Anemia Top 200/300

What kind of vitamin is cyanocobalamin?

1. Fat-soluble, B1

2. Fat-soluble, B12

3. Water-soluble, B12

4. Water-soluble, B1

Water-soluble, B12

• Cyanocobalamin is a form of vitamin B12, a water-soluble vitamin and cannot be stored for an extended period of time in the body 

What is the brand name for folic acid?

1. FA-8

2. Thiamject

3. Niacor

4. Folate

FA-8

• Niacor is the brand name of niacin

• Thiamiject is the brand name of thiamine

• Folate is the natural form of vitamin B9 (folic acid) found in diet

Select the correct alternative name for ferrous sulfate.

1. Biotin

2. Cyanocobalamin

3. Iron

4. Niacor

Iron

• Cyanocobalamin is vitamin B12

• Niacin in the generic of Niacor

• Biotin is also a B vitamin (B7)

Which of the following reasons could be an indication for folic acid supplementation when counseling a patient? 

1. Constipation relief

2. Tingling sensation in feet and hands

3. Macrocytic anemia

4. General malaise

Macrocytic anemia

• Indications of macrocytic anemia include larger than normal red blood cells (RBC), low hemoglobin (Hgb), high mean corpuscular volume (MCV) and low folate levels. To treat this type of anemia, either folic acid or B12 supplementation is needed.

True or False:

Ferrous sulfate facilitates the transportation of oxygen via hemoglobin

True

True or False:

Folic acid is only available with a valid prescription

False

• is available both as a prescription and an over-the-counter (OTC) item

Cyanocobalamin is available in all of the following dosage forms, EXCEPT:

1. oral capsule

2. nasal solution

3. injection

4. sublingual tablet

oral capsule

Which of the following classifications is correct for folic acid?

1. Vitamin, water-soluble

2. Vitamin, fat-soluble

3. Vitamin, non-soluble

Vitamin, water-soluble

• As a water-soluble vitamin, it is dissolved in water upon entering the body and cannot be stored for an extended period of time as a reserve to be used later

True or False:

The most common adverse drug effect seen with cyanocobalamin is rhinitis.

False

• top adverse effects for cyanocobalamin are listed as headache (IM: 20%, Intranasal 4%), Infection (12-13%), and asthenia (IM: 16%, Intranasal 4%). Rhinitis is cited as an incidence rate of 4-8%

True or False:

Cyanocobalamin can be purchased over-the-counter

True

• Available as lozenges and tablets

For an adult patient with macrocytic anemia due to folate deficiency, what is the appropriate oral dose of folic acid to initially recommend?

1. 50 mg once daily 

2. 1-5 mg once daily

3. 0.4 mg once daily

4. 0.1 mg once daily 

1-5 mg once daily

True or False:

Iron is present in breast milk.

True

• it is common to see iron supplementation during pregnancy and post-partum for patients with iron deficiency

Which of the following regimens should a patient be placed on for initial treatment of mild vitamin B12 deficiency?

1. 1000 mcg cyanocobalamin IM once monthly

2. 500 mcg Cyanocobalamin sublingual twice daily

3. 500 mcg Cyanocobalamin intranasally once daily x4-8 weeks then 500 mcg Cyanocobalamin intranasally once weekly

4. 1000 mcg once IM weekly x4-8 weeks, then 1000 mcg Cyanocobalamin IM once monthly

1000 mcg once IM weekly x4-8 weeks, then 1000 mcg Cyanocobalamin IM once monthly

Which counseling point is most appropriate to tell a patient receiving oral cyanocobalamin?

1. This medication is best absorbed on an empty stomach.

2. This medication needs to be taken with a calcium source, such as dairy or a calcium supplement.

3. This medication is best absorbed when taken with a meal.

4. This medication can cause severe nausea and vomiting when taken with alcohol..

This medication is best absorbed when taken with a meal.

Which of the following adverse drug events is most likely due to ferrous sulfate supplementation?

1. Malaise

2. Myalgia

3. Flushing

4. Stool darkening

Stool darkening

What is the breast-feeding recommendation for cyanocobalamin?

1. Human Data Suggest Potential Toxicity

2. Compatible

3. Withhold Breastfeeding

4. Contraindicated

Compatible

True or False:

There are no boxed warnings associated with folic acid

True

Which of the following categories includes ferrous sulfate?

1. Iron supplement

2. Multivitamin 

3. Vitamin B supplement

4. Vitamin D supplement 

Iron supplement

True or False:

A boxed warning for heartburn exists for ferrous sulfate.

False

• Those taking ferrous sulfate may experience heartburn as an ADE, but it is not a boxed warning

True or False:

Ferrous sulfate is available over-the-counter (OTC).

True

Which of the following preparations of folic acid is not commercially available?

1. Oral capsule

2. Oral tablet

3. Solution for injection

4. Oral solution

Oral solution

What is the generic name for Nascobal?

1. Niacin

2. Thiamine

3. Folic Acid

4. Cyanocobalamin

Cyanocobalamin

• Nascobal is the nasal solution formulation of Vitamin B12

• Folic acid is the generic for FA-8

• Niacin is the generic for Niacor

• Thiamine is the generic for Thiamiject

Which of the following adverse effects is associated with metformin?

1. Constipation

2. Vitamin B12 deficiency

3. Folic acid deficiency 

4. Hypoglycemia

Vitamin B12 deficiency

• Metformin inhibits the absorption of B12 from dietary intake; additional supplementation is likely required. Metformin causes diarrhea especially with initiation or dose modifications, not constipation. Metformin is not associated with hypoglycemia, though it lowers blood glucose through multiple mechanisms. Metformin is not associated with folic acid deficiency. 

What role does cyanocobalamin play in human physiology?

1. Promotes synthesis of clotting factors within the liver

2. Enables the synthesis of coenzymes for purine and pyrimidine synthesis

3. Acts as a coenzyme for carbohydrate metabolism only

4. Promotes fat and carbohydrate metabolism, as well as protein synthesis

Pomotes fat and carbohydrate metabolism, as well as protein synthesis

Which of the following counseling points is most appropriate for ferrous sulfate?

1. Ferrous sulfate capsules can be opened and sprinkled on applesauce

2. If a missed dose occurs, it is best to double the next dose

3. Antacids can be taken at the same time

4. Ferrous sulfate works better on empty stomach

Ferrous sulfate works better on empty stomach

Ferrous sulfate is available in all of the following formulations, EXCEPT:

1. nasal spray.

2. immediate release tablet.

3. liquid.

4. controlled release tablet.

nasal spray

For an adult patient with identified iron-deficiency, what is the typical oral dose of ferrous sulfate recommended?

1. 50 mg elemental iron once daily

2. 65 mg of elemental iron every other day or three times weekly

3. 65 mg of elemental iron once daily

4. 1 mg/kg/day elemental iron

50 mg elemental iron once daily

True or False:

Folic acid has been associated with a poor taste after oral administration

True

True or False:

Folic acid is contraindicated in pregnancy.

False

• Folate supplementation (as folic acid) is recommended in all patients planning a pregnancy or who may become pregnant to decrease the risk of fetal neural tube defects.

• Folate supplementation is also the appropriate treatment for anemias due to folate deficiency in patients who are pregnant.