Anemia
What are 2 possible DDx for Microcytic anemia
Iron Deficiency or Thalassemia
What 2 possible complications of IV iron administration?
Anaphylaxis
Hypotension
How soon after initiating iron supplementation should you reassess the patient?
4 weeks
How long after a meal do GERD symptoms typically appear?
30 - 60 min
What are 3 possible adverse effects of acid suppression therapy?
Pneumonia
C. diff
GI Infections
Osteoporosis/bone fractures
What macrocytic anemia might present with symptoms of paresthesia to the extremities
Vit B12 deficiency/Pernicious anemia
Name 5 types of oral iron supplements.
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
Heme Iron Polypeptide
Polysaccharide iron complex
Name 5 investigations you may want to do if you note a macrocytic anemia on CBC
Reticulocyte count
Vit B12
Folate
Blood smear
LFTs
TSH
Name 3 complications of GERD
Barrett's Esophagus
Esophageal strictures
Erosive esophagitis
What class of medications are considered the “Gold Standard” for treatment of GERD?
Proton-pump Inhibitors (PPIs)
What is the treatment for Vit B12 Anemia due to poor nutrition or malabsorption?
Vit B12 100 mcg PO daily
True or False, the dosage of the iron supplement is the same as as the amount of elemental iron the patient will absorb when taking the supplement?
False, you need to look at the elemental iron amount within the supplement to determine the amount that will be absorbed.
Is a hemolytic anemia macrocytic or microcytic?
Macrocytic
Name 6 medication classes that can increase symptoms of GERD.
Benzodiazepines
Calcium Channel Blockers
NSAIDs
Anticholinergics
Theophyllines
Nitrates
If a patient is taking clopidogrel (Plavix) what PPIs should be avoided due to their reduction in antiplatelet activity?
Omeprazole
Esomeprazole
What is the preferred initial medication treatment for Vit B12 Pernicious Anemia with GI absorption issues?
Cyanocobalamin 1000-2000 mcg SC or IM daily x 1-2 weeks (followed by 100-1000 mcg SC/IM weekly until Hgb and HCT normalized, then 100-1000 mcg SC/IM monthly)
What are 2 common side effects of oral iron supplementation?
Nausea
Constipation
If your Iron Panel shows: low iron, high transferrin, high TIBC, low transferrin Sat and low ferritin...what type of anemia would you suspect?
Iron deficiency anemia
True or False. Peppermint can help relieve symptoms of GERD.
False. Peppermint can make GERD symptoms worse as it lowers the LES pressure
What diagnostic test should be considered if a pt is on long-term PPI use?
Bone density
What needs to be monitored for patients who have heart failure or are on diuretics and taking Vit B12 replacement?
Potassium due to risk of hypokalemia
If a patient’s iron levels are not improving after iron supplementation. What is the first thing you should assess?
If they have been taking the medication as prescribed.
Name 4 signs or symptoms of anemia that can be common to all anemia types
Fatigue
Lightheadedness
Dyspnea
Pallor (skin and mucous membranes)
Name at least 3 red flag symptoms for GERD.
Odynophagia
Dysphagia
Severe pain
Prominent upper abdominal pain
Hematemesis
Melena
Unintentional weight loss
What type of antacids should be avoided in pregnant women?
Sodium bicarbonate containing antacids