This document discusses various oral and parenteral iron preparations used to treat iron-deficiency anemia. Oral iron preparations include ferrous sulfate, ferrous gluconate, and carbonyl iron. Parenteral options include iron dextran, ferrous sucrose, ferric carboxymaltose, and sodium ferric gluconate. The ideal daily elemental iron dose is 200 mg in divided doses. Therapy may need to continue for 2-4 months after hemoglobin levels normalize to replenish iron stores. Adverse effects and drug interactions are also reviewed.
Introduction to the endocrine system
Growth hormone: Mechanism of Action, secretion, regulation.
Prolactin
Sex hormones
Oral contraceptives
Corticosteroids
In this PPTs you will get in depth information about insulin and the first class of oral hypoglycemic agents , Sulfonylurea.
useful for GPAT and Third Year B.Pharm students.
Hypolipidemic drug, also called lipid-lowering drug, any agent the reduces the level of lipids and lipoproteins (lipid-protein complexes) in the blood.
Introduction to the endocrine system
Growth hormone: Mechanism of Action, secretion, regulation.
Prolactin
Sex hormones
Oral contraceptives
Corticosteroids
In this PPTs you will get in depth information about insulin and the first class of oral hypoglycemic agents , Sulfonylurea.
useful for GPAT and Third Year B.Pharm students.
Hypolipidemic drug, also called lipid-lowering drug, any agent the reduces the level of lipids and lipoproteins (lipid-protein complexes) in the blood.
Treatment of Iron Deficiency Anemia in AdultsLinh Vo
Describe Pathophysiology of Iron absorption and elimination
Define Iron Deficiency Anemia
Describe Causes, Laboratory and Diagnoses of Iron Deficiency Anemia in Adults
Discuss Non-Pharmacological Treatment
Discuss Pharmacological Treatment and Management of Iron Deficiency
complete treatment guidelines about the iron deficiency anaemia.it gives information about all forms of treatment.information given is more than enough for a medical student
Treatment of Iron Deficiency Anemia in AdultsLinh Vo
Describe Pathophysiology of Iron absorption and elimination
Define Iron Deficiency Anemia
Describe Causes, Laboratory and Diagnoses of Iron Deficiency Anemia in Adults
Discuss Non-Pharmacological Treatment
Discuss Pharmacological Treatment and Management of Iron Deficiency
complete treatment guidelines about the iron deficiency anaemia.it gives information about all forms of treatment.information given is more than enough for a medical student
Iron Chelation Therapy
Ashutosh Lal, MD.
January 18, 2014
Thalassemia Patient and Family Conference
Northern California Comprehensive Thalassemia Center
Children's Hospital Oakland
Iron toxicity in the human body, its mechanism, and effects, How iron toxicity can be treated pharmaceutically and the drugs administered. Mechanism of iron absorption in the body.
The most common causes of anemia are poor nutrition, iron deficiencies, micronutrients deficiencies including folic acid, vitamin A and vitamin B12, diseases like malaria, hookworm infestation and schistosomiasis.
Iron poisoning (physical appearance, sources- dietary and environmental, uses- industrial and biological, usual fatal dose, toxicokinetics, mode of action, clinical features, diagnosis, treatment, autopsy features
Monoferric is indicated for the treatment of iron deficiency anemia (IDA) in adult patients.
who have intolerance to oral iron or have had unsatisfactory response to oral iron.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
6. Ferrous
sulfate
ferrous
sulfate
(exsiccated)
Ferrous
gluconate
Ferrous
fumarate
Polysaccharide
iron complex
Carbonyl
iron
Elemental
iron (%)
20 30 12 33 100 100
Elemental
iron
provided
• 60–65
mg/324–
325 mg
tablet
• 18 mg
iron/5 mL
syrup
• 44 mg
iron/5 mL
elixir
• 15 mg
iron/0.6
mL drop
• 65 mg/200
mg tablet
• 60 mg/187
mg tablet
• 50 mg/160
mg tablet
• 36 mg/325
mg tablet
• 27 mg/240
mg tablet
• 33 mg/100
mg tablet
• 63–66
mg/200 mg
tablet
• 106
mg/324–
325 mg
tablet
• 15 mg/0.6
mL drop
• 33 mg/5 mL
suspension
• 150 mg capsule
• 50 mg tablet
• 100 mg/5 mL
elixir
• 50 mg
caplet
Ferrous salts available in the market
7. • Oral preparations – strong protein precipitating action – can not be
injected
• Variations in the ferrous salts have relatively little effect on the
bioavailability.
• Sulfate, fumarate, and gluconate salts are absorbed approximately same
extent.
• Addition of cobalt, copper, or other substances only adds in expense
without significant benefit.
• Iron is best absorbed in ferrous (Fe2+) reduced form
• Maximum absorption in duodenum (∵ acidic nature of stomach)
• Only 10 – 20 % of administered dose is absorbed from G.I.T.
8. • Slow-release or sustained release iron preparations
do not undergo sufficient dissolution until they
reach the small intestine
⇓
In the alkaline environment of the small intestine
⇓
iron tends to form insoluble complexes
⇓
significantly reduces absorption
9. • Many oral formulations available in India contain iron compounds along
with many vitamins, yeast, amino acids and other minerals.
• But they are considered irrational.
• Technical advisory board (India) has recommended that even B complex
vitamins and zinc should not be added to iron preparations.
• Combination of iron with strychnine, arsenic and yohimbine and all fixed
dose combination of haemoglobin in any form are banned in India.
10. Treatment strategy
Elemental iron content is to be taken into account, not the total iron
compound
• Recommended – 200 mg elemental iron daily in 2 – 3 divided doses
⇛ Maximum haematopoietic effect
• If not tolerated ⇛ - small amounts
- e.g.Tab. Fe sulfate 325 mg ⇛ 65 mg (20%)
• Generally, start with low dose ⇛ escalation gradually to full dose
11. Administration:
• 1 hour before meal (food interferes with absorption), but side effects are
more
• some prefer giving larger amounts after meals, while others like to give
smaller doses in between meals
• Liquid preparations stain the teeth; should be put on back of tongue.
• Less satisfactory in general.
12. Adverse Drug Reactions
• Epigastric pain,
• Heartburn,
• Nausea, vomiting,
• Bloating,
• Staining of teeth, metallic taste,
• Colic
• Constipation (astringent action of iron) is more common than diarrhoea
(irritant action)
13. Common Preparations of oral iron
oFerrous sulfate:
• The cheapest; preferred; Leaves metallic taste
oFerrous fumarate:
• Less water soluble than ferrous sulfate; tasteless
oCarbonyl iron:
• High purity metallic iron in very fine powder form (particle size < 5 μM)
• Absorbed from intestines over a long time, better gastric tolerance
• Bioavailability is about 3/4th that of ferrous sulfate
14. Ferric hydroxy polymaltose:
• Vigorously promoted for its high iron content, no metallic
taste, good g.i. tolerability and direct absorption from the
intestines
• Because the complex releases little free iron in the gut lumen
— g.i. irritation is minimal
• High bioavailability observed in rats has not been found in
humans.
• Reports of its poor efficacy in treating iron deficiency anaemia
have appeared
• Therapeutic efficacy is questionable.
15. Daily Dose of Iron and Improvement in Hb level
• Suppose Ferrous sulphate (hydrated - 7H2O) is administered 300 mg tid total daily
FeSO4 = 900 mg
• 20 % of elemental iron = per day 180 mg (20 % of 900 mg) elemental iron is given
• Presuming that 10 % of this gets absorbed 18 mg available for Hb synthesis
• This increases Hb by about 0.16 g/dl, means correction of Hb deficit is by 1 % per day
• If Hb is deficient by more than 3 g/dl, an average increment of 0.1 - 0.2 g/dl/day is
observed with usual therapeutic doses
16. How long the therapy will be needed?
• Considering daily rate of about 0.2 g/dl rise in Hb and normal level of 14.8
g/dl,
• if Hb level in an anaemic patient is 5 g/dl it may take about 50 days
(approx. 2 months) to reach normal level
• As the anaemic status improves, rate of absorption decreases
• Iron stores (total 40-50 mg/kg) may increase at a rate not more than 100
mg per month
• Hence, therapy should be continued for a 2-4 months after Hb level
becomes normal.
17. DrugsThat Decrease
Iron Absorption
Object Drugs Affected by Iron
Al-, Mg-, and Ca +2 -containing antacids Levodopa ↓ (chelates with iron)
Tetracycline and doxycycline Methyldopa ↓ (decreases efficacy
of methyldopa)
Histamine2 antagonists Levothyroxine ↓ (decreased efficacy
of levothyroxine)
Proton pump inhibitors Penicillamine ↓ (chelates with iron)
Cholestyramine Fluoroquinolones ↓ (forms ferric
ionquinolone complex)
Tetracycline and doxycycline ↓ (when
administered within 2 hours of iron salt)
Mycophenolate ↓ (decreases
absorption)
Drug interactions of iron
18. Failure to respond to therapy
• Poor patient adherence, inability to absorb iron, incorrect diagnosis, continued
bleeding
o Iron test: (To rule out malabsorption)
Administration of 50 mg of elemental iron as liquid Fe2+ sulfate
⇓
Plasma iron levels are determined at half-hour intervals for 2 hours
⇓
If plasma iron levels increase by >50 mcg/dL during this time
⇓
Absorption is satisfactory
20. Indications of Parenteral Therapy
• Oral iron not tolerated
• Oral iron not absorbed
• Non-compliance to oral iron
• Severe deficiency with chronic bleeding
• Along with erythropoietin
Iron requirement (mg) = 4.4 × body weight (kg) × Hb deficit (g/dl)
21. • High molecular weight colloidal solution
The only preparation which can be used
i.m. & i.v.
• i.m. injection
⇓
Absorbed through lymphatics
⇓
Circulates without binding to transferrin
⇓
Engulfed by RE cells
⇓
Iron dissociates & available for haeme
synthesis
• Low MW complex
• Binds with transferrin
⇓
Saturates it if in large quantity
⇓
Remaining free iron is highly toxic
⇓
Not suitable for i.v.
Only i.m. is safe
• Direct absorption into
circulation, not lymphatics
Iron dextran Iron-Sorbitol-Citrate
22. • No local binding in muscles
• But, 30% dose excreted in urine
⇓
Dose needs to be increased
accordingly
ADRs:
• V-Tach, hypotension, A-V block,
flushing
• C/I in Kidney disease
Iron dextran Iron-Sorbitol-Citrate
• 10–30% of the dose remains
locally bound in muscles
⇓
• Unavailable for utilization for
several weeks
⇓
• 25% extra needs to be added to
the calculated dose
ADRs:
• Anaphylactic reaction (dextran)
23. Therapeutic concerns about iron dextran
Intramuscular injection Intravenous injection
• Deeply in the gluteal region using Z –
track technique
Preparation:
• iron dextran 100 mg in 2 ml
Administration:
• 2 ml daily, or on alternate days,
Or
• 5 ml each side on the same day
Problems:
• Discomfort, tissue necrosis, atrophy
Test dose: (Black box warning)
• 0.5 ml iron dextran injected i.v. over
5–10 min
• Observe for 1 hour
• If untoward reaction ⇛ Give
epinephrine, diphenhydramine or
corticoids
• Administration:
• Method 1:
• 2 ml (100 mg) can be injected per day
taking 10 min for the injection.
24. Therapeutic concerns about iron dextran
Intravenous injection
• Method 2: (Total Dose Infusion)
• Total calculated dose is diluted in 500
ml of glucose/saline solution
⇓
infused i.v. over 6–8 hours under
constant observation.
• Higher risk of ADRs
• More risk in pre-existing immune-
mediated disease
Stop infusion if giddiness,
paraesthesia, tightness in chest
25. Adverse Drug Reactions of iron dextran
Local :
• Pain at site of i.m. injection, pigmentation of skin.
• Sterile abscess — especially in old and debilitated patient.
Systemic:
• Fever, headache, joint pains, flushing, palpitation, chest pain, dyspnoea, lymph
node enlargement.
• Rarely, An anaphylactoid reaction resulting in vascular collapse, death
Precaution:
• i.m. dose should not be >25 mg in 5 kg patient, >50 mg in 10 kg, and >100 mg for all
other patients
26. Ferrous sucrose
• Newer high MW compound complex of iron hydroxide with sucrose
• i.v. injection ⇛ taken up by RE cells ⇛ iron dissociates ⇛ Utilized
Administration:
• 100 mg / 5 ml single-dose vials
• 100 mg (max 200 mg/day) once a day to once a week can be given over 5 min
• Only i.v.
• Not to be given i.m. / s.c. (∵ solution is highly alkaline)
27. Indication:
• Anaemia in chronic kidney diseases
Precaution:
• Total dose infusion is not possible
• Oral iron therapy should not be given concurrently and till 5 days after the
last injection (∵ it decrease absorption of oral iron)
28. Ferric carboxymaltose
• Ferric hydroxide core is stabilized by CH shell
• i.v. injection ⇛ macromolecule is taken up by RE cells (mainly by bone marrow, 80
% and also liver, spleen)
Preparation:
• 50 mg / ml, such 2 ml & 10 ml vials
Administration:
• Method – 1: - Daily 100 mg i.v. injection,
• Method – 2: - Up to 1000 mg diluted in 100 ml saline & infused over 15 min or more
29. Advantage:
• In clinical trials, it has caused rapid increase in haemoglobin level and replenished
stores
• very low incidence of acute reaction, rare anaphylaxis
ADRs:
• Mild Headache, nausea, abdominal pain
Caution:
• Due to lack of safety data, it is not recommended for children < 14 years.
30. Sodium Ferric Gluconate
• High MW Iron complex bound to 1 gluconate & 4 sucrose molecules
• i.v. injection of aqueous solution ⇛ complex taken up by phagocytes ⇛
iron is released ⇛ utilized.
Preparation:
• 62.5 mg in 5 ml vials
Administration: (Only i.v.)
• Method – 2: - 125 mg diluted in 100 ml NS ⇛ infused over 60 min
• Method – 2: - slow i.v. injection @ 12.5 mg / min
31. Ferumoxytol
• Approved by USFDA in June – 2009
• i.v. injection ⇛ complex taken up by macrophages in liver, spleen, bone
marrow ⇛ iron is released ⇛ - Enters storage pool as ferritin, or
-Transported by Tf to haeme synthesis
Preparation:
• 30 mg / ml elemental iron
Administration:
• Initial 510 mg dose i.v. ⇛ second dose of 510 mg after 3 – 8 days
32. • Advantage:
• Can be administered at a higher rate than any other iron preparations
• i.e. @ 30 mg / sec
• No anaphylaxis, but should be observed for at least 30 min
• Less g.i. upset, & peripheral oedema
• Caution:
• Higher incidence of hypotension, dizziness
33. Ferumoxytol Sodium Ferric Gluconate Iron Dextran Iron Sucrose
Amount of
elemental
iron
30 mg/mL 62.5 mg iron/5 mL 50 mg iron/mL 20 mg iron/mL
Composition
Superparamagnetic
iron
oxide that is coated
with
a carbohydrate shell
Ferric oxide hydrate
bonded
to sucrose chelates with
gluconate in a molar rate
of
2 iron molecules to 1
gluconate
molecule
Complex of ferric
hydroxide and
dextran
Complex of polynuclear
iron
hydroxide in sucrose
Indication
Treatment of iron
deficiency
anemia for adult
patients
with chronic kidney
disease
(CKD)
Treatment of iron-
deficiency
anemia for patients
undergoing
chronic hemodialysis
who
are receiving
supplemental
erythropoietin therapy
Treatment of
patients with
documented iron
deficiency
in whom oral
therapy is
unsatisfactory or
impossible
Treatment of iron-
deficiency
anemia for patients
undergoing chronic
hemodialysis who are
receiving supplemental
epoetin alfa therapy
34. Ferumoxytol
Sodium Ferric
Gluconate
Iron Dextran Iron Sucrose
Usual
dose
• Initial 510 mg
intravenous
Injection
⇓
• second 510 mg
intravenous injection
3 to 8 days later
(rate 30 mg/s)
• 125 mg (10 mL)
diluted in 100 mL
normal saline, infused
over 60 minutes;
• Also slow IV injection
(rate of 12.5 mg/min).
• 100 mg undiluted
at a rate not to
exceed 50 mg (1
mL) per Minute
• 100 mg into the
dialysis line at a
rate of 1 mL (20
mg of iron)
undiluted solution
per Minute
Treatment
2 doses × 510 mg =
1,020 mg
8 doses × 125 mg = 1,000
mg
10 doses × 100 mg =
1,000 mg
Up to 10 doses × 100
mg =
1,000 mg
Common
adverse
effects
Diarrhea, constipation,
nausea,
dizziness, hypotension,
peripheral edema
Cramps, nausea and
vomiting,
flushing, hypotension,
rash,
pruritus
Pain and brown
staining at
injection site,
flushing,
hypotension, fever,
chills,
Leg cramps,
hypotension
35. Erythropoietin (EPO)
• Sialoglycoprotein hormone (MW 34000) produced by peritubular cells of
the kidney
• Essential for normal erythropoiesis
M/A:
• EPO binds to specific receptors on the surface of its target cells
• Alters phosphorylation of intracellular proteins and activates transcription
factors to regulate gene expression
• induces erythropoiesis in a dose dependent manner, but has no effect on
RBC lifespan.
36. Use:
• Anaemia due to chronic renal failure
• Only symptomatic patients with Hb ≤ 8 g/dl should be considered for EPO
therapy
• Epoetin 25–100 U/kg s.c. or i.v. 3 times a week (max. 600 U/kg/week) raises
haematocrit and haemoglobin
• Start with a low dose and titrate upwards to keep –
- Haematocrit between 30–36%, and
- Hb 10–11 g (max 12 g) per dl
37. ADRs:
• Related to sudden increase in haematocrit, blood viscosity and peripheral
vascular resistance (due to correction of anaemia)
• Increased clot formation in the A-V shunts (most patients are on dialysis),
• Hypertensive episodes, serious thromboembolic events,
• Seizures
• Flu like symptoms lasting 2–4 hr occur in some patients
38. Darbepoetin
• Recently introduced
• Hyperglycosylated modified EPO
Advantages:
• t½ >24 hours,
• Longer acting
• Can be administered once every 2–4 weeks
40. • General
• Gastrointestinal symptoms shortly after ingestion with possible rapid
progression to shock and coma
• Symptoms
• Vomiting, abdominal pain, and diarrhea within 1 to 6 hours
• Lethargy, coma, seizures, bloody vomiting, bloody diarrhea, and shock within 6
to 24 hours
• Signs
• Hypotension and tachycardia within 6 to 24 hours
• Liver dysfunction and failure possible in 2 to 5 days
41. Management
oTo prevent further absorption of iron from gut:
• (a) Induce vomiting or perform gastric lavage with sodium bicarbonate solution—
to render iron insoluble.
• (b) Give egg yolk and milk orally: to complex iron. Activated charcoal does not
adsorb iron.
oTo bind and remove iron already absorbed:
• Desferrioxamine (an iron chelating agent) — is the drug of choice.
• i.m. (preferably) 0.5–1 g (50 mg/kg) repeated 4–12 hourly as required, or
• i.v. (if shock is present) 10–15 mg/kg/hour; max 75 mg/kg in a day till serum iron
falls below 300 μg/dl.
42. Desferrioxamine
• Ferrioxamine is a long chain iron containing complex obtained from an
actinomycete
• Chemical removal of iron from it yields desferrioxamine which has very
high affinity for iron
• 1 g is capable of chelating 85 mg of elemental iron.
• Straight chain desferrioxamine molecule winds round ferric iron and
forms a stable nontoxic complex ⇛ excreted in urine
oAdvantage:
• It removes loosely bound iron as well as that from haemosiderin and
ferritin, but
• Not from haemoglobin or cytochrome
43. oUses:
Acute iron poisoning:
Transfusion siderosis:
• occurs in thalassemia patients who receive repeated blood transfusion
oADRs:
• Histamine release → fall in BP, flushing, itching, urticaria, rashes
oPreparation:
• 0.5 gm / vial
44. Deferiprone
• Orally active iron chelator
• Specially indicated for the treatment of transfusion
siderosis in thalassemia patients
• Less effective alternative to injected desferrioxamine
• Other uses:
• Acute iron poisoning
• Iron load in Liver cirrhosis
• Dose: 50–100 mg/kg daily in 2–4 divided doses.
46. Role of iron for therapeutic or prophylactic is considered only when –
- Iron deficiency has already been established, or
-To prevent further depletion of stores.
Initial approach to treatment depends upon the severity and cause of IDA.
However, the response of iron deficiency anemia to iron is influenced by several
factors like –
- Ability of patient to tolerate and absorb medicinal iron,
- Presence of other complicating illness,
- Severity of the anemia.
47. Take – Home Message
The advantages and disadvantages of the
various preparations and routes of
administration should be fully weighed before
selecting the form of therapy.
In the first instance, Under normal
circumstances, oral iron is the treatment of
choice since it is simple, effective, safe and
cheap.
However, the ultimate decision depends on
patient’s condition & compliance.