Once an anemia is identified and classified based on its underlying pathophysiology, the focus shifts to targeted pharmacotherapy. As detailed in the Patient Care 4 curriculum, the “Therapeutics of Anemias” is a core competency for pharmacists, requiring a nuanced understanding of various treatment strategies. From managing oral iron supplementation for iron deficiency to the complex use of erythropoiesis-stimulating agents (ESAs) in chronic kidney disease, pharmacists are essential for ensuring safe and effective treatment. This quiz will test your knowledge on drug selection, dosing, monitoring, and crucial counseling points for the management of various anemic states.
1. What is the recommended first-line treatment for most cases of uncomplicated iron deficiency anemia (IDA)?
- a. A blood transfusion
- b. IV iron dextran
- c. Oral ferrous sulfate
- d. An erythropoiesis-stimulating agent (ESA)
Answer: c. Oral ferrous sulfate
2. A patient is prescribed ferrous sulfate 325 mg PO TID. How much elemental iron is the patient receiving per day? (Elemental iron in ferrous sulfate is 20%)
- a. 100 mg
- b. 195 mg
- c. 325 mg
- d. 975 mg
Answer: b. 195 mg
3. What is a key counseling point for a patient starting oral iron supplementation?
- a. Take the iron with a large glass of milk to improve absorption.
- b. Take the iron on an empty stomach for best absorption, but with food if GI upset occurs.
- c. Expect the medication to turn your urine red.
- d. Stop taking the medication as soon as your hemoglobin is normal.
Answer: b. Take the iron on an empty stomach for best absorption, but with food if GI upset occurs.
4. The most common side effect of oral iron therapy is:
- a. Headache
- b. Drowsiness
- c. Constipation and GI upset
- d. Hypertension
Answer: c. Constipation and GI upset
5. What is the treatment of choice for a patient with severe Vitamin B12 deficiency due to pernicious anemia?
- a. A high-dose oral folic acid supplement.
- b. A diet high in leafy green vegetables.
- c. Intramuscular (IM) or subcutaneous (SC) cyanocobalamin injections.
- d. Oral iron therapy.
Answer: c. Intramuscular (IM) or subcutaneous (SC) cyanocobalamin injections.
6. The “Therapeutics of Anemias” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Erythropoiesis-stimulating agents (ESAs) like epoetin alfa work by:
- a. Providing iron for heme synthesis.
- b. Stimulating the bone marrow to produce more red blood cells.
- c. Increasing the absorption of Vitamin B12.
- d. Increasing the lifespan of existing red blood cells.
Answer: b. Stimulating the bone marrow to produce more red blood cells.
8. Before initiating ESA therapy in a patient with anemia of chronic kidney disease (CKD), what must be ensured?
- a. The patient’s blood pressure is uncontrolled.
- b. The patient has adequate iron stores (e.g., TSAT ≥20%, ferritin ≥100 ng/mL).
- c. The patient is also taking a Vitamin B12 supplement.
- d. The patient’s hemoglobin is already >12 g/dL.
Answer: b. The patient has adequate iron stores (e.g., TSAT ≥20%, ferritin ≥100 ng/mL).
9. ESAs carry a black box warning for which of the following risks when hemoglobin levels are targeted to >11 g/dL?
- a. Severe anemia
- b. Increased risk of death, myocardial infarction, stroke, and venous thromboembolism.
- c. Liver failure
- d. Aplastic anemia
Answer: b. Increased risk of death, myocardial infarction, stroke, and venous thromboembolism.
10. A patient with folate deficiency macrocytic anemia should be treated with:
- a. Oral folic acid
- b. IM Vitamin B12
- c. IV iron
- d. A blood transfusion
Answer: a. Oral folic acid
11. The pathophysiology of anemia is a specific lecture within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. Which of the following can decrease the absorption of oral iron?
- a. Vitamin C
- b. Antacids and PPIs
- c. Taking it on an empty stomach
- d. Orange juice
Answer: b. Antacids and PPIs
13. Which of the following IV iron formulations has the highest risk of anaphylaxis, often requiring a test dose?
- a. Iron sucrose
- b. Ferumoxytol
- c. Iron dextran (high molecular weight)
- d. Ferric carboxymaltose
Answer: c. Iron dextran (high molecular weight)
14. Darbepoetin alfa has a longer half-life than epoetin alfa, allowing for:
- a. Higher target hemoglobin levels.
- b. Less frequent dosing (e.g., weekly or every 2-4 weeks).
- c. Use in iron deficiency anemia.
- d. Oral administration.
Answer: b. Less frequent dosing (e.g., weekly or every 2-4 weeks).
15. A patient taking oral iron supplements should be counseled that their stools may become:
- a. Lighter in color.
- b. Greenish or black in color.
- c. Smaller in size.
- d. More frequent.
Answer: b. Greenish or black in color.
16. For a patient with pernicious anemia, Vitamin B12 therapy is typically:
- a. A one-time injection.
- b. A 3-month course.
- c. Lifelong.
- d. Only needed when symptoms appear.
Answer: c. Lifelong.
17. The curriculum includes a required reading on anemias from DiPiro’s Pharmacotherapy.
- a. True
- b. False
Answer: a. True
18. What is the role of a pharmacist in managing a patient on an ESA?
- a. Ensuring appropriate initiation based on hemoglobin and iron status.
- b. Monitoring for efficacy (hemoglobin response) and adverse effects (blood pressure).
- c. Recommending dose adjustments based on hemoglobin trends.
- d. All of the above.
Answer: d. All of the above.
19. A patient with IDA is intolerant to oral ferrous sulfate due to severe nausea. What is a reasonable next step?
- a. Discontinue all iron therapy.
- b. Try a different oral iron salt (e.g., ferrous gluconate) or try dosing every other day.
- c. Immediately start an ESA.
- d. Recommend a blood transfusion.
Answer: b. Try a different oral iron salt (e.g., ferrous gluconate) or try dosing every other day.
20. An active learning session on anemia is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
21. Why is it important to treat the underlying cause of an anemia?
- a. It is not important; supplementation is always sufficient.
- b. To ensure the anemia resolves and to address potentially serious conditions (e.g., GI bleed).
- c. To lower the cost of treatment.
- d. To make the patient feel better emotionally.
Answer: b. To ensure the anemia resolves and to address potentially serious conditions (e.g., GI bleed).
22. Which food or drink can enhance the absorption of oral iron?
- a. Milk
- b. Tea
- c. A glass of orange juice (ascorbic acid)
- d. A calcium supplement
Answer: c. A glass of orange juice (ascorbic acid)
23. The most common indication for ESA therapy is:
- a. Iron deficiency anemia
- b. Vitamin B12 deficiency anemia
- c. Anemia of chronic kidney disease
- d. Sickle cell anemia
Answer: c. Anemia of chronic kidney disease
24. The therapeutics of anemia are covered in which course module?
- a. Module 6: Colorectal Cancer
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 6: Colorectal Cancer
25. Which of the following oral iron supplements contains the highest percentage of elemental iron?
- a. Ferrous sulfate
- b. Ferrous gluconate
- c. Ferrous fumarate
- d. Polysaccharide-iron complex
Answer: c. Ferrous fumarate
26. How long should oral iron therapy be continued after hemoglobin levels have normalized?
- a. It should be stopped immediately.
- b. For an additional 1-2 weeks.
- c. For an additional 3-6 months to replete iron stores.
- d. For an additional 1 year.
Answer: c. For an additional 3-6 months to replete iron stores.
27. A patient being treated for Vitamin B12 deficiency should have which lab value monitored, as it can decrease rapidly with initiation of therapy?
- a. Serum sodium
- b. Serum calcium
- c. Serum potassium
- d. Serum glucose
Answer: c. Serum potassium
28. An active learning session on the therapeutics of anemia is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. What is a potential advantage of IV iron over oral iron?
- a. It is less expensive.
- b. It has fewer side effects.
- c. It repletes iron stores much more rapidly.
- d. It can be self-administered at home.
Answer: c. It repletes iron stores much more rapidly.
30. In a patient with anemia of chronic disease and adequate iron stores, what is the primary treatment approach?
- a. A high-dose oral iron supplement.
- b. Treatment of the underlying inflammatory condition.
- c. A Vitamin B12 injection.
- d. A folic acid supplement.
Answer: b. Treatment of the underlying inflammatory condition.
31. A patient with end-stage renal disease on hemodialysis and receiving an ESA will most likely receive iron via which route?
- a. Oral
- b. Intramuscular
- c. Intravenous
- d. Subcutaneous
Answer: c. Intravenous
32. The response to iron therapy can be monitored by checking which lab value after about one week?
- a. Ferritin
- b. Hemoglobin
- c. Reticulocyte count
- d. Vitamin B12 level
Answer: c. Reticulocyte count
33. The goal of ESA therapy is to use the lowest possible dose to achieve a hemoglobin level sufficient to avoid:
- a. Hypertension
- b. Red blood cell transfusions
- c. Thrombosis
- d. The need for iron
Answer: b. Red blood cell transfusions
34. Which of the following is NOT a common side effect of ESA therapy?
- a. Hypertension
- b. Arthralgias
- c. Hypotension
- d. Nausea
Answer: c. Hypotension
35. A patient asks if they can take their ferrous sulfate tablet with their levothyroxine and calcium carbonate in the morning. The best response is:
- a. “Yes, taking them all together is fine.”
- b. “No, you should separate the iron from the levothyroxine and calcium by several hours.”
- c. “You should only take the iron and calcium together.”
- d. “You should only take the levothyroxine and iron together.”
Answer: b. “No, you should separate the iron from the levothyroxine and calcium by several hours.”
36. For a patient with folic acid deficiency, the standard oral dose is typically:
- a. 50 mcg daily
- b. 100 mcg daily
- c. 400 mcg daily
- d. 1 mg daily
Answer: d. 1 mg daily
37. Parenteral Vitamin B12 is available as cyanocobalamin and what other form?
- a. Methylcobalamin
- b. Adenosylcobalamin
- c. Hydroxocobalamin
- d. Pyridoxocobalamin
Answer: c. Hydroxocobalamin
38. The primary role of a pharmacist in the management of anemia is to:
- a. Diagnose the type of anemia.
- b. Ensure the safe and effective use of therapeutic agents through counseling and monitoring.
- c. Perform blood transfusions.
- d. Order bone marrow biopsies.
Answer: b. Ensure the safe and effective use of therapeutic agents through counseling and monitoring.
39. Before starting an ESA, a patient’s ____ must be well-controlled.
- a. Blood glucose
- b. Blood pressure
- c. Cholesterol
- d. Weight
Answer: b. Blood pressure
40. A patient’s hemoglobin has increased by 1 g/dL after one month of oral iron therapy. This indicates:
- a. The therapy is failing.
- b. An adequate response to therapy.
- c. The dose is too high.
- d. An allergic reaction.
Answer: b. An adequate response to therapy.
41. Which formulation of oral iron is a liquid and may stain teeth?
- a. Ferrous fumarate tablets
- b. Carbonyl iron
- c. Ferrous sulfate liquid solution
- d. Polysaccharide-iron complex
Answer: c. Ferrous sulfate liquid solution
42. A patient with a history of gastric bypass surgery who develops macrocytic anemia will likely require:
- a. Lifelong oral folic acid.
- b. Lifelong parenteral or high-dose oral Vitamin B12.
- c. A short course of oral iron.
- d. A blood transfusion only.
Answer: b. Lifelong parenteral or high-dose oral Vitamin B12.
43. The therapeutics of anemia are linked to the colorectal cancer module because:
- a. Anemia can be a presenting sign of colorectal cancer.
- b. Chemotherapy for colorectal cancer can cause anemia.
- c. Both a and b are correct.
- d. There is no link between the two.
Answer: c. Both a and b are correct.
44. What is the most important counseling point for a patient starting folic acid supplementation for deficiency?
- a. Take it with a full glass of milk.
- b. The importance of adherence to replete stores and resolve the anemia.
- c. Expect your stools to turn black.
- d. It must be taken at night.
Answer: b. The importance of adherence to replete stores and resolve the anemia.
45. Which of the following is an indication for IV iron?
- a. A patient with severe, ongoing GI bleeding.
- b. A hemodialysis patient on an ESA.
- c. A patient who cannot tolerate any oral iron formulation.
- d. All of the above.
Answer: d. All of the above.
46. Enteric-coated iron tablets are generally not recommended because:
- a. They are more expensive.
- b. They can bypass the primary site of iron absorption in the duodenum, leading to poor bioavailability.
- c. They have more GI side effects.
- d. They are not stable.
Answer: b. They can bypass the primary site of iron absorption in the duodenum, leading to poor bioavailability.
47. The primary goal of treating anemia of CKD is to:
- a. Increase the patient’s hemoglobin to >13 g/dL.
- b. Improve quality of life and reduce the need for blood transfusions.
- c. Cure the chronic kidney disease.
- d. Lower the patient’s blood pressure.
Answer: b. Improve quality of life and reduce the need for blood transfusions.
48. An active learning session on the therapeutics of anemia is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. If a patient’s anemia does not respond to oral iron therapy, what should be investigated?
- a. Patient adherence.
- b. The possibility of ongoing blood loss.
- c. The possibility of malabsorption.
- d. All of the above.
Answer: d. All of the above.
50. The ultimate goal of understanding the therapeutics of anemias is to:
- a. Recommend the most expensive treatment.
- b. Apply evidence-based principles to treat the specific underlying cause of the anemia safely and effectively.
- c. Memorize all the brand names of iron supplements.
- d. Be able to order blood transfusions.
Answer: b. Apply evidence-based principles to treat the specific underlying cause of the anemia safely and effectively.