydrofolate that is caused by B12 deficiency

Front 8

G-CSF?

Back 8

Hematopoietic growth factor that regulates production and function of neutrophils

Front 9

GM-CSF?

Back 9

Hematopoietic growth factor that regulates production of granulocytes (basophils, eosinophils, and neutrophils) and other myeloid cells

Front 10

Megaloblastic anemia?

Back 10

A deficiency in serum hemoglobin and erythrocytes in which the erythrocytes are abnormally large. Results from either folate or B12 deficiency

Front 11

Microcytic anemia?

Back 11

Deficiency in serum hemoglobin and erythrocytes in which the erythrocytes are abnormally small. Often caused by iron deficiency.

Front 12

Neutropenia?

Back 12

An abnormal decrease in the number of neutrophils in the blood; patients with neutropenia are susceptible to serious infection

Front 13

PBSCs?

Back 13

Peripheral Blood Stem Cells; hematopoietic cells found in peripheral blood that can give rise to several different types of mature blood cells. PBSCs are used for autologous transplantation and allogenic transplantation (transplantation with someone else's cells)

Front 14

Pernicious anemia?

Back 14

A form of megaloblastic anemia that results from a lack of intrinsic factor, a protein that is produced by gastric mucosal cells and is required for intestinal absorption of B12

Front 15

Thrombocytopenia?

Back 15

An abnormal decrease in the number of platelets in the blood; patients with thrombocytopenia are susceptible to severe bleeding

Front 16

Most common anemia?

Back 16

Microcytic hypochromic anemia, caused by iron deficiency is the most common type of anemia.

Front 17

Indication for iron supplement?

Back 17

1. Iron deficiency anemia is the only indication for the use of iron.
2. Iron deficiency anemia is diagnosed from RBC changes and from measurements of serum and bone marrow iron stores. Iron should NOT be given in hemolytic anemia

Front 18

Signs and symptoms of iron intoxication?

Back 18

Depending on the dose:
1. Necrotizing gastroenteritis
2. Shock
3. Metabolic acidosis
4. Coma
5. Death

Front 19

Treatment of acute iron intoxication?

Back 19

1. Removal of unabsorbed tablets from the gut
2. Correction of acid-base and electrolyte abnormalities
3. Parenteral administration of deferoxamine, which chelates iron

Front 20

Treatment of chronic iron toxicity?

Back 20

Treatment of hemochromatosis is usually by phlebotomoy

Front 21

Role of B12?

Back 21

Necessary for the synthesis of DNA. B12 or folic acid deficiencies usually manifests firstly as anemia.

Front 22

B12 is produced

Back 22

by bacteria.

Front 23

Supply of B12?

Back 23

The liver stores enough for 5 years.

Front 24

Key drugs in oral supplements?

Back 24

1. Ferrous sulfate
2. Ferrous gluconate
3. Ferrous fumarate

Front 25

Key parenteral iron?

Back 25

Iron dextran

Front 26

Key B12 drug?

Back 26

1. Cyanocobalamin
2. Hydroxocobalamin

Front 27

Key folic acid drug?

Back 27

1. Pteroylglutamic acid

Front 28

Key red cell CSF drug?

Back 28

1. EPO
2. Darbopoietin alpha

Front 29

Key myeloid growth factors?

Back 29

1. Filgrastim (G-CSF)
2. Sargramostim (GM-CSF)

Front 30

Key megakaryocyte factor?

Back 30

Oprelvekin (IL-11)

Front 31

A 23-y/o pregnant woman is referred by her OB for eval of anemia. She is in her 4th month of pregnancy and has no Hx of anemia; her grandfather had pernicious anemia. Her Hgb is 10 g/dL.

If this woman has macrocytic anemia, an increased serum concentration of transferrin, and a normal serum concentration of B12, the most likely cause of her anemia is a deficiency of?

Back 31

Folic acid or B12 are the most common causes of megaloblastic anemia. If a patient with this type of anemia has a normal serum B12 concentration, folic acid deficiency is the most likely cause of the anemia.

Front 32

A 23-y/o pregnant woman is referred by her OB for eval of anemia. She is in her 4th month of pregnancy and has no Hx of anemia; her grandfather had pernicious anemia. Her Hgb is 10 g/dL.

If the patient had the deficiency identified in the other question, her infant would have a higher than normal risk of?

Back 32

NTD

Front 33

The lab data for your pregnant patient indicate that she does not have macrocytic anemia but instead has microcytic anemia. Optimal treatment of normocytic of mild microcytic anemia associated with pregnancy uses

Back 33

The anemia usually associated with pregnancy is a simple iron deficiency microcytic anemia. In this condition, only oral iron supplementation is indicated. Ferrous sulfate tablets would be the drug of choice.

Front 34

If this patient has a young child at home and is taking iron-containing prenatal supplements, she should have warned that they are a common source of accidental poisoning in young children and advised to make a special effort to keep these pills out of her child's reach. Toxicity associated with acute iron poisoning usually includes

Back 34

GI damage resulting from direct corrosive effects, shock from fluid loss in the GI tract, and metabolic acidosis from cellular dysfunction

Front 35

The iron stored in intestinal mucosal cells is complexed to

Back 35

Ferritin

Front 36

Which of the following is most likely to be required by a 5-y/o boy with chronic renal insufficiency?
a. Cyanocobalamin
b. Deferoxoamine
c. EPO
d. Filgrastim
e. Oprelvekin

Back 36

c. EPO

Front 37

Relative to filgrastim (G-CSF), sargramostim (GM-CSF)

Back 37

stimulates production of a wider variety of hematopoietic stem cells

Front 38

An important biochemical consequence of B12 deficiency is accumulation of

Back 38

N-methyltetrahydrofolate

Front 39

After undergoing surgery for breast cancer, a 53-y/o woman is scheduled to receive 4 cycles of cancer chemotherapy. The cycles are to be adminsitered every 3-5 weeks. Her first cycle was complicated by severe chemotherapy-induced thrombocytopenia.

During the second cycle of chemotherapy, it would be appropriate to consider treating this patient with

Back 39

Oprelvekin (IL-11) stimulates platelet production and decrease the number of platelet transfusions required by patients undergoing bone marrow suppression therapy for cancer

Front 40

After undergoing surgery for breast cancer, a 53-y/o woman is scheduled to receive 4 cycles of cancer chemotherapy. The cycles are to be adminsitered every 3-5 weeks. Her first cycle was complicated by severe chemotherapy-induced thrombocytopenia.

Twenty months after finishing her chemotherapy, the woman had a relapse of breast cancer. The cancer was now unresponsive to standard doses of chemotherapy. The decision was made to treat the patient with high-dose chemotherapy followed by autologous stem cell transplantation. Which of the following drugs is most likely to be used to mobilize the PBSCs needed for the patient's autologous stem cell transplantation?
a. EPO
b. Filgrastim (G-CSF)
c. Folic acid
d. Intrinsic factor
e. Oprelvekin (IL-11)

Back 40

b. Filgrastim (G-CSF). The success of transplantation with PBSCs depends on infusion of adequate numbers of hematopoietic stem cells. Administration of G-cSF to the donor ( in the case of autologous transplantation, the patient who also will be the recipient of the transplantation) greatly increases the number of hematopoietic stem cells harvested from the donor's blood and available for the transplantation procedure.