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Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 55 Drugs for Deficiency Anemias
2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Anemias Anemias Decrease in erythrocytes (RBCs) Number Size Hemoglobin content Causes Blood loss Hemolysis Bone marrow dysfunction Deficiency of substances essential for RBC formation and maturation Deficiency of substances essential for RBC formation and maturation
3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Red Blood Cell Development Development begins in the bone marrow Matures in the blood Evolves through four stages Healthy development requires: Healthy bone marrow erythropoietin, iron, and other factors to support DNS synthesis
4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Biochemistry and Physiology of Iron Metabolic functions Fate in the body Uptake and distribution Uptake into mucosal cells in small intestine Uptake into mucosal cells in small intestine Undergoes storage within mucosal cells Undergoes storage within mucosal cells Undergoes binding to transferrin Undergoes binding to transferrin Utilization and storage Taken up by cells of the bone marrow Taken up by cells of the bone marrow Taken up by the liver and other tissues Taken up by the liver and other tissues Taken up by muscle Taken up by muscle
5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron in the Body Fate in the body (cont’d) Recycling: undergoes continuous recycling Elimination: 1 mg of iron excreted each day Regulated through control of intestinal absorption
6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron Deficiency Most common nutritional deficiency and cause of nutrition-related anemia Causes Consequences Diagnosis
7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron Daily requirements Determined by rate of erythrocyte production Increased requirement during pregnancy Dietary sources Available in foods of plant and animal origin
8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron Deficiency: Causes, Consequences, and Diagnosis Results from an imbalance in iron uptake and iron demand Causes Pregnancy (blood volume expansion) Infancy and early childhood Chronic blood loss Consequences Microcytic, hypochromic anemia
9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron Deficiency: Causes, Consequences, and Diagnosis Diagnosis Presence of microcytic, hypochromic erythrocytes Absence of hemosiderin in bone marrow Other laboratory work RBC count RBC count Reticulocyte count Reticulocyte count Hemoglobin Hemoglobin Hematocrit Hematocrit Serum iron Serum iron Increased serum iron-binding capacity (IBC) Increased serum iron-binding capacity (IBC)
10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Oral Iron Preparations I: Iron Salts Ferrous sulfate Indications—drug of choice Prophylactic therapy Adverse effects GI disturbances Staining of teeth Toxicity
11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Oral Iron Preparations I: Iron Salts Drug interactions Antacids Tetracycline Ascorbic acid Other oral iron salts Ferrous gluconate, ferrous fumarate, and ferrous aspartate Carbonyl iron
12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Parenteral Iron Preparations I: Iron Dextran Iron dextran (INFeD, DexFerrum) Used for patients who have experienced intolerable or ineffective oral dosing Adverse effects Anaphylactic reactions Hypotension Persistent pain with IM injection
13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Parenteral Iron Preparations II: Sodium Ferric Gluconate Complex and Iron Sucrose Alternatives to iron dextran Sodium ferric gluconate (SFGC) (Ferrlecit) Low risk of anaphylaxis Low risk of anaphylaxis Iron sucrose (Venofer) Limited to patients undergoing chronic hemodialysis Limited to patients undergoing chronic hemodialysis All patients must also receive erythropoietin All patients must also receive erythropoietin Most common side effects Hypotension Cramps Ferumoxytol Approved in 2009 Iron deficiency anemia, chronic kidney disease (CKD)
14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Iron Deficiency Treatment Guidelines Assessment Routes of administration Duration of therapy Therapeutic combinations
15Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Vitamin B 12 (Cobalamin) Essential for synthesis of DNA Absorption requires intrinsic factor Elimination takes place very slowly Daily requirement Dietary sources Limited to microorganisms Animal products (liver, dairy products) Fortified foods
16Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Vitamin B 12 (Cobalamin) Fate in the body Absorption Distribution and storage Elimination
17Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Vitamin B 12 Deficiencies: Causes, Consequences, and Diagnosis Causes Usually result of impaired absorption Regional enteritis Celiac disease Absence of intrinsic factor
18Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Vitamin B 12 Deficiencies: Causes, Consequences, and Diagnosis Consequences Megaloblastic anemia Neurologic damage Demyelination of neurons Demyelination of neurons GI disturbances Diagnosis Measurement of plasma B 12 Schilling test
19Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Vitamin B 12 Preparations: Cyanocobalamin Administration Oral, parenteral, intranasal Oral, parenteral, intranasal Adverse effects Hypokalemia Hypokalemia Long-term treatment With lack of intrinsic factor, vitamin B 12 therapy lifelong With lack of intrinsic factor, vitamin B 12 therapy lifelong Potential hazards of folic acid Potential hazards of folic acid
20Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Guidelines for Treating Vitamin B 12 Deficiency Route of B 12 administration Treatment of moderate B 12 deficiency Treatment of severe B 12 deficiency Long-term treatment Potential hazard of folic acid
21Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Folic Acid Deficiency Folic acid Essential factor for DNA synthesis DNA replication DNA replication Cell division cannot proceed Cell division cannot proceed Absorbed in the early segment of the small intestine Significant amounts excreted daily Daily requirements Dietary sources: all foods
22Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Folic Acid Anemia: Causes and Consequences Causes Poor diet (malnutrition and alcoholism) Malabsorption syndrome (sprue) Consequences for developing fetus Neural tube defects (eg, spina bifida, anencephaly) Adequate intake before conception is critical The USPSTF now recommends that women of child-bearing age consume 400 to 800 mcg of supplemental folate each day, in addition to the folate they get in food
23Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Folic Acid Anemia: Causes and Consequences Consequences for anyone Megaloblastic anemia Leukopenia, thrombocytopenia, injury to the oral and GI mucosa May increase risk of colorectal cancer and atherosclerosis
24Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Folic Acid Preparations Nomenclature Folic acid (pteroylglutamic acid)
25Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Guidelines for Treating Folic Acid Deficiency Choice of treatment modality Route of administration Prophylactic use of folic acid Treatment of severe deficiency
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 55 Anemia Drugs.
Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 56 Blood-Forming Drugs.
Dr. Soban sadiq. Oral Therapy: Ferrous Sulphate Ferrous Fumarate Ferrous Gluconate Parenteral Therapy: Iron Dextran Iron-sucrose complex Iron sodium.
Dr. Sadia Batool Shahid PGT-M-Phil, Pharmacology.
MLAB Hematology Fall 2007 Keri Brophy-Martinez Unit 10: Megaloblastic Anemias.
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Agents Used to Treat Anemias. Anemia Decreased number of circulating red blood cells Decreased hemoglobin = decreased oxygen capacity Many causes. 22.
Stored in the body as ferritin Deficiency result from negative iron balance due to depletion of stores and/or inadequate intake. Iron deficiency.
Hematologic Problems Klecka, Spring Learning Outcomes (Anemia) Describe and classify anemia's Understand the nursing management for specific anemia’s.
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Focus on Anemia.
1 Antianemics Prof. Hanan Hagar. 1. Iron. 2. Vitamin B Folic Acid. 4. Erythropoietin 2.
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Chapter 22 Agents Used to Treat Anemias. Anemia p526 Decrease in hemoglobin or decrease in RBCs Many causes of anemia – Iron deficiency anemia – Chemotherapy.
I. PRIMARY PROBLEM II. THERAPEUTIC GOALS III. MANAGEMENT PHARMACOLOGIC NON PHARMACOLOGIC.
Chapter 54 Anemia Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Haematinic Drugs Course: Pharmacology I Course Code: PHR 213 Course Instructor: Md. Samiul Alam Rajib Senior Lecturer Department of Pharmacy BRAC University.
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ANEMIA DRUGS DSN KEVIN DOBI, MS, APRN Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Chapter 54.
Anemias. Body Contents of Iron Structure of Hemoglobin.
Anemia of chronic disease is a hypoproliferative ( بالتدريج) anemia associated with chronic infectious or inflammatory processes, tissue injury, or conditions.
Megaloblastic anemias MA are a group of disorders characterized by defective nuclear maturation caused impaired DNA synthesis. This is usually due to vitamin.
Nada Mohamed Ahmed, MD, MT (ASCP)i. Definition. Physiology of iron. Causes of iron deficiency. At risk group. Stages of IDA (pathophysiology). Symptoms.
Iron Deficiency Anemia Iron Metabolism: Iron Metabolism: IRON INTAKE (Dietary) - “ average ” adult diet = mg Fe/day - absorption = 5-10% (0.5-2 mg/day)
TRACE ELEMENTS IRON. IRON METABOLISM DISTRIBUTION OF IRON IN THE BODY Between 50 to 70 mmol (3 to 4 g) of iron are distributed between body compartments.
Objectives : When you complete this section,you should be able to : 1- Explain where blood is produced in the fetuses, children& adults. 1- Explain where.
A 30 year old male presents to you with complaints of easy fatigability, lack of concentration, breathlessness on performing normal daily activities.
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Drugs used in Anemia :Lecture outline 1. Definition 2. Types of supplements 3. Clinical pharmacology for each 4. Important indications and adverse effects.
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What is Anemia? Anemia is having less than normal number of red blood cells or less hemoglobin than normal in the blood. *Microcytic Anemia: Any abnormal.
The blood cells may lack enough hemoglobin, the protein that gives blood its red color. Anemia affects one in 10 teen girls and women. It also develops.
Chapter 22 Agents Used to Treat Anemias. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Anemia.
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Drugs used in the treatment of Anemia Prepared by: Dr. Ghazi Bamagous.
Causes Blood loss – usually from uterus or GI tract Increased demands such as growth and pregnancy Decreased absorption – post gastrectomy, Coeliac disease.
IRON 7 mg/1000 cal in diet; 10% absorbed Heme iron absorbed best, Fe 2+ much better than Fe 3+ –Some foods, drugs enhance and some inhibit absorption of.
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