Anaemia

in this slides I discussed some anti-anaemia drugs.

1. Anemia & Anti-anemia Drugs PRESENTED BY SHUJAT MUZAFFAR M.Sc. CLINICAL RESEARCH SECOND SEMESTER

2. ANEMIA Anemia is a condition in which lack enough healthy red blood cells to carry adequate oxygen to body's tissues. Having anemia can make feel tired and weak.

3. TYPES Aplastic anemia Iron deficiency anemia Sickle cell anemia Thalassemia Vitamin deficiency anemia

4. SYMPTOMS Fatigue Weakness Pale or yellowish skin Irregular heartbeats Shortness of breath Dizziness or lightheadedness Chest pain Cold hands and feet Headaches

5. Erythropoietin (Epoetin alpha) Trade Names: erythropoietin, Epo, Epogen, Procrit ® Drug Class: Drug Used in Anemia (normocytic) Mechanism of Action: a glycoprotein that stimulates red blood cell production . Epoetin alfa is a 165 amino acid glycoprotein manufactured by recombinant DNA technology, and has the same biological effects as endogenous erythropoietin Hypoxia is the primary physiological stimulus for erythropoietin production in the body Anti anemia Drugs

6. Indications: chronic renal failure patients zidovudine-treated HIV-infected patients cancer patients on chemotherapy reduction of allogeneic blood transfusion in surgery patients. Contraindications: Uncontrolled hypertension or known hypersensitivity Pharmacokinetics: given i.v. or s.c. Half life of 4-13 hrs in patients with chronic renal failure. It is measured in international units (IU). Side Effects: Hypertension & thrombotic complications.

7. Ferrous sulfate Trade Name: generic Drug Class: Drug Used in Anemia (microcytic) Mechanism of Action: Iron combines with porphyrin and globin chains to form hemoglobin, which is critical for oxygen delivery from the lungs to other tissues. Indications: Iron deficiency anemia, blood loss related to pregnancy or GI bleeding (NSAIDs), hookworm infestation, or excess coffee Contraindications: Patients with hemochromatosis, hemosiderosis or hemolytic anemia Pharmacokinetics: An oral (absorbable) iron formulation .

8. Side Effects: Therapeutic doses - dose related nausea, upper abdominal pain, constipation or diarrhea Iron overdose (1-2 g) can lead to circulatory collapse and death . Non-intentional iron overdose has been a leading cause of fatal poisoning in children <6 years old. Keep out of reach of children. Iron overdose can be treated by gastric lavage with a phosphate solution and deferoxamine (iron chelator) . Drug interactions: it may decrease the absorption of other medications

9. Iron Dextran Trade Name: INFeD ® Drug Class: Parental Iron Preparation Mechanism of Action: Same as ferrous sulfate (but has a different route of administration) Indications: Seldom used now (newer orally effective agents including iron sucrose & ferric gluconate complex are most commonly used). Reserved for patients with iron deficiency who: are unable to tolerate oral iron cannot absorb oral iron (e.g. due to inflammatory bowel disease affecting the proximal small bowel, post-gastrectomy conditions, or previous small bowel resection ). Ferric gluconate & iron sucrose are two alternative parenteral forms of iron that can be given i.v., but should NOT be given intramuscularly.

10. Pharmacokinetics: Given by deep i.m. injection or i.v. Most adults with iron deficiency require 1-2 g of replacement iron, or 20-40 ml. The favored route of administration is i.v. infusion in several hundred mls of normal saline over 1-2 hrs. Side Effects: More dose-dependent side effects compared to administering oral iron supplements, which limits the dose that can be given. Side effects include : Local pain & tissue staining (brown discoloration), headache, light-headedness, fever, nausea, flushing, urticaria, bronchospasm, and rarely anaphylaxis & death .

11. Folic acid Trade Name: Folvite ® Drug Class: Drug used in anemia (megaloblastic) Mechanism of Action: Essential cofactor for synthesis of amino acids, purines and DNA Indications: Treatment of megaloblastic anemias A reduced form of folic acid known as citrovorum factor (or leucovorin) Contraindications: Folic acid should not be given alone in patients with pernicioius anemia without knowing whether they also have a Vit B12 deficiency. The Shilling test can be used to test for abnormalities in Vit B12 absorption.

12. Pharmacokinetics: 1 mg of folic acid orally daily is typically sufficient to reverse megaloblastic anemia & restore normal folate levels. Side Effects: Allergic sensitization Notes: Folate deficiency (in pregnant women) is implicated as a cause of congenital malformations in newborns Folate may also play a beneficial role in preventing the development vascular disease such as ischemic heart disease & stroke. Folic acid supplements may mask the signs of Vit B 12 deficiency, which can produce neurological disease if undetected Folic acid deficiency is also known as Will's disease .

13. Vitamin B12 Generic Names: generic, cyanocobalamin, hydroxocobalamin Drug Class: Vitamin Mechanism of Action: A cofactor for several essential biochemical reactions. Indications: Used to treat or prevent deficiency of Vit B12. The most common causes of Vit B12 deficiency are: Pernicious anemia (results from defective secretion of intrinsic factor by the gastric mucosal cells) Fish tapeworm infection Partial or total gastrectomy Various intestinal disorders that impair absorption of Vit B12. Pharmacokinetics: Different formulations can be administered orally, or by parenteral injection.

14. Notes: Vit B12 deficiency leads to megaloblastic anemia , GI symptoms & neurological abnormalities including degeneration of myelin sheaths in axons of the spinal cord & peripheral nerves. Vit B12 deficiency symptoms: paresthesias & weakness in peripheral nerves, progressing to spasticity, ataxia & other CNS dysfunctions. Vit B12 deficiency in elderly patients due to abnormal absorption of dietary Vit B12 is relatively common and easily treated.