Transcript Hematopoitics, Vitamins & Antioxidants-Dr Rishi Pal [PPT]

Haematopoietic agents, Vitamins
& Antioxidants
Dr. Rishi Pal
Assistant Professor
Department of
Pharmacology
Haematopoietic system
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Erythrocytes
Leukocytes
Thrombocytes
Exogenous nutrients
Endogenous nutrients
Types of anaemia
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Microcytic hypochromic anaemia
Megaloblastic anaemia
Pernicious anaemia
Haemolytic anaemia
Aplastic anaemia
Sickle cell anaemia
Sideroblastic anaemia
Iron deficiency anaemia
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Pallor
Fatigue
Dizziness
Exertional dyspnoea
Iron deficiency
Dietary deficiency
Faulty absorption, transport and storage
Excessive blood loss
Worm infestation
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Max iron absorption: duodenum & jejunum
Haem iron & non haem iron (Fe+++)
Ascorbic acid, SH, Succinic acid facilitate
conversion of Fe+++ to Fe++ form
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Body requirement of iron
Hb has 33% of iron (50 mg in 100 ml of
blood)
Daily requirement
Male: 0.5-1 mg
Female: 1-2 mg
Children: 25 mg
Pharmacokinetics of iron
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Iron absorbs by active transport across intestinal
mucosa.
Converted Fe2+ to Fe3+
Apoprotein-iron complex (ferritin)
Release on demand
Absorption depends on apoprotein to ferritin ratio.
Transferrin binds with free Fe2+ or Fe3+ from ferritin
and carries to bone marrow
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Haemosiderin granules seen with iron
overload & gives rise to haemosiderosis or
bronze diabetes.
Treatment of iron defeciency anaemia
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Oral iron therapy: ferrous salts of
sulfate,fumerate,gluconate, lactate, succinate and
glycine sulfate etc.
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Ferric salts: ferric ammonium citrate, iron
polysaccharide and ferric hydroxide polymaltose
complex.
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Ferrous salts better absorbed than ferric salts.
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Ferrous salts: 100mg provides 20% of elemental iron
Ferrous fumerate: 33%
Ferrous sulfate:19%
Ferrous succinate: 12%
Adult: 200mg of elemental iron administered in 2-3
divided doses after meal
Children:3-5mg/kg in 3 divided doses
325mg tablets of ferrous sulfate, thrice a day
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Ferrous sulfate: FERSOLATE 200mg tab
Ferrous fumerate: NORI-A 200mg tab
Ferrous gluconate:FERRONICUM 300mg tab
Collodial ferric hydroxide: NEOFERRUM 200
mg tab. 400mg/5ml syrup
Parenteral iron therapy
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For those who are not able to absorb oral iron
preparations.
Not able to maintained iron content because of
acute/chronic blood loss or GITdisorders like sprue
or inflammatory bowel disease.
Iron-dextran: iv or im (50mg/ml)
Iron sucrose complex: iv or im
Iron-sodium gluconate: iv or im
Iron-sorbitol-citrate: only im
Vitamin B12
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Cyanocobalamine
Hydroxycobalamine
Methylcobalamine
5’ deoxyadenosyl cobalamine
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Pharmacokinetics of cobalamine
Intrinsic factor (IF)
Transcobalamine-II
Metabolic functions
Therapeutic uses
Daily requirement: 2-3 ug/day
Therapeutic dose: 100-1000ug/day i.m
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Cyanocobalamine
REDISOL, MACRABIN 100µg, 500µg/day
Hydroxocobalamine
REDISOL-H, MACRABIN-H 500µg, 1000µg
per vial inj.
Methylcobalamine
METHYLCOBAL 500µg tab, NEUROKINDOD 1500µg tab., 500µg/ml inj.
Folic acid
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Pteroylglutamic acid
Pharmacokinetics
Metabolic functions
Deficiency
Therapeutic uses
Daily requirement: 50µg
Therapeutic doses: 1-5mg/day
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Folic acid
FOLVITE, FOLITAB 5mg tab
Folinic acid
RECOVORIN 15 mg tab., 75mg/ml, 10mg/ml
inj.
Haematopoietic growth factors
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Erythropoietin: epoietin 100 IU/kg s.c or i.v 3
times a week, darbepoetin.
Preparations available
EPOX, ZYROP,EPREX 2000IU, 4000IU/ml
inj.
Colony stimulating factor (CSF)
G-CSF & GM-CSF
Filgrastim & pegfilgrastim 300µg/inj.
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Megakaryocyte growth factors
Interleukin-11
Vitamins
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Fat soluble vitamins: A, D, E and K
Water soluble vitamins
B-complex group: B1,B2,B3,B5,B6 and Biotin
Haematopoietic B-complex vitamins
Folic acid and cyanocobalamin
Non B-complex group: Ascorbic acid (vitamin-C)
Vitamin A (Retinol)
Dietary sources
 Physiological role
a) Proper vision in dim light
b) Structural integrity of epithelial cells
 Deficiency
a) Night blindness
b) Keratomalacia
c) Xerophthalmia
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Vitamin A analogs
Beta-Carotene: 30-300µg/day
Tritinoin
Isotritinoin:500µg/kg in 2 divided doses for 3-4
months
Etretinate: For refractory Psoriasis
Tazarotene and Bexarotene
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Daily requirements
Adult doses: 4000IU/day
Therapeutic doses
50,000IU-1 lac IU orally for 3 days
Hypervitaminosis
Preparations available
AROVIT 50,000IU tab., 1 lacIU/2 ml inj
AQUQSOL-A 50,000IU cap
Vitamin E(Tocoferol)
Dietary sources
 Phyiological role
 Deficiency symptoms: Peripheral
neuropathy,Sterility in males and Recurrent
abortion in females
 Therapeutic doses:400mg/day
Nocturnal muscle cramps:400mg/day for 6-12
weeks
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Vitamin E contd.
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Fibrocystic breast disease:600mg/day for 3-6
months
Intermittent claudication:400mg/day for 12-15
weeks
Acanthocytosis:100mg/week i.m inj
Thiamine (Vitamin B1)
Dietary sources
 Physiological role
 Deficiency symptoms
Dry Beri-Beri,Wet Beri-Beri
 Therapeutic doses:100mg/day i.m or iv then
5-10mg/day orally as maintenance dose
 Preparations available:BERIN 50mg-100mg
tab,100mg/ml inj,BENALGIS 75mg tab
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Riboflavin (Vitamin B2)
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Dietary sources
Physiological role
Deficiency symptoms:
Glossitis,Cheilosis,Cataract formation
Therapeutic doses:5-20mg/day
Preparations available:RIBOFLAVIN10mg
tab,10mg/ml inj.
Niacin (Vitamin B3)
Dietary sources
 Physiological role
 Deficiency symptoms
Pellagra(Dermatitis,Dementia,Insomnia,Diarrhoea,Deat
h)
 Prophylactic doses:15-20mg/day
 Therapeutic doses:200-500mg/day oral
 Preparations available:NEASION-SR,NIALIP
375mg,500mg tab
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Pantothenic acid (Vitamin B5)
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Dietary sources
Physiological role
Deficiency symptoms:Intermittent diarrhoea,
Leg cramps,Paraesthesia,Insomnia
Therapeutic doses:50-100mg/day
Pyridoxine (Vitamin B6)
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Dietary sources
Physiological role
Deficiency symptoms
Peripheral neuropathy,Stomatitis,Precipitation of
epilepsy and growth retardation.
Prophylactic doses:2-5mg/day
Therapeutic doses:50-200mg/day Preparations
available:PYRIDOX,BENADON50mg tab
Ascorbic acid (Vitamin C)
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Dietary sources
Physiological role
Deficiency symptoms: Scurvy (defect in collegen
formation)
Prophylactic doses:50-500mg/day
Therapeutic doses:1-1.5g/day
As antioxidant:100mg/day
Haematinic formulations 150mg/day
Preparations
available:CELIN,CHEWCEE,REDOXON 500mg tab
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Antioxidants
Erythropoietin
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Cytokine produced in juxtatubular cells in the
kidney and also in macrophages.
Produced by recombinant technology.
Available as epoeitin α and β.
25-100 IU/kg, s.c. or i.v. 3 times a week.
Uses of Erythropoietin
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Anaemia due to:
Chronic renal failure.
Cancer chemotherapy.
AIDS.
Premature infants.
Blood transfusion
Adverse effects: flu-like symptoms, mild
hypertension, encephalopathy, occasionally
convulsions, risk of thrombosis due to hematocrit
rises.