Ross 43 - Pharm Antianemia Rx

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Carbonyl Iron

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Iron Preparations
Contra: hemochromatosis, hemolytic anemia, non-iron-def. anemia, peptic ulcer, regional enteritis, ulcerative colitis
Use: for Fe-DEFIC. ANEMIA, treat for 3-6 MOS.
Route: Oral (suspension, chewable, tab. w/ Vit C - *PREFERRED ROUTE*)
MOA: Fe supplementation
Exc./Met.: NONE
SE: BLACK BOX: OD RISK (especially children), dark stool, hemosiderosis, urine discoloration, stained teeth

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Ferric Gluconate

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Iron Preparations
Contra: hemochromatosis, hemosiderosis, hemolytic anemia, peptic ulcer, ulcerative colitis; PREGNANCY: Cat B
Use: *HD Tx Pts* w/ ESA Therapy
Route: IV
MOA: Fe supplementation
Exc./Met.: NONE
SE: diarrhea, n/v, injection site Rx, Hypo/HyperTN, hyperkalemia, electrolyte abnormalities

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Ferrous Gluconate

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Iron Preparations
Contra: hemochromatosis, hemosiderosis, hemolytic anemia, non-iron-deficiency anemia
Use: Fe-DEFIC. ANEMIA
Route: *ORAL*
MOA: Fe supplementation
Exc./Met.: NONE
SE: BLACK BOXL OD RISK (especially children), dental staining, urine discoloration, dark stool

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Iron Dextran

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Iron Preparations
Contra: non-iron-deficiency anemia, *ACUTE PHASE of INFECTIOUS RENAL Dz*, *INFANTS <5 mos/o*; PREGNANCY: Cat C
Use: Fe-DEFIC. ANEMIA for Pts w/ *CHR ANEMIA* where oral Rx does not work
Route: IV, IM
MOA:
Exc./Met.:
SE: BLACK BOX: ANYPHYLAXIS, seizure, CP, HypoTN shock, dyspnea, resp. arrest, leukocytosis, hematuria, brown skin

Front 5

Deferoxamine

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Iron Antidotes
Contra: Anuria, severe renal Dz; PREGNANCY: Cat C
Use: Acute Fe poisoning, CHR Fe overload
Route: IM, IV, SC
MOA: Iron chelator (binds/sequesters metal)
Exc./Met.: Urine
SE: injection site reaction, HypoTN, shock, anaphylaxis, *GROWTH RETARDATION/BONE CHANGE (in 1st 3 years of life)*, neuropathy, sensorineural hearing loss

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Deferasirox

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Iron Antidotes
Contra: only available with *EPASS COMPLETE CARE*, Cr >2x upper limit of normal, or CrCl <40, high risk myelodysplastic syndrome, advanced malignancy, platelets < 50,000
Use: chronic Fe overload *DUE TO BLOOD TRANSFUSIONS*
Route: Oral
MOA: Tridentate iron chelator, binds ferric Fe
Exc./Met.: mostly FECES, some urine
SE: BLACK BOX: RENAL FAILURE, HEPATIC FAILURE, GI HEMORRHAGE, serum creatinine increase, proteinuria, anaphylaxis, agranulocytosis, neutropenia, thrombocytopenia

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Cyanocobalamin

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Vit B12 Preparation (Vit B12 = Extrinsic Factor)
Contra: *EARLY LEBER'S OPTIC NERVE ATROPHY*, IV; PREGNANCY: Cat A (Cat C for nasal)
Use: Vit B12 deficiency (pern. anemia, ileum damage, etc.)
Route: Oral (tab), IM, SC, *NASAL (spray)*
MOA: important in transfer of METHYL converting HOMOCYSTEINE to METHIONINE via METHIONINE SYNTHASE, and conversion of N5-METHYL[THF] (inc. = methylfolate trap) to THF, conversion of L-METHYLMALONYL-CoA (build up can Dx B12 def.) to SUCCINYL-CoA
Exc./Met.: Primarily Stored in LIVER, little secretion in feces/urine
SE: injection site pain, CHF, PVD, anaphylaxis

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Folic Acid

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Folic Acid Preparation
Contra: undiagnosed anemia
Use: Folic Acid deficiency (1-6 mos post-cessation - *MORE RAPID CONDITION THAN B12 def.*), IV: methanol toxicity, Topical: anti-photo-aging
Route: Oral, *TOPICAL (cream/ointment)*, IV, IM
MOA: converted by B12 dependent DEMETHYLATION Rx to THF, converted to DIHYDROFOLIC ACID (for 'folate cycle') by *DIHYDROFOLATE REDUCTASE (parenteral, NOT NECESSARY in ORAL ADMIN.)*
Exc./Met.: stored mainly in LIVER and other tissues, exc. feces & urine
SE: irritability, difficulty sleeping, confusion, bronchospasm, rash, phenytoin def., masking of pernicious anemia

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Leucovorin

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Folic Acid Preparation
Contra: vit B12 def. anemia, pernicious anemia; PREGNANCY: Cat C
Use: prophylaxis of METHOTREXATE (Ca Rx) TOXICITY/OD, "leucovorin rescue"
Route: Oral (tab) for *TRIMETHOPRIM TOXICITY, inhibit BACTERIAL DHF REDUCTASE*, IV for *METHANOL POISONING, 5-FU Tx*, IM
MOA: metabolized into THF cofactors (methyl/methylene-THF), *BYPASS DIHYDROFOLATE REDUCTASE STEP*
Exc./Met.: absorbed in small intestine, converted in GI cells, exc. in the urine
SE: stomatitis, thrombocytosis, anaphylactoid Rx

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Darbepoetin Alfa

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Erythropoiesis-Stimulating Agents
Contra: uncontrolled HTN, anemia in Cancer Pts; PREGNANCY: Cat C
Use: anemia associated w/ CKD (w/ or w/o HD Tx), need Fe/Folate supp. for inc. erythrop., chemotherapy-related anemia (non-myeloid malignancies)
Route: IV, SC (has longer HL [21-49 hrs.], thus less admin.)
MOA: binds EPO-Rs on RBC progenit., stimulates JAK/STAT, inc. transcript. for RBC growth/prolif., corrects tissue hypoxia anemia as long as BM is intact (corrects for nonFx KIDNEYS), induces reticulocyte release from BM
Exc./Met.: -
SE: BLACK BOX: INC. MORTALITY & INC. CARDIAC EVENTS in CKD, INC. TUMOR PROGR. in CANCER PTs; Cancer Pts: fatigue, death, PE, HTN encephalopathy, seizures; CKD Pts: infection, Hypo/HyperTN, death, cardiac arrest, CHF, HTN encephalopathy, TIA

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Epoetin Alfa

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Erythropoiesis-Stimulating Agents
Contra: uncontrolled HTN, anemia in Cancer Pts, *PURE RED CELL APLASIA*; PREGNANCY: Cat C
Use: anemia associated w/ CKD (w/ or w/o HD Tx), need Fe/Folate supp. for inc. erythrop., chemotherapy-related anemia, zidovudine anemia (HIV Tx), blood transfusion pre-op (w/ Fe)
Route: IV, SC (more freq. admin. [3x/wk.])
MOA: binds EPO-Rs on RBC progenit., stimulates JAK/STAT, inc. transcript. for RBC growth/prolif., corrects tissue hypoxia anemia as long as BM is intact (corrects for nonFx KIDNEYS), induces reticulocyte release from BM
Exc./Met.: -
SE: BLACK BOX: INC. MORTALITY & INC. CARDIAC EVENTS in CKD, INC. TUMOR PROGR. in CANCER PTs; pyrexia, HTN, stomatitis, vasc. occlusion, PE, seizures, serious Ax Rx

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Schilling Test Results for B12 Deficiency Causes

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