PMCOL 233 Midterm 2

hypochromic anemia

hypochromic anemia

chronic blood loss

megaloblastic anemia

vit b12 or folic acid deficiency (large cells)

pernicious anemia

fewer cells bc of IF deficiency

hematinic agents

iron, folic acid, B12

hematopoietic GF

EPO, gcsf, gmcsf, magakaryocyte,

iron absorption

ferric iron ingested, ferrous iron absorbed

iron formualtions (oral)

ferrous sulfate, ferrous fumarate, ferrous gluconate, polysaccharie iron complex

iron formualtions IV

iron dextran, sodium ferric gluconate, iron sucrose

iron in body

RBC contain majority of iron in Hb

iron side effects

GI distrubances, toxic effects

iron chelators usage

for iron toxicity

iron chelators examples

desferrioxamine, deferiprone, deferasirox

desferrioxamine

forms complex to excrete in urine

deferiprone

orally absorbed alternative to desferrioxamine

deferasirox

alternative but GI bleeding

folic acid mechanism

reduction of folic acid to FH4 and FH2 (FH4 for DNA synthesis)

B12 mechanism

converts methyl FH4 to FH4

EPO

stimulate RBC production

EPO mechanism

released in response to hypoxia form kidneys (10% liver) and inhbits apoptosis to prevent early cell death AND proliferation thru JAK2

EPO side effects

iron deficiency (cant keep up so RBC draw iron from blood), thrombosis (dialysis patients need anticoagulant), hypertension (increased hematocrit and AT2), seizures

aldosterone effect

increases Na reabsorption in kidney and excretes K+

aldosterone triggers

low Na+ increase AT II

loop diuretics examples

furosemide, bumetanide

loop diuretic mechansm

inhibit NA/K/2Cl carrier so Na+ not reabsorbed and 2Cl and K+ pee out

loop diuretics adverse effects

excessive loss, hypovolemia, hypoklemia, alkalosis, hypomagnesaemia, hyperuricemia, reduced renal perfusion, hearing loss, rashes, bone marrow depression, contraindicated w sulfa allergy

thiazides examples

bendroflumethiazide, hydrochlorothiazide

diuretic purpose purpose

edema, heart failure, cirrhosis, nephrotic syndrome, renal failure, hypertension

thiazide purpose

hypertension, mild heart failure, resistant edema, diabetes insipidus, hypertension

thiazide mechanism

bind Cl site of NA/Cl co transporter to stimulate natriuresis and stimulate renin secretion also reduce Ca excretion

thiazide adverse ffects

erectile dysfunction, hypochloremic alkalosis, impaured glucose intolerance, hyponatremia, hypokalemia, rashes

aldosterone antagonists examples

sprionolactone, eplernone

aldosterone antagonist purpose

resistant hypertension, heart failure, hyperaldosteronism, secondary aldosteronism

aldosterone antagonist mechanism

compete w aldosterone to inhibit Na retention and K secretion

aldosterone antagonist adverse effects

hyperkalemia, GI upset, gynecomastia, menstrual disorders, testicular atrophy

triamterene/amiloride

prevent hypokalemia, inhibit Na reabsorption,

triamterene/amiloride adverse effects

hyperkalemia, GI upset

osmotic diuretics

only water excretion

osmotic diuretics adverse effects

risk for precipitating left ventricular fialure, headache, nausea, vomiting

electrolyte disorders

important in renal failure; hypoerphosphatemia; hyperkalemia

antihypertensive for renal failure

ACE inhibitors and ARBs; reduce risk for major CV events

vit D analogues for renal failure (FYI)

used to manage secondary hyperPTH

diuretics in renal failure

treat edema; lower tendenct to develoop hyperkalemia; decrease blood pressure

potassium sparing diuretics in renal failure

should be used cautiously, hyperkalemia associated with heart failure

renal failure and epoeitin

often have impraied EPO levels and anemia; need treatment

hyperphosphatemia

increased blood phosphate levels

chronic kidney disease hyperphosphatemia

hallmark, big risk of CV disease

hyperkalemia

high blood potassium levels; more severe than phosphatemia

medications inducing hyperkalemia

K+ sparing diuretics, NSAIDs, ACE inhibitors

phosphate binding agents

prevent absorption by forming insoluble complexes in GI tract

aluminum hydroxide

bind phosphate in GI

aluminum hydroxide adverse effects

increase Al levels in dialysis patients (toxic)

calcium carbonate

binds phosphate in GI tract

calcium carbonate effects

increase calcium levels: helps hypocalcemia in CKD but may cause calcification

sevelamer hydrochloride

non calcium based phosphate binder; anion exhcange resin

sevelamer hydrochloride effects

less likely to lead to tissue calcification, lowers LDL cholestrol, GI disturbances, affects fat soluble vitamin absorption, dont use in hypophsophatemia or bowel obstruction

how to treat hyperkalemia

cation exchange resin to bind potassium in colon

sodium or calcium polystyrene sulfonate

binds K in colon in exhcange for Na or Ca

sodium or calcium polystyrene sulfonate and sorbitol effects

increased risk for GI, bleeding, ischemic cholitis, perfroation, constipation

glucose + insulin mechanism

insulin activates Na/K ATPase to move K into cells

salbutamol

B2 agonist linked to Na/K ATPase - causes K uptake into cells

desmopressin

vasopressin analogue for nocturnal enuresis in kids

desmopressin mechanism

acts on V1 V2 receptors to faciliate water reabsopriton

desmopressin adverse effects

water intoxication (hyponatremia)

hypotension when low cardiac output

anticholinergics for incontinence

mAChR antagonists to prevent contraction s

M3 selective antagonists

darifenacin, solifenacin

nonselective mAChR antagonists

oxybutinin, tolterodine

mirabegron

B3 agonist

mirabegron mechanism

B3 agonist in detrusor smooth muscle to induce relaxation and increase bladder capacity

mirabegron adverse effects

BP, bladder pain, dry mouth, headache, dizzy, less UTI likelihood

2 types hormonal contraceptives

combined pill, progestogen only

combined pill

ethinyletradiol + progestogen

2nd gen progestogens (3)

noresthisterone, levonorgestrel, ethynodiol

3rd gen progestogen (2)

desogestrel, gestodene

combined pill mechanism

estrogen inhbits FSH to suppress follicular deveoopment, and progestogen inhbits LH to prevent ovulation; discourages implantation

combined pill adverse effects

nausea, tender breasts, flushing, breakthru bleeding, dizzy, depression, acne, weight gain, thromboembolism

combined pill benefits

reduce ovarian/ endometrial cancer risk, decreased menstrual symptoms, reduced iron deficient anemia

progestogen only pill

taken daily no breaks for people who experience complications from estrogen

progestogen only pill mechanism

makes cervical mucus inhospitable to sperm, inhbits implantation, and alters motility/secretions of fallopian tubes

progestogen only pill adverse effects

irregular bleeding, less reliable,

emergency contraception effects

nausea and vomiting

levonorgestrel

emergency contraception

long acting progestogen only

depot medroxyprogestogen IM

oxytocin

nonapeptide to promote contraction- receptor expression induced by estrogen

oxytocin mechanism

Gq GPCR yo increase Ca2+ to activate calmodulin and stimulate MLCK

oxytocin adverse effects

hypotensio/ reflex tachycardia, sustained contractions reducing blood flow and O2 delivery leading to fetal death/distress, uterine rupture, antidiuretic effects

ergometrine

only works onrelaxed uterus to cause contraction

ergometrin emechanism

a- adrenoreceptors and also 5HT receptors

ergometrine adverse effects

vomiting by activating D2 receptors in CTZ, vasoconstriction and increased blood pressure

mifepristone

induce medical abortion when followed by prostaglandin

mifepristone mechanism

antiprogestogen; compettiive anatagonist to sensitize uterus to prostaglandins

prostaglandins mechanism

analogs to induce myometrial contraction

dinoprostone, gemeprost

prostaglandin E2 analog

carboprost

prostaglandin F2a analog

atosiban

inhibit uterine motility (delay labour)

atosiban mechanism

competitive antagonist of oxytocin receptor; decrease IP3 decrease Ca prevent MLCK activation

treat infertitlity examples

clomiphene, gonadorelin, follitropin, lutropin

GnRH

buserelin, leuprorelin, goserelin, nafarelin

clomiphene mechanism

estrogen antagonist to promote gonadotropin release by inhibiting estrogen affects; promotes FSH secretion

infertility drugs adverse effects

flushing, vaginal dryness, bone loss

clomiphene adverse effect

reversible ovarian enlargement