Drugs for deficiency anemias

1
Drugs for deficiency anemias
2
anemia

• Decrease in number of RBCs size, hemoglobin
  content
• Why?

3
Development of RBCs

• Requirements healthy bone marrow
• Erythropoietin
• Iron
• Vitamin B12
• Folic acid

4
Functions of iron

• Enzymes
• Hemoglobin
• myoglobin

5
Daily requirements

• Determined by rate of RBC production
• Sources

6
Iron deficiency

• Usually increased demand
• Red cells becomes small and pale
• Decreased RBC count
• Decreased reticulocyte hemoglobin content
• Decreased H H

7
Treatment

• Replace the iron with Ferrous sulfate
• PO
• Given for prophylaxis
• Adverse effects include GI symptoms, staining
  of teeth (liquid)
• Poisoning in children

8

• Should be given with food to prevent GI side
  effects but effects absorption
• Doses should be spaced evenly throughout the day

9
Parenteral iron

• Iron dextran
• Given to individuals who cannot tolerate oral
  dosing or unable to absorb po iron
• Can cause anaphylactic reactions, fever, IM
  pain and discoloration at injection site, IV
  route is preferred

10
Vitamin B 12 deficiency

• Known as cobalamins
• Consequences of deficiency include anemia and
  injury to the nervous system, GI disturbances,
  impaired production of WBC and platelets
• Required for growth and division of all cells
  because it helps catalyze the conversion of folic
  acid to its active form

11

• Absorption requires intrinsic factor which is
  secreted by parietal cells of the stomach
• Most is stored in liver
• Sources

12
Deficiencies

• Usually impaired absorption
• Lack of intrinsic factor gastric surgery,
  atrophy of parietal cells
• Enteritis, celiac disease, antibodies against B
  12 intrinsic factor complex

13
Megaloblastic anemia

• Demyelination of neurons may not be reversed by
  folic acid but hematologic effects may be
  helped by folic acid
• Hypoxia
• Deficiency of B12 will also prevent bone marrow
  from making WBC and plt
• Can measure amount in serum and Schilling
  measures B 12 absorption

14

• B12 can be given oral, intranasal, and parenteral
  (IM, SC)
• Should not be given IV

15
Folic acid deficiency

• Megaloblastic anemia also
• Must determine source
• Deficiency of folic acid, B12 or both?
• Folic acid important for DNA synthesis
• Usual cause is poor diet (alcoholics) and
  malabsorption

16

• Consequences of deficiency leukopenia,
  thrombocytopenia, oral and GI disturbances
• Neural tube defects in developing fetus
• Can draw plasma levels
• Given in inactive and active forms
• Most common active form

17

• Oral therapy most commonly used
• Can be given IM

18
Erythropoietin

• Epogen, procrit
• Uses patients with chronic renal failure, HIV
  infected patients taking zidovudine (AZT) and
  patients with nonmyeloid malignancies taking
  chemotherapy

19

• Purpose is to stimulate production of
  erythrocytes
• Can see improvement in 1-2 weeks
• Given IV or SC
• Patients may need adjustment of antihypertensive
  med with giving

20

• Do not shake vial
• 50-100u/kg 3x per week
• Patients taking chemotherapy dosage is 150u/kg

21
Filgrastim

• Neupogen
• Given for elevation of neutrophil counts in
  cancer patients
• Treatment of severe chronic neutropenia
• Acts on bone marrow to increase production of
  neutrophils

22

• Given to reduce the risk of infection in patients
  receiving myelosuppressive chemotherapy
• Give to patients for high-dose chemo following
  bone marrow transplant
• Patients with severe chronic neutropenia

23

• Given IV or SC
• Can cause bone pain
• Elevated uric acid, alkaline phos

24

• END
• Return to Course Site