Term
| Which of the following is a common cause of macrocytic, or megaloblastic, anemia? |
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Definition
| Macrocytic anemia is due to a vitamin B12 or folate deficiency, or both. Chronic alcoholism is a common cause. |
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Term
| A female patient needs to take Procrit for her anemia because her kidney's cannot produce which hormone? |
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Definition
Erythropoeitin
Procrit is a brand name for epoetin alfa which is an erythropoiesis-stimulating agent. |
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Term
Patient RH is taking Procrit, an erythropoiesis-stimulating agent commonly used in patients with ESRD who are on hemodialysis. Which of the following statements is correct?
A
Erythropoiesis-stimulating agents can increase the risk of serious bleeding, such as intracranial hemorrhage.
B
RH should be evaluated for parenteral iron therapy; Procrit will not be effective if she is iron deficient.
C
Side effects of Procrit include hypotension; enalapril should be discontinued.
D
RH should have her albumin level monitored frequently while taking Procrit.
E
If RH was switched to darbepoetin, it would be dosed less frequently and would correct her anemia more quickly. |
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Definition
B
In ESRD patients, Aranesp is dosed weekly or every two weeks (versus about three times weekly - or at every dialysis - for the older epoetin alfa formulations), however, it does not normalize hemoglobin more quickly. Erythropoiesis-stimulating agents have serious side effects (thrombosis, uncontrolled hypertension etc.). They are not effective if iron stores are deficient so parenteral iron therapy is usually warranted. |
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Term
A patient is on Procrit 8,000 units 3x/week during hemodialysis.
Vitals:
Height: 5'6" Weight: 178 lbs
BP: 105/61 mmHg HR: 101 BPM RR: 22 BPM Temp: 100.4ºF Pain: 2/10
Assessment/Plan: Viral PCR for influenza. She will undergo hemodialysis x 4 hours today and tomorrow for fluid/electrolyte balance. A review of outpatient labs from January 2nd shows a hemoglobin of 9.4 g/dL.
Current hemoglobin on 2/4 is 9.8 (males: 13.5–18, females: 12–16)
Choose the most accurate statement below regarding RH's erythropoeisis-stimulating agent.
A
She should receive her Procrit at the current dose with dialysis.
B
Her dose can be increased to 10,000 units three times weekly.
C
Her dose can be increased to 16,000 units three times weekly.
D
Her dose should be decreased to 6,000 units three times weekly.
E
Her next dose should be held as it doesn't appear to be improving her anemia. |
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Definition
B
In a hemodialysis patient, erythropoiesis-stimulating agents are started when the Hgb drops below 10 g/dL and treatment should be interrupted when it is at or approaching 11 g/dL. The dose can be increased by 25% no more frequently than Q4 weeks if the Hgb does not rise by 1 g/dL (as shown by the hemoglobin on 1/2 and 2/5). |
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Term
| TL has been using Procrit for quite some time. She has heard that there is a similar agent that requires less frequent dosing. Which formulation is given weekly (or every other week) due to a longer drug half-life? |
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Definition
| Aranesp is the brand name for darbepoietin which has a half-life that is 3-fold longer than Epogen or Procrit. |
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Term
| SB is a female patient who lacks adequate secretion of intrinsic factor. The lack of intrinsic factor can put her at risk for what type of anemia? |
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Definition
| Intrinsic factor is required for adequate vitamin B12 absorption in the small intestine. This type of anemia is called pernicious anemia. |
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Term
| High risk drugs in patients with inherited G6PD deficiency |
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Definition
Chloroquine
Dapsone
Methylene blue
Nitrofurantoin
Primaquin
Probenecid
Sulfonamides |
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Term
IV iron can cause anaphylaxis. Which of the following IV iron preparations has the highest risk for anaphylaxis and requires a test dose prior to administration?
A
Iron sucrose (Venofer)
B
Sodium ferric gluconate (Ferrlecit)
C
Ferumoxytol (Feraheme)
D
Iron dextran (INFeD)
E
Ferric carboxymaltose (Injectafer) |
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Definition
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Term
Which of the following statements concerning vitamin B12 deficiency and supplementation are correct?
A
B12 is generally given as an injection to bypass absorption issues.
B
B12 is called pyridoxine.
C
B12 is used to treat microcytic anemia.
D
Metformin use long-term can increase vitamin B12 levels.
E
A typical starting dose would be 1,000 mg. |
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Definition
A
Vitamin B12 is generally given as an injection because macrocytic anemia can be caused by poor oral absorption of B12. It is dosed in mcg, not mg. |
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Term
| A pharmacy in a hospital has an order for injectable vitamin B12. What medication should be ordered? |
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Definition
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Term
| What is the antidote for iron overdose? |
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Definition
| The antidote for iron overdose is deferoxamine (Desferal). |
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Term
| Which lab values are indicative of macrocytic, or megaloblastic, anemia? |
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Definition
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Term
| Which lab values are indicative of macrocytic, or megaloblastic, anemia? |
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Definition
Low: Hgn, reticulocyte count, serum folate and/or B12
High: MCV (>100), homocysteine (folate and B12 deficiency), methylmalonic acid (specific to vitamin B12 deficiency) |
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Term
SR has chronic kidney disease and has been prescribed epoetin alfa (Epogen). Counseling points for self-injection of this medication should include which of the following?
A
Use each syringe and needle only once; the vial may be used multiple times.
B
It is best to use the same site of injection each time to ensure subcutaneous absorption is consistent.
C
Shake the vial before use to ensure the drug is distributed evenly in the solution.
D
Throw away needles and syringes in the regular trash by placing them in a brown paper bag.
E
The preferred sites of injection are the abdomen, upper arms and the front of the thighs. |
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Definition
E
Do NOT shake hormones or proteins that are used as injectable drugs; this damages the drug. Vials are single-dose and should only be used once. It is best to rotate sites to avoid bruising and infections. |
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Term
| MC is a 57 year old female whose hemoglobin is 9.8 g/dL and hematocrit is 29%. Which lab value is used to distinguish between microcytic and macrocytic anemia? |
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Definition
Mean corpuscular volume (MCV)
<80 mm^3 in microcytic
>100 mm^3 in macrocytic |
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Term
| estrogen-based contraceptives in SCD |
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Definition
| Due to the increased risk of stroke in SCD, estrogen-based contraceptives are not preferred. Women with SCD have a higher risk of complications in pregnancy than females without sickle cell disease. |
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Term
| Indication for hydroxyurea |
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Definition
| Adults with 3 or more moderate to severe pain crises in 1 year OR patients with severe or recurrent acute chest syndrome |
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Term
| Additional vaccines due to functional asplenia in Sickle Cell Disease |
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Definition
Meningococcal conjugate series plus routine boosters
Meningococcal serogroup B (Bexsero, Trumenba)*
PNeumovax 23 (PPSV23)**
Prevnar (PCV13) x 1 in adults if never received
*At age 10 or older
**At age 2 years or older, booster 5 years later, and at age 65 years or older |
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Term
| What is the primary cause of iron overload in patients with sickle cell disease? |
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Definition
Chronic blood transfusions
Iron overload can damage the liver, heart and other organs. Chronic blood transfusions often require use of chelating agents to remove excess iron. |
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Term
| PD is a 3 year-old male with sickle cell disease and functional asplenia. Which of the following vaccinations are recommended for this patient? |
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Definition
| The spleen, which plays a unique role in clearing infections with encapsulated bacteria, is damaged by repeated vaso-occlusive crises, placing SCD patients at higher risk of infections. In addition to the normal childhood vaccine series (which includes HiB and pneumococcal conjugate [Prevnar 13 or PCV13] vaccines), PD should receive the meningococcal and pneumococcal polysaccharide [Pneumovax 23 or PPSV23] vaccines. |
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Term
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Definition
| Deferoxamine is the antidote for iron toxicity. It has significant toxicities, requires prolonged infusions and because it is an injection, it cannot have drug interactions in the gut. Chelation therapy with deferoxamine has been replaced by use of the newer oral chelating agents (Exjade and Jadenu). |
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