USMLE

Iron

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Hematology Drugs
  1. Dabigatran / Argatroban
  2. Factor Xa Inhibitors (Rivaroxaban, Apixaban)
  3. Heparin
  4. Low Molecular Weight Heparins (Enoxaparin, Fondaparinux, Dalteparin)
  5. Warfarin
  6. Aspirin
  7. GPIIb/IIIa Inhibitors (Abciximab, Tirofiban, Eptifibatide)
  8. Alteplase / tPA
  9. Iron
  10. Filgrastim
  11. Epoetin Alfa

Summary

Iron is a naturally occurring mineral that may be given as a drug to patients. As a component of hemoglobin, iron can be used to treat anemia, especially in the context of iron-deficiency anemia. Side effects of iron use include constipation. Notably, patients taking iron may experience black, tarry stools, which are a harmless and expected side effect of the drug. When taken in a liquid form, iron can cause tooth discoloration, so encourage patients to drink the mixture through a straw and rinse their mouth afterwards. Iron may cause the side effects of nausea and vomiting, which can be alleviated by taking iron with a little bit of food. Remind patients taking iron to avoid milk or other dairy products, since calcium decreases absorption of iron in the gut. Instead, encourage them to take iron with foods high in vitamin C, like citrus fruits and juices.

Key Points

  • Iron Supplements
    • Variety of formulations including ferrous sulfate, ferrous fumarate, ferrous gluconate
    • Mechanism
      • Iron is necessary to produce heme in hemoglobin, used for the transportation of oxygen
      • Absorption decreased with calcium/dairy products
        • Avoid giving with milk
      • Absorption increased with vitamin C
        • Encourage iron to be taken with citrus fruits and juices
    • Clinical Use
      • Iron-deficiency anemia
        • Manifests as fatigue, weakness, shortness of breath, pallor
        • Iron will increase hemoglobin
    • Side Effects and Adverse Reactions
      • Tooth discoloration
        • If taken in a liquid form
        • Instruct patient to dilute in water or juice, drink with a straw, and rinse mouth after swallowing
      • GI upset
        • Nausea and vomiting may be seen
      • Constipation
        • Black tarry stools are expected
        • Encourage a high-fiber diet, regular exercise, and adequate fluid intake