Notes in PH.S1.L07.Agents Used in Anemia

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Published	10/21/2024	{{c1::Hematopoiesis}}: Production from {{c2::undifferentiated stem cells}} of circulating erythrocytes, platelets, and leukocytes.
Published	10/21/2024	Hematopoiesis primarily resides in the {{c1::bone marrow}} in adults.
Published	10/21/2024	Essential nutrients needed in hematopoiesis:{{c1::Iron }}{{c1::Cobalamin (Vitamin B12)}} {{c1::Folic acid (Vitamin B9)}} {{c1::Hematopo…
Published	10/21/2024	{{c1::image-occlusion:rect:left=.495:top=.5577:width=.1267:height=.0932:oi=1}}{{c2::image-occlusion:rect:left=.0252:top=.553:width=.1177:height=.1026:…
Published	10/21/2024	{{c1::Sickle cell anemia}}: A condition resulting from a genetic alteration in the hemoglobin molecule
Published	10/21/2024	Treatment for Sickle cell anemia: {{c1::Hydroxyurea (hydroxycarbamide)}}
Published	10/21/2024	{{c1::Hydroxyurea (hydroxycarbamide)}} Reduces veno-occlusive eventsIncreases the production of {{c2::fetal hemoglobin y(HbF)}} which interferes with …
Published	10/21/2024	{{c1::Iron deficiency}} is the most common cause of chronic anemia
Published	10/21/2024	Cardiovascular adaptations to chronic anemia: (3){{c1::Tachycardia }}{{c1::Increased cardiac output }}{{c1::Vasodilation (hypotension)}}
Published	10/21/2024	{{c1::Iron}} forms the {{c2::nucleus}} of the {{c3::iron-porphyrin heme}} ring
Published	10/21/2024	{{c1::Hgb}} reversibly binds oxygen and provides the critical mechanism for oxygen delivery from the lungs to other tissues
Published	10/21/2024	Iron deficiency anemia is is characterized by:{{c1::Microcytosis::Microcytosis, Normocytosis, or Macrocytosis?}}{{c2::Hypochromia::Hypochromia, normoc…
Published	10/21/2024	Intestinal epithelial cells actively absorb: {{c1::Inorganic iron}} via the {{c2::divalent metal transporter 1 (DMT1)}} {{c1::Heme iron}} via the…
Published	10/21/2024	Iron that is absorbed or released from absorbed heme iron in the intestine:Actively transported into the blood by {{c1::ferroportin (FP)}} and stored …
Published	10/21/2024	{{c1::Hepcidin}} inhibits {{c2::ferroportin}}
Published	10/21/2024	{{c1::Low hepatocyte iron}} and {{c1::increased erythroferrone}} inhibits hepcidin and enhances iron absorption via {{c2::ferroportin}}
Published	10/21/2024	Iron Absorption:{{c1::5-10% of iron or 0.5-1 mg daily::amount absorbed daily?}}
Published	10/21/2024	Iron absorption: {{c1::Duodenum and proximal jejunum::Site of absorption?}}
Published	10/21/2024	Iron absorption: {{c1::1-2 mg/d::recommended intake?}} in menstruating women
Published	10/21/2024	Iron absorption: {{c1::3-4 mg/d::recommended intake?}} in pregnant women
Published	10/21/2024	Iron is abundant in {{c1::meat}} products
Published	10/21/2024	{{c1::Heme}} iron in meat hemoglobin and myoglobin can be absorbed intact without first having to be dissociated into elemental iron
Published	10/21/2024	{{c1::Nonheme}} iron in foods and iron in {{c2::inorganic iron salts and complexes}} must be reduced by a {{c3::ferrireductase}} to {{c4::ferrous iron…
Published	10/21/2024	Mechanism of Iron Absorption Iron crosses the luminal membrane of the intestinal mucosal cell by two mechanisms: {{c1::Active transport}} of ferrous i…
Published	10/21/2024	{{c1::Apoferritin}} → A shell of a specialized storage protein
Published	10/21/2024	{{c1::Ferritin}} → Water-soluble complex consisting of a core of {{c2::ferric hydroxide}} covered by {{c3::apoferritin}}
Published	10/21/2024	Iron is stored in the: {{c1::Intestinal mucosal cells}} {{c2::Macrophages}} in liver, spleen, and bone {{c3::Parenchymal liver cells}}
Published	10/21/2024	Hepcidin regulation of ferroportin activity Primarily controls the mobilization of iron from {{c1::macrophages}} and {{c1::hepatocytes}} ↓ hepcidin co…
Published	10/21/2024	Pharmacokinetics: Elimination (Iron){{c1::Feces, bile, urine, and sweat::Excreted as (4)?}}
Published	10/21/2024	Pharmacokinetics: Elimination (Iron)No more than {{c1::1}} mg of iron per day
Published	10/21/2024	Body’s ability to excrete iron is {{c1::limited}}
Published	10/21/2024	Most common cause of IDA: {{c1::Blood loss}}
Published	10/21/2024	Menstruating women lose about {{c1::30}} mg of iron with each menstrual period
Published	10/21/2024	Most common site of blood loss that leads to IDA: {{c1::GIT}}
Published	10/21/2024	Mechanism of Iron Deficieny?{{c1::Increased iron requirements::}} Premature infants Children during rapid growth periods Pregnant and lactating women …
Published	10/21/2024	Available preparations for oral iron therapy: {{c1::ferrous sulfate}}, {{c2::ferrous gluconate}}, {{c3::ferrous fumarate}}
Published	10/21/2024	{{c1::200-400}} mg of elemental iron should be given daily to correct iron deficiency most rapidly
Published	10/21/2024	Duration of oral iron therapy: {{c1::3-6 months duration}}
Published	10/21/2024	Common adverse effects of oral iron therapy{{c1::Nausea}} {{c1::epigastric discomfort }}{{c1::diarrhea}} {{c1::Constipation }}{{c1::abd…
Published	10/21/2024	Parenteral Iron is most commonly indicated for patients with {{c1::advanced kidney disease}} who are undergoing hemodialysis
Published	10/21/2024	Available Parenteral Preparation:{{c1::Available Parenteral Preparation}}{{c2::Sodium Ferric Gluconate complex and Iron Sucrose}}{{c3::Ferric Carboxym…
Published	10/21/2024	{{c1::Iron Dextran}} {{c2::50}} mg elemental iron per ml of solution Thru deep {{c3::IM}} or {{c3::IV}} (with small test dose)
Published	10/21/2024	{{c1::Ferumoxytol}} Superparamagnetic iron oxide nanoparticles coated with carbohydrate It may interfere with MRI studies
Published	10/21/2024	Do {{c1::small dose testing}} to avoid severe hypersensitivity with parenteral iron therapy.
Published	10/21/2024	Adverse Effects of Acute Iron Toxicity:{{c1::Necrotizing gastroenteritis::NG}} with vomiting{{c2::Abdominal pain::AP}} {{c3::Bloody diarrhea::BD}} fol…
Published	10/21/2024	Management of Acute Iron Toxicity{{c1::Whole Body Irrigation}} To flush out unabsorbed pill {{c2::Deferoxamine }}Potent iron-chelating compound C…
Published	10/21/2024	{{c1::Hemochromatosis}}Excess iron is deposited in the heart, liver, pancreas, and other organs
Published	10/21/2024	Treatment for Chronic Iron Toxicity{{c1::Intermittent phlebotomy}} Absence of anemia {{c1::Iron chelation therapy}} {{c2::Deferoxamine}} ({{c3::parent…
Published	10/21/2024	Vit B12 Deficiency results from:{{c1::Malabsorption of vit. B12::M}}{{c2::Nutritional deficiency::N}}{{c3::Congenital Deficiency of IF::C}}
Published	10/21/2024	Malabsorption of vit. B12 Lack of {{c1::intrinsic factor}} Loss or malfunction of the absorptive mechanism in the {{c2::distal ileum}}
Published	10/21/2024	Nutritional deficiency- rare Strict {{c1::vegetarians}} after many years without meat, eggs or dairy products
Published	10/21/2024	Congenital Deficiency of IF Eg. Defects of the receptor sites for {{c2::Vit. B12 intrinsic factor}} complex located in the {{c1::distal ileum}}
Published	10/21/2024	Vit B12 Deficiency leads to: {{c1::Megaloblastic anemia::MA}} {{c2::Gastrointestinal symptoms::GS}} {{c3::Neurologic abnormalities::NA}}
Published	10/21/2024	{{c1::image-occlusion:rect:left=.0219:top=.6849:width=.2679:height=.0817}}{{c2::image-occlusion:rect:left=.0219:top=.8195:width=.2803:height=.0861}}{{…
Published	10/21/2024	Also known as extrinsic factor: {{c1::Vitamin B12}}
Published	10/21/2024	AbsorptionIntrinsic factor + Vitamin B12 = {{c2::intrinsic factor-vitamin B12}} complex Subsequently absorbed in the {{c1::distal ileum}} by a highly …
Published	10/21/2024	Transport To the various cells of the body bound to a family of specialized {{c1::glycoproteins}}, {{c2::transcobalamin I, II, III}}
Published	10/21/2024	Metabolism Excess vitamin B12 is stored in the {{c1::liver}}, with an average adult having a total Vit. B12 storage pool of {{c2::3000- 5000}} mcg Nor…
Published	10/21/2024	Available Parenteral Preparation : {{c1::cyanocobalamin}} or {{c1::hydroxocobalamin}}
Published	10/21/2024	Twoessential enzymatic reactions in human require vitamin B12: {{c1::Methyl transfer}} {{c2::Methylcobalamin}} (active form) serves as an intermediate…
Published	10/21/2024	Clinical Indications for the Use of Vit. B12 {{c1::Megaloblastic, macrocytic}} anemia Mild or moderate {{c1::leukopenia}} or {{c1::thrombocytopenia}} …
Published	10/21/2024	Causes of Vit. B12 Deficiency {{c1::Pernicious Anemia::PA}} Defective secretion of intrinsic factor by the gastric mucosal cells {{c1::Partial or Tota…
Published	10/21/2024	{{c1::Reduced forms of folic acid}} → Required for essential biochemical reactions that provide precursors for the synthesis of amino acids, purines, …
Published	10/21/2024	{{c1::Vitamin B9}} Deficiency is a cause of congenital malformations in newborns and may play a role in vascular disease
Published	10/21/2024	Vitamin {{c2::B9}} reduces the incidence of {{c1::neural tube defects (NTDs)}}
Published	10/21/2024	Vitmain B9  protects against cancers including: {{c1::Colorectal::C}} {{c1::Breast::B}} {{c1::Cervical cancer::C}}
Published	10/21/2024	Pharmacokiteics of Folic Acid{{c1::50-200}}mcg: usually absorbed in adult
Published	10/21/2024	Pregnant women → May absorb as much as {{c1::300–400}} mcg of folic acid daily
Published	10/21/2024	Storage of folates Stored in the {{c2::liver}} and other tissues {{c1::5-20}} mg Body stores Relatively {{c3::low}} Daily requirements {{c4::high}}
Published	10/21/2024	Folic acid deficiency and megaloblastic anemia →Can develop within {{c1::1–6}} months after the intake of folic acid stops
Published	10/21/2024	Folic Acid is excreted in the {{c1::urine}} and {{c1::stool}} and destroyed by {{c2::catabolism}}
Published	10/21/2024	Richest sources of Folic Acid: {{c1::yeast}}, {{c2::liver}}, {{c3::kidney}}, {{c4::green vegetables}}Mnemonic: You LiKe Green
Published	10/21/2024	{{c2::Unaltered::Form?}} folic acid → Readily and completely absorbed in the {{c1::proximal jejunum}}.
Published	10/21/2024	{{c3::Dietary::Form?}} folates → consist primarily of {{c1::polyglutamate}} forms of {{c2::N-5-methyltetrahydrofolate}}
Published	10/21/2024	{{c1::Tetrahydrofolate cofactors}} participate in {{c2::one}}-carbon transfer reactions Cofactor is {{c3::oxidized::chemical process}} to {{c4::dihydr…
Published	10/21/2024	dTMP synthesis cycle →Combined catalytic activities of: {{c1::dTMP synthase::DS}} {{c1::Dihydrofolate reductase::DR}} {{c1::Serine transhydroxymethyla…
Published	10/21/2024	Clinical Indications for the Use of Folic Acid{{c1::Megaloblastic Anemia}} Does not cause the characteristic neurologic syndrome seen in Vitamin B12 d…
Published	10/21/2024	Folic Acid DeficiencyOften caused by:Inadequate dietary intake of folateAlcohol dependence and liver diseaseDue to poor diet and diminished {{c3::hepa…
Published	10/21/2024	{{c1::HEMATOPOIETIC GROWTH FACTORS (HGF)}} are {{c2::glycoprotein}} hormones that regulate the proliferation and differentiation of hematopoietic prog…
Published	10/21/2024	{{c1::Colony stimulating factors}} First growth factors to be identified Could stimulate the growth of colonies of various bone marrow progenitor cell…
Published	10/21/2024	HGF currently in clinical use:{{c1::Erythropoietin}}{{c2::Epoetin alfa}} {{c2::Epoetin beta}}{{c1::Granulocyte colony-stimulating factor (G-CSF)}…
Published	10/21/2024	{{c1::Epoetin Alfa}}First human hematopoietic growth factor to be isolated Originally purified from the {{c2::urine}} of patients with severe anemia
Published	10/21/2024	T½ (serum half-life) of Epoetin Alfa : {{c1::4-13}} hours (in patients with {{c2::chronic renal failure}})
Published	10/21/2024	Administration of Epoetin Alfa: {{c1::Subcutaneous}}, {{c2::3x}} per week
Published	10/21/2024	{{c1::Darbepoetin Alfa}}Modified form of erythropoietin More heavily glycosylated as a result of changes in amino acids Has a {{c2::two}}-fold to {{c2…
Published	10/21/2024	{{c1::Methoxy Polyethylene Glycol–Epoetin Beta}}Isoform of erythropoietin Covalently attached to a {{c2::long polyethylene glycol}} polymer Administer…
Published	10/21/2024	Pharmacodynamics of EPONormally, an {{c1::inverse::inverse/direct}} relationship exists between the hematocrit/ hemoglobin level and the serum erythro…
Published	10/21/2024	In most primary bone marrow disorders (aplastic anemia, leukemias, myeloproliferative and myelodysplastic disorders, etc) and most nutritional and sec…
Published	10/21/2024	Clinical Indications for the Use of Erythropoietin Stimulating Agents (ESA) For patients with several types of {{c1::anemia}}Consistently improve the …
Published	10/21/2024	Target hemoglobin before ESA administration: {{c1::10 to 12}} g/dL
Published	10/21/2024	Contraindications of ESA Methoxy polyethylene glycol-epoetin betaShould not be used for treatment of anemia caused by {{c1::cancer chemotherapy}}
Published	10/21/2024	Toxicity of EPO {{c1::Hypertension::1}} and {{c1::thrombotic complications::2}} Increase risk of: {{c2::Serious cardiovascular events::CV}} {{c2::Thro…
Published	10/21/2024	Recommended Use/Limits of ESARecommended in patient with hemoglobin level not exceed {{c1::11}}g/dl in patients with chronic kidney disease receiving …
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