Hematopoietic medications

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Hematopoietic medications

End of Rotation™ exam review

Cardiovascular

Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Aortic dissections and aneurysms: Pathology review
Coronary artery disease: Pathology review
Peripheral artery disease: Pathology review
Cardiovascular disease screening: Clinical sciences
Carotid artery stenosis screening: Clinical sciences
Abdominal aortic aneurysm: Clinical sciences
Acute coronary syndrome: Clinical sciences
Acute limb ischemia: Clinical sciences
Acute mesenteric ischemia: Clinical sciences
Aortic dissection: Clinical sciences
Approach to chest pain: Clinical sciences
Approach to dyspnea: Clinical sciences
Approach to syncope: Clinical sciences
Ischemic colitis: Clinical sciences
Chronic mesenteric ischemia: Clinical sciences
Coronary artery disease: Clinical sciences
Peripheral arterial disease and ulcers: Clinical sciences
Venous insufficiency and ulcers: Clinical sciences
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
Adrenergic antagonists: Presynaptic
Calcium channel blockers
Cholinomimetics: Direct agonists
Cholinomimetics: Indirect agonists (anticholinesterases)
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Fibrates
Lipid-lowering medications: Statins
Miscellaneous lipid-lowering medications
Muscarinic antagonists
Positive inotropic medications
Sympatholytics: Alpha-2 agonists
Sympathomimetics: Direct agonists
Thiazide and thiazide-like diuretics

Gastrointestinal and nutritional

Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Inguinal region
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Anatomy clinical correlates: Other abdominal organs
Appendicitis: Pathology review
Colorectal polyps and cancer: Pathology review
Diverticular disease: Pathology review
Eating disorders: Pathology review
Esophageal disorders: Pathology review
Gallbladder disorders: Pathology review
Gastrointestinal bleeding: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Jaundice: Pathology review
Pancreatitis: Pathology review
Colorectal cancer screening: Clinical sciences
Acute pancreatitis: Clinical sciences
Approach to acute abdominal pain (pediatrics): Clinical sciences
Approach to the acute abdomen (pediatrics): Clinical sciences
Approach to biliary colic: Clinical sciences
Approach to upper abdominal pain: Clinical sciences
Anal cancer: Clinical sciences
Anal fissure: Clinical sciences
Approach to chronic abdominal pain (pediatrics): Clinical sciences
Approach to vomiting (acute): Clinical sciences
Appendicitis: Clinical sciences
Approach to constipation (pediatrics): Clinical sciences
Approach to vomiting (chronic): Clinical sciences
Approach to constipation: Clinical sciences
Approach to abdominal wall and groin masses: Clinical sciences
Approach to vomiting (newborn and infant): Clinical sciences
Approach to vomiting (pediatrics): Clinical sciences
Approach to diarrhea (chronic): Clinical sciences
Cholecystitis: Clinical sciences
Approach to diarrhea (pediatrics): Clinical sciences
Choledocholithiasis and cholangitis: Clinical sciences
Approach to hematochezia (pediatrics): Clinical sciences
Chronic pancreatitis: Clinical sciences
Approach to hematochezia: Clinical sciences
Colonic volvulus: Clinical sciences
Approach to hepatic masses: Clinical sciences
Colorectal cancer: Clinical sciences
Approach to jaundice (conjugated hyperbilirubinemia): Clinical sciences
Diverticulitis: Clinical sciences
Approach to jaundice (newborn and infant): Clinical sciences
Approach to jaundice (unconjugated hyperbilirubinemia): Clinical sciences
Esophageal cancer: Clinical sciences
Esophageal perforation: Clinical sciences
Approach to melena and hematemesis (pediatrics): Clinical sciences
Approach to melena and hematemesis: Clinical sciences
Fecal impaction: Clinical sciences
Femoral hernias: Clinical sciences
Approach to pancreatic masses: Clinical sciences
Gastric cancer: Clinical sciences
Approach to perianal problems: Clinical sciences
Approach to periumbilical and lower abdominal pain: Clinical sciences
Gastroesophageal reflux disease: Clinical sciences
Approach to pneumoperitoneum and peritonitis (perforated viscus): Clinical sciences
Gastroesophageal varices: Clinical sciences
Approach to postoperative abdominal pain: Clinical sciences
Hemorrhoids: Clinical sciences
Hepatocellular carcinoma: Clinical sciences
Ileus: Clinical sciences
Inflammatory bowel disease (Crohn disease): Clinical sciences
Inflammatory bowel disease (ulcerative colitis): Clinical sciences
Inguinal hernias: Clinical sciences
Intra-abdominal abscess: Clinical sciences
Ischemic colitis: Clinical sciences
Large bowel obstruction: Clinical sciences
Medication-induced constipation: Clinical sciences
Pancreatic cancer: Clinical sciences
Paraesophageal and hiatal hernia: Clinical sciences
Peptic ulcer disease: Clinical sciences
Perianal abscess and fistula: Clinical sciences
Pilonidal disease: Clinical sciences
Pyloric stenosis: Clinical sciences
Small bowel obstruction: Clinical sciences
Umbilical hernias: Clinical sciences
Ventral and incisional hernias: Clinical sciences
Acid reducing medications
Antidiarrheals
Laxatives and cathartics

Neurology

Anatomy clinical correlates: Cerebral hemispheres
Anatomy clinical correlates: Cerebellum and brainstem
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Posterior blood supply to the brain
Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves
Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves
Anatomy clinical correlates: Trigeminal nerve (CN V)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves
Anatomy clinical correlates: Spinal cord pathways
Anatomy clinical correlates: Vertebral canal
Adult brain tumors: Pathology review
Amnesia, dissociative disorders and delirium: Pathology review
Cerebral vascular disease: Pathology review
Traumatic brain injury: Pathology review
Carotid artery stenosis screening: Clinical sciences
Acute stroke (ischemic or hemorrhagic) or TIA: Clinical sciences
Approach to acute vision loss: Clinical sciences
Approach to aphasia: Clinical sciences
Approach to blunt cerebrovascular injury: Clinical sciences
Approach to diplopia: Clinical sciences
Approach to traumatic brain injury (pediatrics): Clinical sciences
Approach to traumatic brain injury: Clinical sciences
Subarachnoid hemorrhage: Clinical sciences
Anti-parkinson medications
Anticonvulsants and anxiolytics: Barbiturates
Anticonvulsants and anxiolytics: Benzodiazepines
Antiplatelet medications
General anesthetics
Local anesthetics
Medications for neurodegenerative diseases
Migraine medications
Neuromuscular blockers
Nonbenzodiazepine anticonvulsants
Osmotic diuretics
Thrombolytics

Preoperative and postoperative care

Acid-base disturbances: Pathology review
Adrenal insufficiency: Pathology review
Coronary artery disease: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Diabetes mellitus: Pathology review
Drug misuse, intoxication and withdrawal: Alcohol: Pathology review
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Drug misuse, intoxication and withdrawal: Other depressants: Pathology review
Drug misuse, intoxication and withdrawal: Stimulants: Pathology review
Electrolyte disturbances: Pathology review
Heart blocks: Pathology review
Heart failure: Pathology review
Obstructive lung diseases: Pathology review
Supraventricular arrhythmias: Pathology review
Thrombosis syndromes (hypercoagulability): Pathology review
Valvular heart disease: Pathology review
Ventricular arrhythmias: Pathology review
Acute coronary syndrome: Clinical sciences
Adrenal insufficiency: Clinical sciences
Alcohol use disorder: Clinical sciences
Alcohol withdrawal: Clinical sciences
Aortic stenosis: Clinical sciences
Approach to a postoperative fever: Clinical sciences
Approach to acid-base disorders: Clinical sciences
Approach to ascites: Clinical sciences
Approach to bradycardia: Clinical sciences
Approach to hypercalcemia: Clinical sciences
Approach to hyperkalemia: Clinical sciences
Approach to hypernatremia: Clinical sciences
Approach to hypocalcemia: Clinical sciences
Approach to hypokalemia: Clinical sciences
Approach to hyponatremia: Clinical sciences
Approach to lower limb edema: Clinical sciences
Approach to metabolic acidosis: Clinical sciences
Approach to metabolic alkalosis: Clinical sciences
Approach to nosocomial infections: Clinical sciences
Approach to postoperative abdominal pain: Clinical sciences
Approach to postoperative acute kidney injury: Clinical sciences
Approach to postoperative hypotension: Clinical sciences
Approach to postoperative respiratory distress: Clinical sciences
Approach to postoperative wound complications: Clinical sciences
Approach to respiratory acidosis: Clinical sciences
Approach to respiratory alkalosis: Clinical sciences
Approach to tachycardia: Clinical sciences
Asthma: Clinical sciences
Atrial fibrillation and atrial flutter: Clinical sciences
Atrioventricular block: Clinical sciences
Central line-associated bloodstream infection: Clinical sciences
Chronic obstructive pulmonary disease: Clinical sciences
Congestive heart failure: Clinical sciences
Coronary artery disease: Clinical sciences
Deep vein thrombosis: Clinical sciences
Delirium: Clinical sciences
Diabetes mellitus (Type 1): Clinical sciences
Diabetes mellitus (Type 2): Clinical sciences
Diabetic ketoacidosis: Clinical sciences
Essential hypertension: Clinical sciences
Hyperosmolar hyperglycemic state: Clinical sciences
Hypovolemic shock: Clinical sciences
Medication-induced constipation: Clinical sciences
Opioid intoxication and overdose: Clinical sciences
Opioid use disorder: Clinical sciences
Opioid withdrawal syndrome: Clinical sciences
Pressure-induced skin and soft tissue injury: Clinical sciences
Pulmonary embolism: Clinical sciences
Right heart failure (cor pulmonale): Clinical sciences
Substance use disorder: Clinical sciences
Surgical site infection: Clinical sciences
Tobacco use: Clinical sciences
Ventricular tachycardia: Clinical sciences
Acetaminophen (Paracetamol)
Anticoagulants: Direct factor inhibitors
Anticoagulants: Heparin
Anticoagulants: Warfarin
Antiplatelet medications
Cell wall synthesis inhibitors: Cephalosporins
DNA synthesis inhibitors: Metronidazole
Glucocorticoids
Insulins
Laxatives and cathartics
Miscellaneous cell wall synthesis inhibitors
Non-steroidal anti-inflammatory drugs
Opioid agonists, mixed agonist-antagonists and partial agonists
Protein synthesis inhibitors: Aminoglycosides

Assessments

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Questions

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A 60-year-old woman comes to the emergency department because of worsening shortness of breath for the past month. The patient states that she is unable to perform simple activities without getting short of breath. Today, the patient was unable to climb the stairs and decided to come to the emergency department. Past medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes mellitus complicated by end-stage renal disease managed with dialysis. Current medications include insulin, metformin, lisinopril and atorvastatin. The patient is non-adherent to her medications. Temperature is 36.7°C (98.0°F), pulse is 65/min, respirations are 20/min and blood pressure is 134/83 mmHg. The EKG and chest x-ray are within normal limits. Laboratory results are shown below. There are no signs of active bleeding. The patient is given a unit of packed red blood cells with an appropriate response in her repeat hemoglobin. The physician is considering starting the patient on a medication commonly used to improve hemoglobin levels. Which of the following is a side-effect of this long-term therapy?  

Laboratory value  Result 
 Hemoglobin  6.8 g/dL 
 Hematocrit  21% 
 Leukocyte count  5,000/mm3 
 Platelet count    200,000/mm3 
 Mean corpuscular volume  81 μm3 
 Serum  
 Creatinine   2.5 g/dL 
 BUN  29 mg/dL 

Transcript

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Hematopoietic medications increase the amount of blood cells.

Ηema refers to blood and poiesis means to make.

Specifically, hematopoietic medications increase the production of erythrocytes or red blood cells, leukocytes or white blood cells, and platelets, which are small clot forming fragments of a larger cell called a megakaryocyte.

Now, before we discuss these medications in detail, let's take a step back and talk about the physiology of hematopoiesis, which can result in the production of over one hundred billion new cells every single day!

Hematopoiesis occurs in the bones of the body, but primarily in the bones of the pelvis, ribs, and sternum.

This process starts in the bone marrow, the innermost portion of bone, where the hematopoietic stem cells reside.

These serve as progenitor cells for all the different cell types found in the blood.

First, hematopoietic stem cells, also called hemocytoblasts, can become lymphoid progenitors or myeloid progenitors.

The lymphoid progenitors can develop into lymphoblasts, which can then differentiate into T-lymphocytes, B-lymphocytes, or natural killer cells.

The myeloid progenitors can differentiate into erythrocytes, megakaryocytes, or myeloblasts, which can then become immune cells like monocytes, neutrophils, basophils, and eosinophils.

Now, in order for a hematopoietic stem cell to reach its final, mature form, the cell needs to receive the appropriate signals in the form of specific growth chemicals, called growth factors or stimulating factors.

While there are a multitude of these factors that cause differentiation of these cells, we’re only going to discuss the most important ones related to hematopoietic medications.

First, GM-CSF, or granulocyte macrophage colony stimulating factor, and G-CSF, or granulocyte colony stimulating factor, are glycoproteins released in response to infection by the endothelium, which is the inner lining of blood vessels, and immune cells such as macrophages, T-cells, and natural killer cells.

GM-CSF stimulates myeloid progenitors and causes them to divide and differentiate into all of its derivative cell types.

It also speeds up the maturation of monocytes (or macrophages), neutrophils, eosinophils, and basophils so they’ll be ready for action.

G-CSF, on the other hand, specifically induces myeloblasts to mature into neutrophils.

Next, thrombopoietin is a glycoprotein produced in the liver and kidneys.

It stimulates hematopoietic stem cells to differentiate into megakaryocytes, and also speeds up their maturation and fragmentation to generate platelets.

Finally, erythropoietin or EPO, which is produced in the kidneys, and to a lesser extent in the liver, stimulates hematopoietic stem cells and myeloid progenitors to differentiate into erythrocytes, or red blood cells.

Now, most hematopoietic medications act like analogues or synthetic versions of these growth factors.

Let’s start with sargramostim, which is a synthetic version of GM-CSF.

Sargramostim is often used to boost myeloid precursor production and maturation after a person undergoes a bone marrow transplant.

Other uses for sargramostim include increasing the myelocyte derived white blood cell count following chemotherapy or radiation therapy.

These therapies target rapidly dividing cells like cancer cells, but hematopoietic stem cells in the bone marrow are also dividing rapidly, so they almost always get affected too.

Sources

  1. "Katzung & Trevor's Pharmacology Examination and Board Review,12th Edition" McGraw-Hill Education / Medical (2018)
  2. "Rang and Dale's Pharmacology" Elsevier (2019)
  3. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)
  4. "Nomograms" D. Nicoll , C. Mark Lu, S.J. McPhee (Eds.), Guide to Diagnostic Tests, 7e. McGraw-Hill (2017)
  5. "Overview of hemostasis" J.C. Aster, H. Bunn (Eds.), Pathophysiology of Blood Disorders, 2e. McGraw-Hill. (2016)
  6. "Granulocyte-Colony Stimulating Factor (G-CSF) for stroke: an individual patient data meta-analysis" Scientific Reports (2016)
  7. "The evolution of value with filgrastim in oncology" Future Oncology (2019)