Page 197 - pharma 1 theoretical updated MNU_Neat

Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)
 ACD/AI anemia

➢ Erythropoietin Stimulating Agents (ESAs)
Primary Epoetin Darbepoetin

treatment recombinant human synthetic EPO analog → ↑ half-
EPO life → ↑ dosing interval.

 EPO treatment → effective when the marrow has an adequate
Safety concerns of supply of iron, vit B12, and folic acid.
ESAs →
restrictive  Oral iron supplementation should be given if transferrin
saturation drops below 20% or the serum ferritin level
guidelines:
<100 ng/mL

 Anemia Due to CKD

➢ It is essential to treat anemia in patients before they progress to stage 5
When
CKD (GFR< 15 ml/min)

How ➢ Patients with CKD typically develop normocytic anemia as a result of
EPO deficiency → ESA therapy

 Iron deficiency in CKD

Sodium ferric gluconate & iron sucrose (1000 mg) → used for treatment of
iron-deficiency anemia in patients undergoing chronic hemodialysis who are
receiving ESAs.
TTT

dosage  E.g. 100 mg iron sucrose ➔ at each consecutive hemodialysis ttt for a
total of 10 doses (1000 mg in total).
 125 mg of sodium ferric gluconate ➔ at each consecutive hemodialysis
ttt for a total of eight doses (1000 mg in total)

1) initiate ESA treatment when Hgb levels are <10 g/dl
2) monitor Hgb levels weekly → If Hgb levels approach
For patients with or exceed 11 g/dl, hold further doses until the level
CKD on dialysis
drops below 10.0 g/dl → Restart the ESA at the
Evaluation lowest dose sufficient to ↓ transfusions.
of

outcome 1) initiate ESA treatment when Hgb levels are <10 g/dl
For patients with 2) monitor Hgb levels weekly → If Hgb levels approach

CKD not on or exceed 10 g/dl, hold further doses until the level
dialysis drops below 10.0 g/dl → Restart the ESA at the

lowest dose sufficient to ↓ transfusions

| P a g e 181