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Questions and Answers
What is one of the primary reasons for poor absorption of oral iron in this patient?
What is one of the primary reasons for poor absorption of oral iron in this patient?
What is the daily recommendation of elemental iron for patients with iron deficiency anemia?
What is the daily recommendation of elemental iron for patients with iron deficiency anemia?
Which of the following medications can significantly interact with orally given iron tablets?
Which of the following medications can significantly interact with orally given iron tablets?
What adverse effect might cause the patient to forget doses of FeSO4?
What adverse effect might cause the patient to forget doses of FeSO4?
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What condition is noted that could lead to poor response to oral iron therapy?
What condition is noted that could lead to poor response to oral iron therapy?
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How does the use of antacid preparations affect oral iron absorption?
How does the use of antacid preparations affect oral iron absorption?
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What is the potential impact of higher doses of elemental iron on patient compliance?
What is the potential impact of higher doses of elemental iron on patient compliance?
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Which treatment can potentially contribute to poor absorption of iron when administered concurrently?
Which treatment can potentially contribute to poor absorption of iron when administered concurrently?
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What should be done if a patient experiences side effects from FeSO4?
What should be done if a patient experiences side effects from FeSO4?
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What dietary component can improve iron absorption?
What dietary component can improve iron absorption?
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What is a potential underlying cause for low response to oral iron therapy?
What is a potential underlying cause for low response to oral iron therapy?
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Why is erythropoietin given to patients with CKD?
Why is erythropoietin given to patients with CKD?
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What precaution should be observed when administering erythropoietin?
What precaution should be observed when administering erythropoietin?
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What are the symptoms commonly associated with anemia in the patient case described?
What are the symptoms commonly associated with anemia in the patient case described?
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How might antacids interact with oral iron supplementation?
How might antacids interact with oral iron supplementation?
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In patients with CKD, the production of which hormone is insufficient leading to anemia?
In patients with CKD, the production of which hormone is insufficient leading to anemia?
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What is a contraindication for initiating treatment with erythropoietin?
What is a contraindication for initiating treatment with erythropoietin?
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Which of the following side effects should patients be informed about after starting erythropoietin treatment?
Which of the following side effects should patients be informed about after starting erythropoietin treatment?
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What Hb concentration should be closely monitored and not exceed during erythropoietin treatment?
What Hb concentration should be closely monitored and not exceed during erythropoietin treatment?
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How much folic acid is recommended for women to prevent neural tube defects during pregnancy?
How much folic acid is recommended for women to prevent neural tube defects during pregnancy?
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What should be done if a patient’s Hb level exceeds 11 g/dL during erythropoietin treatment?
What should be done if a patient’s Hb level exceeds 11 g/dL during erythropoietin treatment?
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What additional supplements might be necessary for patients with chronic kidney disease receiving erythropoietin?
What additional supplements might be necessary for patients with chronic kidney disease receiving erythropoietin?
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Why is it important to correct factors contributing to anemia in CKD in addition to administering erythropoietin?
Why is it important to correct factors contributing to anemia in CKD in addition to administering erythropoietin?
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What skin reaction should patients be advised to monitor for when starting erythropoietin treatment?
What skin reaction should patients be advised to monitor for when starting erythropoietin treatment?
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Study Notes
Hematological Disorders - Pharmacology Tutorial
- A 30-year-old male with iron deficiency anemia (IDA) and gastritis was prescribed ferrous sulfate (FeSO4) 200mg three times daily (tds) and omeprazole for antacid.
- After six weeks, there was no improvement in the hemoglobin (Hb) level.
- Possible reasons for lack of response to iron therapy include impaired oral iron absorption due to concomitant antacid use (omeprazole reduces gastric acidity).
- Antacids containing divalent metal ions (e.g., Zn, Mg, and Ca) compete with iron for absorption through the divalent metal transporter (DMT1).
- Timing of iron and antacid administration (e.g., two hours apart) can also affect absorption.
- Gastritis can cause occult bleeding, further contributing to iron-deficiency anemia and a poor response to therapy.
Measures to Address Iron Deficiency
- Ensure appropriate daily iron intake: Ferrous sulfate 200mg contains approximately 65mg of elemental iron, which is often sufficient.
- Optimize iron absorption: Recommend taking iron supplements two hours before or four hours after antacids to minimize interference.
- Rule out other causes of anemia: Consider GI bleeding, endoscopy if necessary.
Iron Absorption Factors
- Antacids (e.g., omeprazole) interfere with iron absorption, reducing gastric acidity and competing for transporters.
- Dietary factors like oxalates (spinach, tea), phytates (whole grains), and calcium (milk, yogurt) can reduce iron absorption.
- Foods containing vitamin C (e.g., citrus fruits, tomatoes) enhance iron absorption, and should be consumed with iron supplements.
- Food groups rich in these compounds are to be avoided during iron therapy.
Erythropoietin in Chronic Kidney Disease (CKD)
- CKD is a progressive disease where kidneys gradually lose function, leading to reduced erythropoietin production.
- Erythropoietin (EPO) is a glycoprotein hormone. It stimulates red blood cell (RBC) production in bone marrow.
- In CKD patients, EPO production is reduced leading to anemia.
- EPO therapy aims to correct anemia.
- Important precautions include monitoring for hypertension, thrombotic complications, and skin reactions.
- Hb levels should be maintained between 10 and 12 g/dL to avoid overcorrection of anemia. Further patient monitoring is necessary.
Folic Acid
- Folate deficiency can cause megaloblastic anemia.
- Folic acid supplementation (5 mg daily for four months) is used to treat folate deficiencies, often combined with vitamin B12 (if needed).
- Folic acid is necessary to prevent neural tube defects during pregnancy.
- A dosage of 400-500 mcg before or in the early stages of pregnancy is common, and higher doses might be necessary for conditions like pregnancy-related folate deficiencies.
- Some drugs, such as methotrexate, can interfere with folic acid absorption and therefore require alternate administration schedules if necessary.
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Description
This quiz explores the pharmacological management of hematological disorders, particularly focusing on iron deficiency anemia and its treatment implications. It covers the effects of antacids on iron absorption and the importance of appropriate therapy to improve hemoglobin levels. Test your knowledge on the mechanisms and recommendations for effective treatment.
