Mmc Pharmacology - Drugs To Treat Anemias

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Ferrous Sulfate

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1) Given orally for treatment of microcytic anemia

2) One of cheapest and most widely used forms of iron supplementation

3) Produces mild side effects such as nausea, abdominal cramps and diarrhea

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Iron-Dextran

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1) Given to patients via IM or IV route

2) Used in patients who can't take oral iron

3) Side effects can include anaphylactic shock and death

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Acute Iron Toxicity

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1) Occurs primarily in children (via accidental ingestion of iron pills)

2) Symptoms include vomiting, abdominal pain, necrotizing gastroenteritis, and bloody diarrhea

3) May result in severe metabolic acidosis, coma and death

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Chronic Iron Toxicity/Iron Overload

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1) Occurs in patients with repeated blood transfusions and and inherited hemochromatosis

2) Produces iron deposition in heart, liver, pancreas and other organs

3) Can cause organ failure and death

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Deferoxamine

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1) Iron chelator administered IM, IV or SC

2) Used to treat patients with acute iron toxicity and those with refactory anemias who have iron overload

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Ferritin

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Complexed to iron stored in mucosal cells

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Vitamin B12

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1) Required for production of folate cofactors and one carbon transfer reactions

2) Absorbed through distal ileum via receptor mediated endocytosis

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Hydroxocobalamin

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A form of vitamin B12 that is highly bound to protein; remains in circulation longer when given IM

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Cyanocobalamin

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1) Preparation of vitamin B12 that is given to patients IM

2) Used to treat megaloblastic anemia, pernicious anemia

3) Used to treat B12 deficiency due to gastrectomy, malabsorption syndrome or IBD

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Oral Vitamin B12

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Form of vitamin B12 used to treat pernicious anemia patients who can't or won't tolerate B12 injections

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Drugs that lower Folic Acid absorption

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1) Antacids

2) NSAIDS

3) H2 blockers

3) Trimethoprim

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Darbepoetin alfa

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1) Erythropoietin preparation with long half life

2) Given IV or SC to treat anemia due to chronic kidney failure, HIV therapy or myelosuppressive cancer chemotherapy

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Epoetin alfa

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1) Shorter acting version of erythropoietin

2) Given IV or SC to treat anemia due to chronic kidney disease, HIV therapy or myelosuppressive cancer chemotherapy

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Side effects of EPO administration

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1) Hypertension

2) Thrombotic Complications

3) Allergic reactions

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Treatment Strategy for Severe Aplastic Anemia

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1) Blood transfusions

2) Blood and marrow stem cell transplants

3) Immunosuppressive therapy

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Hydroxyurea

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1) Used to treat sicke cell anemia

2) Increases HbF production, which interferes with HbS polymerization

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Treatment Strategy for Hemoglobin H Disease

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1) Folate Supplementation

2) Avoid sulfonamides and other oxidative drugs

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Treatment for Severe Thalassemia

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1) Regular blood transfusions and folate supplementation

2) Splenectomy

3) Deferoxamine

4) Low iron diet

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Treatment of Glucose - 6 - Phosphate Dehydrogenase Deficiency

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Avoid known oxidant drugs

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Drugs Used to Treat Megaloblastic Anemia

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1) Cyanocobalamin

2) Hydroxocobalamin

3) Oral Folate

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Treatment for Chronic Iron Toxicity

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1) Intermittent phlebotomy

2) Deferoxamine

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Treatment for Acute Iron Toxicity

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1) Whole bowel irrigation (CoLyte)

2) Deferoxamine

3) Bicarbonate (to treat metabolic acidosis)

4) Fluids (to treat shock)

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Transferrin

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A beta-globulin that transports iron within the bloodstream; binds ferric (Fe3+) form of iron

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Sites of Iron Storage

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1) Intestinal mucosal cells

2) Macrophages in liver, spleen and bone

3) Parenchymal liver cells

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Forms of Parenteral Iron

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1) Iron dextran

2) Sodium ferric gluconate complex

3) Iron-sucrose complex

4) Ferric carboxymaltose

5) Ferumoxytol

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There is a lifetime requirement for this drug in patients who have undergone gastrectomy

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Cyanocobalamin or Hydroxocobalamin

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Therapeutic Goals of Iron Supplementation

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1) Provide iron immediately for hemoglobin synthesis

2) Replenish tissue stores of iron

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Forms of Oral Iron

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1) Ferrous sulfate

2) Ferrous gluconate

3) Ferrous fumarate

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Deferasirox

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1) Oral iron chelator

2) Approved for treatment of iron overload due to blood transfusions

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DMT1

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1) also known as divalent metal transporter 1

2) involved in active transport of ferrous (Fe2+) iron

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Darbepoetin alfa and epoetin alfa:

Mechanism of action

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1) Agonists of erythropoeitin receptors

2) stimulate erythroid proliferation and differentation; also induce release of reticulocytes from bone marrow