Anemia Types, Thyroid Disorders, and Neurotransmitters

Anemia Classifications and Management

• Iron Deficiency: Symptoms include fatigue, shortness of breath (SOB), chest pain (CP), and brittle hair/nails.
• Pernicious Anemia: Caused by autoimmune destruction or gastric surgery, leading to B12 malabsorption and decreased RBCs.
• Vitamin B12 Deficiency: Essential for RBC production.
• Folic Acid Deficiency: Lack of folate prevents RBC production. Determine the cause of anemia before administering folic acid; if heavy periods are present, consult an OBGYN.
• Sickle Cell Anemia: Characterized by abnormal hemoglobin and rigid, sickle-shaped RBCs. Causes severe pain (vaso-occlusion), swollen hands/feet, and poor wound healing.

Iron Supplementation Protocols

• Take iron with Vitamin C; avoid milk or antacids.
• Use Z-track method for IM injections.
• IV Iron: Monitor for anaphylaxis.
• Ferrous Salts: Known to be harsh on the GI system.
• Dextran: Contraindicated in all anemias except iron-deficiency.
• Liquid Iron: Administer through a straw.
• Oral Iron: Best taken between meals for maximum absorption, though may be taken with meals if GI distress occurs.

Thyroid Disorders

Hypothyroidism

Treated with levothyroxine (T4) or liothyronine (T3). Side effects include cardiac dysrhythmias, tachycardia, anxiety, weight loss, and heat intolerance. Effects typically appear in 4-6 weeks.

Hyperthyroidism

Treatments include radioactive iodine, surgery, or antithyroid drugs (e.g., Thiamazole). Monitor cardiac status, weight, and pregnancy status. Take medication in the morning and monitor TSH, T3, and T4 levels. Drug interactions include increased anticoagulation effects, increased need for diabetic medications, and decreased digoxin levels.

Neurotransmitters and Psychopharmacology

Key Neurotransmitters

• Glutamate: Primary excitatory transmitter; essential for memory, learning, and neural plasticity.
• GABA: Main inhibitory transmitter; reduces neuronal excitability to regulate anxiety and sleep.
• Dopamine: Controls reward, motivation, and motor control. Decreased levels are linked to Parkinson’s disease; high levels are linked to schizophrenia.
• Serotonin: Modulates mood, sleep, and appetite. Low levels are associated with depression.
• Norepinephrine: Increases heart rate and blood pressure; involved in fear and stress responses.
• Acetylcholine: Enhances memory and cortical arousal.

Psychiatric Medications

• Tricyclics: Used for depression (e.g., Imipramine, which may cause dry mouth, blurred vision, constipation, and urinary retention).
• SSRIs: Example: Paxil.
• Lithium: Affects fluid balance; monitor for polyuria and edema.
• Risperidone: Associated with movement disorders.
• MAOIs: Risk of hypertensive crisis; avoid specific foods. Nardil requires a low-thiamine diet.
• Anticholinergics: Act as dopamine blockers; can cause restless or uncontrolled motion (PNS effects).