NAPLEX Practice Question # 68

Naplex Examination.

Practice Question # 68.


NAPLEX Practice Question # 68



Epoetin alfa and Darbepoetin

Treatment of anemia includes administration of iron (e.g., ferrous sulfate), folate supplements, and epoetin alfa.

(1) Severe anemia may warrant transfusion with packed red blood cells.

(2) Epoetin alfa (Procrit®, Epogen®) stimulates the production of red cell progenitors and the production of hemoglobin. It also accelerates the release of reticulocytes from the bone marrow.

(a) An initial dose of epoetin alfa is 50 to 100 U/kg intravenously or subcutaneously three times a week. Th e dose may be adjusted upward to elicit the desired response.

(b) Epoetin alfa works best in patients with a hematocrit below 30%. During the initial treatment, the hematocrit increases 1.0% to 3.5% in a 2-week period. Th e target hematocrit is 33% to 35%. Maintenance doses are titrated based on hematocrit aft er this level is reached.

(c) Epoetin alfa therapy should be temporarily stopped if hematocrit exceeds 36%. Additional side effects include hypertension in up to 25% of patients. Headache and malaise have been reported.

(d) Th e eff ects of epoetin alfa are dependent on a ready supply of iron for hemoglobin synthesis. Patients who do not respond should have iron stores checked. This includes serum iron, total iron-binding capacity, transferrin saturation, and serum ferritin. Iron supplementation should be increased as indicated.


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