Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
Anemia
|
Below normal concentration of hemoglobin in the body
Hb < 13g/dL in men Hb < 12 g/dL in women |
|
Anemias are classified
|
1. morphology
2. etiology 3. pathophysiology |
|
Morphology - Macrocytic
|
1. Vitamin B12 or Folic Acid Deficiency
2. Cells are larger |
|
Morphology - Microcytic
|
1. Iron Deficiency
2. Cells are small, Hb down |
|
Morphology - Normocytic
|
1. Recent blood loss
2. Cells are normal, Hb normal |
|
Etiology of Anemia
|
1. Deficiency (iron, Vit B12, Folic Acid)
2. Central (impaired bone marrow function) 3. Peripheral (bleeding, hemolysis) |
|
Pathophysiology of Anemia
|
1. Excessive blood loss (hemorrhage, trauma, peptic ulcer)
2. Chronic Hemorrhage (vaginal bleeding, peptic ulcer) 3. Excessive RBC destruction 4. Inadequate production of RBCs |
|
Life span of Red Blood cells
|
120 days
|
|
Entire process of formation of Red blood cells
|
1 week
|
|
Erythropoeitin
|
1. produced mainly in the kidneys
2. initiates and stimulates the production of RBCs MOA: prevents apoptosis of erythroid precursor cells to allow for proliferation and susequent maturation 3. decreased tissue oxygen signals to kidney to increase production |
|
Clinical presentation of Acute Onset Anemias
|
1. Tachycardia
2. Lightheadedness 3. Palpitations 4. Hypotension 5. Angina 6. Dyspnea |
|
Clinical Presentation of Chronic Anemia
|
*May present as asymptomatic at first*
1. Weakness/lethargy/fatigue 2. headache 3. vertigo 4. faintness 5. edema 6. SOB 7. Sensitivity to cold 8. Hunger for ice, starch, clay |
|
Goal of Anemia Therapy
|
1. improve RBC oxygen carrying capacity
2. Alleviate symptoms 3. Prevent anemia complications |
|
Sources of Dietary Iron
|
1. Seafood (oysters, tuna, salmon)
2. Meats (liver, lean red meat) 3. Grains (fortified cereals, whole grains) 4. Veggies (spinach, broccoli, asparagus) |
|
Iron is best absorbed in what form
|
Ferrous form
|
|
Findings in Iron Deficiency Anemia
|
1. Decreased Serum Iron
2. Decreased Serum Ferritin 3. Decreased TSAT% 4. Increased TIBC 5. Decreased Hb & Hct 6. Peripheral smear: microcytosis, hypochromia |
|
Signs and Symptoms of Iron Deficient Anemia (Microcytic)
|
1. Hb <9g/dL
2. Headache, Cardiovascular, SOB (general) 3. Smooth, sore tongue 4. Pica - compulsive eating of nonfood items 5. spoon shape fingernails |
|
Treatment of Iron Deficiency Anemia
|
1. Treat Underlying cause
2. Replenish iron stores (200mg of elemental iron daily) |
|
Recommended dose of Iron for Anemia
|
200mg elemental iron daily taken in 2-3 divided doses on an empty stomach
|
|
Ferrous Sulfate for Anemia
|
*Formulation of choice for iron deficiency anemia
1. Effective and Low Cost 2. 60-65mg of elemental iron per 325mg tablet 3. take 1 tablet TID 4. Should not be administered 1 hour before or 2 hours after a meal |
|
When should response to iron therapy be seen
|
1. within 7-10 days
2. Hb should rise 2-4g/dL every 3 weeks |
|
ADRs of Iron supplement
|
*primarily GI*
1. Dark discoloration of feces 2. Constipation 3. Ab cramping |
|
Drugs that decrease Iron Absorption
|
1. Al-, Mg, Ca containing antacids
2. H2 antagonists 3. PPIs 4. Caffiene |
|
Drus that are affected by iron
|
1. Decrease levothyroxine
2. Decrease fluoroquinolones 3. Decrease Methyldopa |
|
Counseling points for Iron
|
1. Keep out of reach of children
2. take on an empty stomach 3. take 2 hours before or after antacids, PPIs, H2RAs |
|
How long should treatment be given for Anemia
|
3-6 months after the anemia is resolved
|
|
Which parenteral Iron needs to have a test dose
|
Iron Dextran (0.5mL = 25mg)
|
|
What is the dose for the parenteral Irons (Sodium Ferric Gluconate, Iron Sucrose, Ferumoxytol)
|
1 gram given over several days
|
|
Must rule out Vitamin B12 deficiency before treating what
|
Folic Acid Deficiency must be treated first
|
|
Signs and Symptoms of Vitamin B12 Deficient Anemia
|
1. Physical (Glossitis, Anorexia/weight loss, Beefy red tongue)
2. Neurological (peripheral neuropathy) 3. Psychiatric (irritability, memory impairment, depression) |
|
Laboratory Findins for Vitamin B12 Defiency Anemia (Macrocytic)
|
1. Decreased Hct
2. Decreased reticulocyte count 3. Decreased Vit B12 level 4. Increased MCV & MCH SMEAR: macrocytosis |
|
Treatment for Vitamin B12 Deficient Anemia
|
1. Cyanocobalamin Oral
2. Cyanocobalamin Parenteral (preferred for Neurological symptoms) 3. Cyanocobalamin Intranasal Spray |
|
ADRs of Cyanocobalamin
|
*RARE - well tolerated*
1. Hypokalemia 2. Injection site pain 3. Pruritis 4. Rash |
|
Causes of Folic Acid Deficiency Anemia
|
1. Inadequate Intake
2. Malabsorptive Disease 3. Medication Use 4. Inadequate utilization 5. Hyperutilization |
|
Signs and Symptoms of Folic Acid Deficiency Anemia
|
SAME AS Vitamin B12 Deficiency Anemia EXCEPT no Neurological symptoms
|
|
Laboratory Findings for Folic Acid Deficiency Anemia
|
1. Decreased Hct
2. Decreased Reticulocyte count 3. Decreased Serum Folic Acid 4. Increased MCV & MCH SMEAR: macrocytosis |
|
Treatment for Folic Acid Deficiency Anemia
|
Supplementation (OTC or RX)
|
|
ADRs of Folic Acid Supplementation
|
1. Bitter/Bad taste
2. GI upset (nausea, flatulence, anorexia) |
|
Ingestion of what interferes with the absorption of folate
|
Alcohol
|
|
Factors responsible for Anemia of CKD
|
1. Decreased erythropoietin production (MAJOR)
2. shorter life span of RBCs 3. blood loss during dialysis |
|
New Recommendation with erythropoiesis stimulating agents (ESAs)
|
*NO TARGET Hb RANGE*
increased mortality, MI, Stroke, thromboembolism when using ESAs to target Hb > 11g/dL |
|
2 agents available as erythropoiesis stimulating agents (ESAs)
|
1. Epoetin-a (Epogen, Procrit)
2. Darbepoetin a (Aranesp) |
|
Starting dose of Epoetin a
|
50-100 units/kg/dose IV or SC 2-3 times/week
|
|
Starting dose of Darbepoetin-a
|
Dialysis: 0.45mcg/kg IV once weekly
No Dialysis: 0.45mcg/kg IV or SC once every 4 weeks |
|
ADRs of Epoetin-a and Darbepoetin-a
|
1. Hypertension (most common) - do not start med if BP >180/100
2. seizures 3. edema 4. allergic reactions |
|
Evaluation of Therapeutic Outcomes with ESAs
|
1. Hb levels monitored every week, then every 2-4 weeks when stable
2. upward dose adjustments made every 4 weeks 3. patients dont respond after 8 weeks, do not continue |
|
Change in dosing of Epoetin-a and Darbepoetin-a
|
*made in 25% intervals
1. change in Hb < 1g/dL in 4 weeks - increase dose by 25% 2. change in Hb >1g/dL in 2 weeks - decrease dose by 25% |
|
Common causes of inadequate response to ESAs
|
1. Iron deficiency (Most Common)
2. infection/inflammation 3. chronic blood loss 4. folate or B12 deficiency 5. malnutrition |
|
ESAs will not be effective if
|
Iron stores are not adequate
|
|
Most patients with CKD require
|
an Iron Supplement
|
|
Oral Iron therapy is not effective for patients...
|
for CKD patients on Dialysis (USE IV THERAPY)
|
|
oral Iron supplementation indicated for patients who do not have IV access
|
1. Stages 3 and 4 CKD
2. Receiving peritoneal dialysis 3. Switch to IV if unable to manage |
|
Shape of Sickled Cells
|
1. Oxygen is unloaded into tissues - HbS solubility decreases
2. deoxygenated Hgb becomes semi-solid gel 3. lose biconcave shape, become elongated and stiff with curved ends |
|
Pathophys of Sickle Cell Anemia
|
1. Sickled Cells increase blood viscosity and cause sludging = tissue hypoxia
2. cell membrane damage, loss of membrane flexibility = vasoocclusion 3. Damage to cell membranes - dehydrated, dense sickle cells 4. loss of potassium/water RESULT: impaired circulation, RBC destruction, stasis of blood flow |
|
Clinical presentation of Sickle Cell Anemia
|
1. Painful Vasoocclusive Crisis (Hallmark)
2. Dactylitis (sausage toe/finger) 3. Infaction of spleen, liver, bone marrow 4. Gallstones 5. Priapism 6. Weakness/fatigue |
|
Signs of Sickle Cell Anemia
|
1. Chronic Hemolytic Anemia
2. Enlargement of Heart or spleen |
|
Non-Pharmacological Therapy of Sickle Cell Anemia
|
1. HYDRATION - decrease blood viscosity
2. Pain control |
|
Immunization Schedule for Sickle Cell Anemia
|
1. Annual Flu Vaccine
2. Pneumococcal Vaccine (6wks-4months = 4 shots; >2 years = 1 shot booster) 3. Meningococcal ( >2 years) |
|
MOA of Hydroxurea for Sickle Cell Anemia
|
1. stimulates the production of HbF levels
2. decreases hemolysis 3. Vasodilation |
|
Hydroxyurea (Droxia, Hydrea) is indicated for
|
patients with 3+ vasoocclusive pain crisis and/or ACS per year or severe symptomatic anemia
|
|
Dosing for Hydroxyurea (Droxia, Hydrea) in Sickle Cell Anemia
|
10-15 mg/kg/day (up to 35mg/kg/day) and adjust by 5 mg/kg after 8-12 hours
|
|
Most common ADRs of Hydroxyurea
|
1. MYELOSUPPRESSION
2. nausea/vomiting 3. constipation 4. confusion 5. peripheral neuropathy |
|
MOnitoring of Hydroxyurea
|
Baseline: CBC, MCV, Hgb (goal increase 15-20%), SCr
CBC - every 2 weeks then every 4 weeks once stable HbF - every 3 months |
|
What do you do if there is a toxicity with Hydroxyurea
|
stop use for at least one week then restart at 2.5mg/kg/day less than previous dose
|
|
Deferasirox
|
USE: chelating agent for iron overdose
INDICATION: after 1 year of chronic transfusion or serum ferritin > 1500-2000 ADRs: SCr increase, fever, headache |
|
Deferoxamine
|
USE: IV chelating agent for hemosiderosis
INDICATION: after 1 year of chronic transfusion or serum ferritin > 1500-2000 *supplement with Ascorbic acid ADRs: associated growth failure |
|
Deferiprone
|
USE: oral chelating agent (LAST LINE)
INDICATION: treatment of transfusion iron overload due to thalessemia syndromes BLACK BOX: agranulocytosis |
|
Acute Complications with 'iron chelators' in sickle cell anemia
|
1. Fever and infection (empirical antibiotics)
2. Neurologic 3. Acute Chest Syndrome 4. Priapism |
|
Sickle Cell Crisis problems
|
1. Vasoocclusion Pain
2. Aplastic Crisis 3. Acute Splenic Sequestration Crisis |
|
Therapeutic regiment for Mild-to-Moderate Pain with Sickle Cell
|
non-opioid with/without weak opioid
|
|
Therapeutic Regimen for Moderate-to-Severe pain with Sickle Cell
|
weak opioid OR low dose of strong opioid with/without nonopioid
|
|
Therapeutic regimen for Severe pain with Sickle Cell
|
strong opioid with nonopioid
|
|
Weak Opioids used in Sickle Cell
|
1. APAP w/ Codeine
2. Hydrocodone w/ APAP |
|
Strong Opioids used in Sickle Cell
|
1. Morphine
2. Hydromorphone 3. Fentanyl 4. Methadone |
|
Non-Opioids used in Sickle Cell
|
1. Naproxen
2. Ibuprofen 3. Ketorlac (IV) |