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16 Cards in this Set
- Front
- Back
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Paneth Cells
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Contain lysozymes; located at the base of the crypt of Lieberkuhn
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Parietal/Oxyntic Cell
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Secretes gastric acid and If
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Iron Dextran
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Give if iron absorption is impaired or pt has PUD; since it doesn't have to be absorbed it can be in the ferric (Fe3+ form)
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Iron Supplements
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Tx iron deficiency; continu for months after anemia to replete iron stores; don't stop tx in response to hb alone, keep tx to get ferritin up too
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Deferoxamine
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Parenteral iron chelator for iron toxicity; excreted in urine
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How does vitamin B12 deficiency contribute to folate deficiency?
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B12 needed to demethylate folate to be turned into THF and then into DNA
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Methotrexate
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Used to tx cancers and autoimmune dx (RA); inhibits folate metabolism (so rapid proliferating cells suffer first)
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Leuxocorin
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Used to rescue healthy cells (erythrogenic progenitor cells in bone marrow) from methotrexate tx - but since this counteracts the effects of MTX it's usually not an option to manageMTX induced anemia except as part of a cell rescue strategy w/ high dose MTX cycles of cancer therapy
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What type of cells are produced if EPO is given to a pt w/ iron deficiency?
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Microcytic hypochromic RBC
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What type of cells are produced if EPO is given to a pt w/ folate/B12 deficiency?
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Macrocytic RBCs
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Menstrual blood loss and dieting put women at particular risk for microcytic anemia. A 26 y.o. woman takes oral contraceptives because she knows that the drug she takes for epilepsy can cause birth defects. Unfortunately, oral contraceptives and phenytoin also put this woman at risk for macrocytic anemia. What supplement has potential to reduce her risk for macrocytic anemia and risk for embryonic neural tube defects if she happens to become pregnant?
What will you prescribe if she develops microcytic anemia with low ferritin (low TIBC)? Will you expect to prescribe for: about 7 days about 2 weeks about 3 months |
Both drugs interfere w/ folate absorption
Folate, high dose ~ 4mg/d Iron supplement such as ferrous sulfate |
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A child overdoses on a parent's oral iron supplement.
a. What is the first line antidote? b. How does the antidote work? c. Would it be reasonable to discharge a child that initially seemed very toxic if the symptoms were much improved by about 18 hours after the overdose? |
a. Deferoxamine
b. Iron chelator; forms insoluble complex that is excreted in the urine over time c. No, pts may initially recover by coagulopathies may ensue, as well as liver or kidney injury over 2-7 days |
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What are the risks of long term tx w/ EPO?
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Significantly higher risk of MI, stroke, cancer
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What effect might EPO have on a pt taking PPI?
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Long term PPI might be associated with macrocytic anemia due to effects on vitamin b12
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A poorly nourished elderly alcoholic has suffered from neglect. Mean corpuscular volume 110 fL (80-100), ferritin was 35 μg/L (12-150) serum folate was 350 nmol/L (370-1800 nmol/L), TIBC 68 μmol/L (45-82) so she was treated with a folate supplement. After a few months her hemoglobin had increased from 9.1 mg/dL to 11.8 mg/dL. What test was forgotten and why is it important?
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Test macrocytic anemia pts for B12 and folate; if you miss the B12 deficiency you could get subacute combined neurodegeneration; supplement w/ B12 as well if deficit
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Fran has developed macrocytic anemia after about 4 years of continuing symptomatic improvement of rheumatoid arthritic symptoms on methotrexate. She does not want to stop taking methotrexate because it has been very effective in reducing the number and severity of painful joints and increasing periods of remission.
a. Could MTX be at fault after all that time? b. Would high dose folate supplement be an option to reverse the anemia while continuing MTX? c. Would folinic acid (leucovorin) be a rational choice to reverse the anemia while continuing MTX? |
a. Yes
b. Useless, folate can't overcome noncompetitive inhibition of folate reductase by MTX c. No, it would counteract the bone marrow suppressive effects of MTX, but all of the therapeutic effects of the drugs as well |
