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El objetivo es dominar los mecanismos, indicaciones, farmacocinética y toxicidad de los minerales (hierro), vitaminas (B12 y ácido fólico) y factores de crecimiento hematopoyético utilizados en la práctica clínica. ## Clasificación de las Anemias y Drepanocitosis La hematopoyesis es el proceso continuo de producción de células sanguíneas, generando más de 200,000 millones de células al día. Este proceso exige un suministro constante de nutrientes esenciales y factores de crecimiento; su déficit detiene la síntesis celular y produce diferentes tipos de anemia. La anemia se define como una deficiencia en los eritrocitos que transportan oxígeno, provocando hipoxia tisular. Se clasifica principalmente según su etiología nutricional o genética: 1. **Déficit de Hierro:** Causa más común. Produce anemia microcítica e hipocrómica. 2. **Déficit de Vitamina B12:** Produce anemia macrocítica y normocrómica, con daño neurológico asociado. 3. **Déficit de Ácido Fólico:** Produce anemia macrocítica y normocrómica, sin daño neurológico. 4. **Déficit de factores de crecimiento hematopoyético:** Típico en insuficiencia renal crónica (déficit de eritropoyetina) o síndromes de falla medular. 5. **Drepanocitosis o Falsimorfismo:** Trastorno genético (mutación de hemoglobina S) que produce eritrocitos deformes, reduciendo su deformabilidad y causando daño venooclusivo. **Anemia de células falciformes (Drepanocitosis)** Enfermedad genética homocigota para la hemoglobina S (HbS) o heterocigota compuesta. Los eritrocitos adquieren forma de hoz en condiciones de baja oxigenación, agregándose en la microvasculatura y causando crisis dolorosas e isquemia. Para el tratamiento de la drepanocitosis se utiliza la **hidroxiurea** (hidroxicarbamida). Parámetro | Descripción Mecanismo de acción | Inhibe la ribonucleótido reductasa, deteniendo el ciclo celular en fase S. Aumenta la producción de hemoglobina fetal (HbF), la cual interfiere con la polimerización de la HbS. Indicaciones | Tratamiento de adultos y niños con crisis recurrentes vasooclusivas en anemia de células falciformes. Toxicidad | Depresión hematopoyética, efectos gastrointestinales, teratogenicidad. Embarazo | Contraindicado (teratogénico). La anemia puede ser carencial (hierro, B12, folato), por déficit de estímulo (eritropoyetina) o genética (drepanocitosis). La hidroxiurea es el fármaco de elección para reducir las crisis vasooclusivas en la anemia de células falciformes al incrementar la hemoglobina fetal. ------ ## Farmacología del Hierro El hierro forma el núcleo del anillo de porfirina del grupo hem, esencial para la hemoglobina, mioglobina y citocromos. Su déficit detiene la síntesis de eritrocitos, resultando en células pequeñas y pálidas (anemia microcítica hipocrómica). ### Farmacocinética y Farmacodinamia El hierro inorgánico libre es altamente tóxico, por lo que el cuerpo carece de vías de excreción activa (las pérdidas fecales y por sudor son menores a 1 mg/día). El control sistémico se basa exclusivamente en la regulación de su absorción intestinal. ```mermaid flowchart TD A["Hierro Hem (Dieta)"] -->|"HCP1"| B["Enterocito (Duodeno)"] C["Hierro No Hem (Fe3+)"] -->|"Ferrireductasa"| D["Fe2+"] D -->|"DMT1"| B B -->|"Almacén"| E["Ferritina"] B -->|"Ferroportina"| F["Torrente Sanguíneo"] F -->|"Transferrina"| G["Médula Ósea (Eritropoyesis)"] F -->|"Transferrina"| H["Hígado (Depósito)"] ``` * **Absorción:** Ocurre en duodeno y yeyuno proximal. El hierro hem entra intacto. El hierro inorgánico $(Fe^{3+})$ debe reducirse a ferroso $(Fe^{2+})$ e ingresa mediante el transportador DMT1. * **Regulación:** La **hepcidina** (péptido hepático) es el regulador central. Un aumento en las reservas de hierro eleva la hepcidina, la cual destruye la ferroportina y bloquea la absorción. * **Transporte y Almacenamiento:** Se transporta en plasma unido a la **transferrina** y se almacena en macrófagos y hepatocitos como **ferritina**. La ferritina sérica es el indicador más exacto de las reservas totales. ### Tratamiento Clínico de la Anemia Ferropénica La única indicación es el tratamiento o prevención de la anemia por deficiencia de hierro. Las dosis requeridas suelen ser de 200 a 400 mg de hierro elemental al día (solo se absorbe un ~25%). Fármaco | Hierro elemental | Dosis habitual (adultos) Sulfato ferroso | 65 mg (por 325 mg) | 2 a 4 tabletas/día Gluconato ferroso | 36 mg (por 325 mg) | 3 a 4 tabletas/día Fumarato ferroso | 106 mg (por 325 mg) | 2 a 3 tabletas/día **Ajustes y poblaciones especiales:** Se debe tratar durante 3 a 6 meses después de corregir el sangrado para reponer reservas. Aprobado en pediatría y embarazo con dosis adaptadas al peso y trimestre (dosis exactas no especificadas en la fuente). Indicado para pacientes con absorción intestinal intacta. Efectos adversos GI frecuentes (náuseas, calambres, heces negras que pueden enmascarar sangrado GI). Indicado para intolerancia oral, resección intestinal o insuficiencia renal crónica en hemodiálisis tratada con EPO. Formulaciones coloidales: Hierro dextrán, sacarosa, ferumoxitol. El **Hierro Dextrán** de alto peso molecular y el **Ferumoxitol** tienen riesgo de causar reacciones de hipersensibilidad, anafilaxia y muerte. Se exige siempre una dosis de prueba antes de la infusión completa. ### Toxicidad y Sobredosis Casi exclusiva en niños por ingestión accidental (<10 tabletas pueden ser letales). Produce gastroenteritis necrotizante, choque, letargo, acidosis metabólica y muerte. **Tratamiento:** Lavado intestinal y **Deferoxamina IV** (quelante). El carbón activado NO funciona. Hemocromatosis por genéticas o politransfusiones. Provoca falla orgánica (hígado, corazón). **Tratamiento:** Flebotomía. Si hay anemia severa, quelantes orales (**Deferasirox**, **Deferiprona**). La deferiprona exige monitoreo por riesgo de agranulocitosis. Manejo de intoxicación aguda por hierro El carbón activado no se une al hierro inorgánico. La flebotomía es para toxicidad crónica. La intoxicación aguda requiere quelación sistémica con deferoxamina. El hierro requiere un control estricto de absorción mediado por hepcidina. Se prefiere la vía oral (sulfato ferroso), reservando la vía IV para síndromes de malabsorción o diálisis, vigilando el riesgo de anafilaxia. La intoxicación aguda exige deferoxamina. ------ ## Vitamina B12 y Ácido Fólico Ambas vitaminas actúan en vías metabólicas interconectadas esenciales para la síntesis de ADN. Su deficiencia produce anemia megaloblástica, pero solo la falta de B12 genera un cuadro neurológico progresivo. ### Vitamina B12 (Cobalamina) * **Farmacocinética:** No es sintetizada por plantas ni animales (origen bacteriano; obtenida de carne/lácteos). Requiere unión al **Factor Intrínseco** (FI) gástrico para ser absorbida en el íleon distal. Se almacena masivamente en el hígado (3,000-5,000 mcg). Tarda hasta 5 años en agotarse tras el cese de absorción. * **Farmacodinamia (Mecanismo):** Es cofactor en dos vías: 1. *Metilcobalamina:* Convierte la homocisteína en metionina, liberando tetrahidrofolato para la síntesis de ADN. 2. *Desoxiadenosilcobalamina:* Isomeriza la metilmalonil-CoA a succinil-CoA. Su fallo acumula ácido metilmalónico, lo que causa desmielinización neurológica. * **Indicaciones:** Anemia perniciosa (autoinmune contra el FI), gastrectomía, malabsorción, dietas veganas estrictas. * **Dosis y Vía:** Inicial de 100-1000 mcg IM diario/interdiario por 1-2 semanas. Mantenimiento de 100-1000 mcg IM mensual de por vida. (Vía oral solo útil a dosis gigantes de 1000 mcg/día). Se usa la **Hidroxicobalamina** o Cianocobalamina. ### Ácido Fólico * **Farmacocinética:** Presente en vegetales. Se absorbe en el yeyuno proximal como monoglutamato. Depósitos hepáticos pequeños (5-20 mg); se agotan rápido en 1 a 6 meses. * **Farmacodinamia:** El {{tetrahidrofolato}} dona unidades de un carbono para sintetizar desoxitimidilato (dTMP) mediante la timidilato sintasa, paso crítico para la replicación del ADN. * **Indicaciones:** Déficit nutricional, alcoholismo, embarazo (prevenir defectos del tubo neural), estados de hemólisis crónica. * **Dosis:** $1~mg/dia$ vía oral es curativo y suficiente para reponer reservas. Característica | Vitamina B12 | Ácido Fólico Reserva hepática | Años (3,000 - 5,000 mcg) | Meses (5 - 20 mg) Daño Neurológico | Sí (acumula ácido metilmalónico) | No Sitio de absorción | Íleon distal (requiere Factor Intrínseco) | Yeyuno proximal Dosis terapéutica | 100 - 1000 mcg (Intramuscular) | 1 mg/día (Oral) Embarazo | Mantenimiento estándar | Suplementación crucial (previene DTN) **La trampa del folato:** Administrar grandes dosis de ácido fólico a un paciente con deficiencia de B12 corregirá la anemia megaloblástica, pero **no detendrá el daño neurológico**, permitiendo que progrese hasta ser irreversible. Siempre se deben medir ambos niveles séricos. La B12 y el folato son inseparables en la síntesis de ADN. El déficit de B12 (común por malabsorción gástrica/ileal) exige reposición intramuscular de por vida y causa daño neurológico. El folato se repone fácilmente vía oral. ------ ## Factores de Crecimiento Hematopoyético: Serie Roja Los Factores Estimulantes de la Eritropoyesis (ESA) son hormonas glucoproteicas sintetizadas por tecnología recombinante, utilizadas para tratar anemias crónicas refractarias al soporte nutricional. ### Fármacos y Farmacocinética Existen tres formulaciones principales, que difieren fundamentalmente en su vida media gracias a modificaciones de bioingeniería: 1. **Epoetina alfa (rHuEPO):** Estructura original. Vida media de 4-13 horas. Se administra por vía IV o SC, 1 a 3 veces por semana. No se elimina por diálisis. 2. **Darbepoetina alfa:** Altamente glucosilada. Vida media 2 a 3 veces mayor. Se administra semanalmente. 3. **Metoxi-polietilenglicol epoetina beta:** Isoforma PEGilada de acción ultralarga. Se administra 1 o 2 veces al mes. ### Farmacodinamia Actúan como agonistas de los receptores de eritropoyetina en los progenitores eritroides de la médula ósea (superfamilia JAK/STAT). Inducen proliferación, síntesis de hemoglobina y liberación de reticulocitos. Fisiológicamente, hay una relación inversa: a menor oxigenación, mayor secreción renal de EPO endógena. Si la médula falla primariamente o falta hierro, la EPO endógena será altísima y la exógena no servirá. ### Indicaciones y Uso Clínico * **Enfermedad Renal Crónica (ERC):** Indicación principal (el riñón no produce EPO). Requiere aporte estricto simultáneo de **hierro**. * **Anemia por Quimioterapia:** Útil si la Hb es $<10~g/dL$, para evitar transfusiones (solo en cánceres no mieloides). * **Síndromes Mielodisplásicos (SMD):** Solo en bajo riesgo transfusional y si la EPO endógena es $<100~IU/L$. * *Ajustes y Monitoreo:* Dosis ajustadas para mantener la hemoglobina en el rango estricto de **10 a 11 g/dL** (o 10-12 g/dL según el contexto). ### Toxicidad y Contraindicaciones **Riesgo Cardiovascular y Oncológico:** Si la dosis eleva la hemoglobina por encima de $11~g/dL$, aumenta exponencialmente el riesgo de hipertensión, trombosis venosa profunda, infarto, ACV y mortalidad general. La **Metoxi-polietilenglicol epoetina beta** está contraindicada en anemia por quimioterapia por aumento documentado de muertes. Los ESA (epoetina, darbepoetina) son vitales en la anemia por insuficiencia renal crónica. Requieren hierro concomitante. Su principal riesgo es la trombosis y muerte si se intenta "normalizar" la hemoglobina por encima de los 11 g/dL. ------ ## Factores de Crecimiento Mieloide Estas citocinas estimulan la proliferación, diferenciación y supervivencia de los leucocitos (específicamente neutrófilos), siendo el pilar del rescate inmunológico post-quimioterapia. ### Fármacos de la Clase * **Filgrastim (G-CSF):** Péptido no glucosilado (E. coli, 18 kDa). Vida media corta (2-7 horas). Administración diaria subcutánea. * **Pegfilgrastim:** Conjugado con polietilenglicol. Larga vida media que permite una **única dosis de 6 mg por ciclo de quimioterapia**. * **Sargramostim (GM-CSF):** Péptido parcialmente glucosilado (levadura). Vida media corta (2-7 horas). ### Farmacodinamia e Indicaciones * **Mecanismo:** Activan receptores JAK/STAT. El **G-CSF** es selectivo para neutrófilos, mejorando su fagocitosis. El **GM-CSF** es multipotencial (granulocitos, macrófagos, eritroides, megacariocitos). * **Quimioterapia citotóxica:** Aceleran la recuperación del recuento absoluto de neutrófilos (ANC), reduciendo neutropenias febriles, uso de antibióticos y días de hospitalización. Se inicia 24-72h posquimioterapia hasta lograr ANC $>10,000~celulas/\mu L$. * **Movilización de Células Madre (PBSC):** El G-CSF moviliza células CD34+ de la médula a la sangre para leucaféresis en trasplantes autólogos/alogénicos. Si la respuesta es subóptima, se añade **Plerixafor** (inhibidor del receptor CXCR4). Parámetro | G-CSF (Filgrastim / Pegfilgrastim) | GM-CSF (Sargramostim) Selectividad | Específico para linaje de neutrófilos | Multipotencial (mieloide global) Dosis (Quimioterapia) | Filgrastim: 5 mcg/kg/día SC | Sargramostim: 250 mcg/m²/día SC Efectos Adversos Comunes | Dolor óseo (reversible) | Fiebre, artralgias, mialgias Toxicidad Grave | Rotura esplénica (rara) | Síndrome de fuga capilar (edema, derrame pleural/pericárdico) Uso Principal | Prevención de neutropenia, movilización PBSC | Neutropenia (menos usado por intolerancia) ¿Cuál es la ventaja clínica del pegfilgrastim sobre el filgrastim? El pegfilgrastim tiene una vida media prolongada que permite administrar una sola dosis por ciclo de quimioterapia, mejorando la adherencia frente a las inyecciones diarias del filgrastim. El G-CSF (filgrastim) y pegfilgrastim son el estándar para el rescate neutropénico posquimioterapia y la movilización de células madre, presentando dolor óseo como efecto adverso principal. El GM-CSF tiene mayor toxicidad (fuga capilar, fiebre). ------ ## Factores de Crecimiento de Megacariocitos Los fármacos de esta clase combaten la trombocitopenia para reducir el riesgo de sangrado y la necesidad de transfusiones de plaquetas. La evolución farmacológica migró de las interleucinas a los agonistas del receptor y bloqueadores enzimáticos. ### Farmacología de la Clase 1. **Oprelvekin (Interleucina-11, IL-11):** * *Farmacocinética:* Vida media 7-8 horas. Dosis 50 mcg/kg/día SC. * *Farmacodinamia:* Activa receptores IL-11 estimulando precursores megacariocíticos. * *Indicaciones:* Prevención secundaria de trombocitopenia en quimioterapia no mieloide. * *Toxicidad:* Fatiga, edema pulmonar, anemia dilucional y **arritmias auriculares transitorias**. 2. **Agonistas del Receptor de Trombopoyetina (MPL):** Creados para eludir la formación de autoanticuerpos contra la TPO nativa. * *Romiplostim:* "Peptibody" subcutáneo semanal. Vida media inversa al recuento plaquetario (3-4 días). * *Eltrombopag:* Molécula no peptídica oral. Vida media 26-35 horas. * *Avatrombopag:* Agonista oral (dosis 20-60 mg/día dependiendo de la función hepática/plaquetas). * *Efectos adversos:* Hepatotoxicidad (eltrombopag), trombosis portal (en cirróticos), fibrosis medular (reversible) y trombocitopenia de rebote al suspender. Aumentan blastos en SMD. 3. **Inhibidor de la Cinasa SYK:** * *Fostamatinib:* Profármaco oral. Su metabolito (R406) bloquea la cinasa SYK y las vías del receptor Fc, frenando la destrucción plaquetaria mediada por anticuerpos por los macrófagos. * *Toxicidad:* Diarrea, hipertensión, neutropenia. Metabolismo por CYP3A4 (interactúa con ketoconazol). Fármaco | Clase / Mecanismo | Vía | Indicación Principal Oprelvekin | Recombinante IL-11 | SC | Trombocitopenia por quimioterapia Romiplostim | Agonista receptor MPL (peptídico) | SC | Trombocitopenia Inmune Crónica (TIIC) Eltrombopag | Agonista receptor MPL (no peptídico) | Oral | TIIC; trombocitopenia en Hepatitis C Avatrombopag | Agonista receptor MPL | Oral | TIIC; previo a cirugía en hepatopatía Fostamatinib | Inhibidor cinasa SYK | Oral | TIIC refractaria (frena destrucción) Para todos los agonistas del receptor TPO en el contexto de la Trombocitopenia Inmune Crónica (TIIC), se consideran terapia de segunda línea: se usan a la dosis mínima requerida para mantener recuentos $>50,000~celulas/\mu L$ cuando hay respuesta inadecuada a esteroides, inmunoglobulinas o esplenectomía. Ajustes hepáticos, renales, pediátricos o en embarazo no están especificados en la fuente para todos los agentes, salvo la alerta hepática para Eltrombopag. La trombocitopenia se aborda históricamente con IL-11 (limitada por arritmias y edema), y modernamente con agonistas del receptor de trombopoyetina (Romiplostim SC, Eltrombopag/Avatrombopag oral) para estimular producción, o Fostamatinib para evitar la destrucción inmunitaria. Exigen estricta vigilancia de trombosis portal y toxicidad hepática. 5:["$","$L24",null,{"value":{"GET /exams/6a9c7103f1d401406a25a69b":{"user":null,"exam":{"questions":[{"id":"dd232e51-229d-4379-aa9a-bee3ef0c7ab2","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción de la hidroxiurea en la anemia de células falciformes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Inhibe la ribonucleótido reductasa y eleva la hemoglobina fetal"},{"id":"B","text":"Estimula la producción de eritropoyetina en el riñón"},{"id":"C","text":"Bloquea los canales de calcio en los eritrocitos"},{"id":"D","text":"Actúa como quelante del hierro libre"}],"correctOptions":["A"],"matches":[],"match_pairs":[],"explanation":"La hidroxiurea inhibe la ribonucleótido reductasa y aumenta la producción de hemoglobina fetal (HbF), que interfiere con la polimerización de la HbS.","helpful_links":[],"tags":["anemia falciforme","fármacos"]},{"id":"72f43e6e-fd30-42a9-9b17-c85ae5dcc2d0","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción del voxelotor?","questionImage":null,"type":"single","options":[{"id":"A","text":"Inhibe la ribonucleótido reductasa"},{"id":"B","text":"Se une a la HbS y aumenta su afinidad por el oxígeno"},{"id":"C","text":"Estimula los receptores de eritropoyetina"},{"id":"D","text":"Quela el hierro libre en el plasma"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El voxelotor es un fármaco oral que se une a la HbS y reduce la adopción de la forma falciforme aumentando su afinidad por el oxígeno.","helpful_links":[],"tags":["anemia falciforme","fármacos"]},{"id":"9a27fd04-2431-480e-a99b-18653870f8eb","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la mutación característica de la anemia de células falciformes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Deleción del gen de la globina beta"},{"id":"B","text":"Sustitución de valina por ácido glutámico en la posición 6 de la globina beta"},{"id":"C","text":"Sustitución de glutamina por valina en la globina alfa"},{"id":"D","text":"Duplicación del gen de la hemoglobina fetal"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La HbS resulta de la sustitución de valina por ácido glutámico en la posición 6 de la cadena beta de la globina.","helpful_links":[],"tags":["anemia falciforme","genética"]},{"id":"dacb6d86-25dc-4806-ae35-1ac471af7393","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el problema principal en la anemia de células falciformes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anemia severa por producción reducida de eritrocitos"},{"id":"B","text":"Deficiencia de hierro y vitamina B12"},{"id":"C","text":"Daño venooclusivo por polimerización de HbS desoxigenada"},{"id":"D","text":"Infección por bacterias encapsuladas"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El problema principal es que las cadenas de HbS desoxigenadas forman polímeros que causan daño venooclusivo en la microvasculatura.","helpful_links":[],"tags":["anemia falciforme","fisiopatología"]},{"id":"3446e13a-0b4f-41db-ae39-a16f97082f2e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué complicación es común en pacientes con anemia de células falciformes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipoglucemia severa"},{"id":"B","text":"Infección por bacterias encapsuladas como Streptococcus pneumoniae"},{"id":"C","text":"Hipertiroidismo"},{"id":"D","text":"Insuficiencia hepática fulminante"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El daño al bazo aumenta el riesgo de infección, en particular por bacterias encapsuladas como Streptococcus pneumoniae.","helpful_links":[],"tags":["anemia falciforme","complicaciones"]},{"id":"59791676-92f0-44d3-a0d1-728087560ecb","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el tratamiento de soporte para la anemia de células falciformes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Solo hidroxiurea"},{"id":"B","text":"Eritropoyetina recombinante"},{"id":"C","text":"Analgésicos, antibióticos, vacunación y transfusiones"},{"id":"D","text":"Filgrastim subcutáneo"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El tratamiento de apoyo incluye analgésicos, antibióticos, vacunación neumocócica y transfusiones de sangre.","helpful_links":[],"tags":["anemia falciforme","tratamiento"]},{"id":"43739b72-b516-46e1-a560-05dccb2000a6","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la causa más común de anemia crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"Deficiencia de vitamina B12"},{"id":"B","text":"Deficiencia de ácido fólico"},{"id":"C","text":"Deficiencia de hierro"},{"id":"D","text":"Anemia de células falciformes"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La deficiencia de hierro es la causa más común de anemia crónica.","helpful_links":[],"tags":["anemia","hierro"]},{"id":"1544409b-2318-46c0-97ce-2759113edca2","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la función principal de la hepcidina?","questionImage":null,"type":"single","options":[{"id":"A","text":"Transportar oxígeno en la sangre"},{"id":"B","text":"Regular la absorción y liberación de hierro"},{"id":"C","text":"Estimular la eritropoyesis en la médula ósea"},{"id":"D","text":"Quelar el hierro sérico circulante"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La hepcidina, producida por el hígado, es el regulador central clave del sistema de absorción y liberación de hierro.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"66f8ab5a-abd4-40e4-99ce-d2c4555a7796","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿En qué porción del intestino se absorbe principalmente el hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Íleon distal"},{"id":"B","text":"Duodeno y yeyuno proximal"},{"id":"C","text":"Colon ascendente"},{"id":"D","text":"Estómago"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El hierro se absorbe en el duodeno y el yeyuno proximal, aunque el intestino delgado más distal puede absorberlo si es necesario.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"ef5c7eb4-4e9e-4af4-993c-2f584e7884ca","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué transportador media la absorción de hierro ferroso en la membrana luminal intestinal?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ferroportina"},{"id":"B","text":"Transferrina"},{"id":"C","text":"DMT1"},{"id":"D","text":"Hepcidina"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El transportador de metales divalentes DMT1 media la absorción activa de hierro ferroso en las células epiteliales intestinales.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"52079c27-e16c-49be-8534-613cff856695","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué proteína exporta el hierro desde las células intestinales hacia la sangre?","questionImage":null,"type":"single","options":[{"id":"A","text":"DMT1"},{"id":"B","text":"Transferrina"},{"id":"C","text":"Ferritina"},{"id":"D","text":"Ferroportina"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"La ferroportina transporta el hierro a través de la membrana basolateral hacia la sangre, donde es oxidado por la hefaestina.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"36dc40e0-515c-4023-a505-883412ea3d71","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué proteína transporta el hierro en el plasma?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ferritina"},{"id":"B","text":"Hepcidina"},{"id":"C","text":"Transferrina"},{"id":"D","text":"Hemoferritina"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La transferrina es una globulina beta que transporta el hierro férrico en el plasma.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"3d6fa81e-b383-4031-b950-3fe0a37f01d9","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la principal forma de almacenamiento de hierro en el organismo?","questionImage":null,"type":"single","options":[{"id":"A","text":"Transferrina"},{"id":"B","text":"Hemosiderina"},{"id":"C","text":"Mioglobina"},{"id":"D","text":"Ferritina"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"El hierro se almacena principalmente como ferritina en macrófagos del hígado, bazo y médula ósea, y en hepatocitos.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"4b9bcac2-e370-49bb-a004-d97266db95d0","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cómo regula la hepcidina la liberación de hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Estimula la ferroportina intestinal"},{"id":"B","text":"Inhibe la ferroportina y desencadena su internalización"},{"id":"C","text":"Aumenta la absorción intestinal de hierro"},{"id":"D","text":"Bloquea la transferrina plasmática"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La hepcidina inhibe la liberación de hierro uniéndose a la ferroportina y desencadenando su internalización y destrucción.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"d0088570-5ba9-4393-9466-c8d3816be565","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la principal vía de eliminación del hierro del cuerpo?","questionImage":null,"type":"single","options":[{"id":"A","text":"Excreción renal activa"},{"id":"B","text":"Excreción biliar activa"},{"id":"C","text":"No hay mecanismo activo; se pierde por descamación y sudor"},{"id":"D","text":"Excreción pulmonar pasiva"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"No hay un mecanismo para la excreción del hierro; pequeñas cantidades se pierden en heces, bilis, orina y sudor.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"025ea373-d447-4dc4-878e-a3e0d69f6f5c","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la única indicación clínica para el uso de preparados de hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anemia megaloblástica"},{"id":"B","text":"Neutropenia febril"},{"id":"C","text":"Trombocitopenia inmune"},{"id":"D","text":"Tratamiento o prevención de anemia por deficiencia de hierro"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"La única indicación clínica para el uso de preparados de hierro es el tratamiento o prevención de la anemia por deficiencia de hierro.","helpful_links":[],"tags":["hierro","indicaciones"]},{"id":"ec646f48-272b-4b71-957e-6d2fa3594b1f","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué preparación oral de hierro se recomienda para la mayoría de los pacientes por su eficacia y bajo costo?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hierro dextrán"},{"id":"B","text":"Sulfato ferroso"},{"id":"C","text":"Complejo de gluconato férrico de sodio"},{"id":"D","text":"Ferumoxitol"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El sulfato ferroso, gluconato ferroso y fumarato ferroso son efectivos, de bajo costo y recomendados para la mayoría de los pacientes.","helpful_links":[],"tags":["hierro","tratamiento"]},{"id":"8961ea7d-296e-484f-a80f-905506bb3a3a","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis típica de hierro elemental diario para corregir la deficiencia de hierro en adultos?","questionImage":null,"type":"single","options":[{"id":"A","text":"50-100 mg"},{"id":"B","text":"10-20 mg"},{"id":"C","text":"200-400 mg"},{"id":"D","text":"500-1000 mg"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Se deben administrar 200-400 mg de hierro elemental al día para corregir la deficiencia rápidamente.","helpful_links":[],"tags":["hierro","dosis"]},{"id":"2d5c1143-8d09-4fd2-99fc-52af1b9d3aa7","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuánto hierro elemental contiene una tableta de sulfato ferroso hidratado de 325 mg?","questionImage":null,"type":"single","options":[{"id":"A","text":"36 mg"},{"id":"B","text":"106 mg"},{"id":"C","text":"325 mg"},{"id":"D","text":"65 mg"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"El sulfato ferroso hidratado de 325 mg contiene 65 mg de hierro elemental.","helpful_links":[],"tags":["hierro","dosis"]},{"id":"8aea555a-707c-4604-85cb-c1cb7b1e29c8","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuánto hierro elemental contiene una tableta de fumarato ferroso de 325 mg?","questionImage":null,"type":"single","options":[{"id":"A","text":"106 mg"},{"id":"B","text":"65 mg"},{"id":"C","text":"36 mg"},{"id":"D","text":"325 mg"}],"correctOptions":["A"],"matches":[],"match_pairs":[],"explanation":"El fumarato ferroso de 325 mg contiene 106 mg de hierro elemental.","helpful_links":[],"tags":["hierro","dosis"]},{"id":"fe51d102-b53a-412f-912e-a0a5aafd823d","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuánto hierro elemental contiene una tableta de gluconato ferroso de 325 mg?","questionImage":null,"type":"single","options":[{"id":"A","text":"65 mg"},{"id":"B","text":"106 mg"},{"id":"C","text":"36 mg"},{"id":"D","text":"325 mg"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El gluconato ferroso de 325 mg contiene 36 mg de hierro elemental.","helpful_links":[],"tags":["hierro","dosis"]},{"id":"31a141e8-2a3e-4287-a61f-d9326aa6f65e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso gastrointestinal es común con la terapia oral de hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Diarrea acuosa"},{"id":"B","text":"Melena"},{"id":"C","text":"Estreñimiento"},{"id":"D","text":"Hematemesis"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Los efectos adversos comunes del hierro oral incluyen náuseas, malestar epigástrico, calambres abdominales, estreñimiento y diarrea.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"53f3a4cf-ab6c-4c06-96f2-9bb76c2744e1","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la vía de administración preferida para el hierro dextrán?","questionImage":null,"type":"single","options":[{"id":"A","text":"Intramuscular"},{"id":"B","text":"Oral"},{"id":"C","text":"Subcutánea"},{"id":"D","text":"Intravenosa"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"Aunque el hierro dextrán puede administrarse IM o IV, la vía intravenosa se usa con mayor frecuencia porque elimina el dolor local y la tinción tisular.","helpful_links":[],"tags":["hierro","farmacocinética"]},{"id":"e95a0eeb-7bed-41d2-89e2-f0427ee2a821","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué preparación de hierro parenteral tiene mayor riesgo de anafilaxia?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hierro sacarosa"},{"id":"B","text":"Gluconato férrico de sodio"},{"id":"C","text":"Hierro dextrán de alto peso molecular"},{"id":"D","text":"Carboximaltosa férrica"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El riesgo de anafilaxia está muy asociado con formulaciones de hierro dextrán de alto peso molecular como Dexferrum.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"a8ec8ec0-989d-46de-86d1-7e34636c22d1","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué se debe administrar antes de una dosis completa de hierro dextrán intravenoso?","questionImage":null,"type":"single","options":[{"id":"A","text":"Un antihistamínico"},{"id":"B","text":"Un corticoide"},{"id":"C","text":"Una pequeña dosis de prueba"},{"id":"D","text":"Nada, se administra directamente"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Debido al riesgo de hipersensibilidad, siempre debe administrarse una pequeña dosis de prueba de hierro dextrán antes de dosis completas.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"ec40de80-086e-4050-aceb-3a04453425fe","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el antídoto para la toxicidad aguda por hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Naloxona"},{"id":"B","text":"Flumazenil"},{"id":"C","text":"Acetilcisteína"},{"id":"D","text":"Deferoxamina"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"La deferoxamina es un potente quelante del hierro que se administra por vía intravenosa para unir el hierro absorbido y favorecer su excreción.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"b85921c8-f34d-4b22-a2bd-5eb2689168e0","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué quelante oral de hierro se usa para hemocromatosis?","questionImage":null,"type":"single","options":[{"id":"A","text":"Deferoxamina"},{"id":"B","text":"Penicilamina"},{"id":"C","text":"Edetato de calcio"},{"id":"D","text":"Deferasirox"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"El deferasirox es un quelante de hierro administrado por vía oral para el tratamiento de la hemocromatosis.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"85a2df5c-bc36-402f-ba45-df4d0724db9a","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se asocia con la deferiprona?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipertensión"},{"id":"B","text":"Agranulocitosis"},{"id":"C","text":"Trombosis"},{"id":"D","text":"Hepatotoxicidad"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La deferiprona rara vez se ha asociado con agranulocitosis, por lo que se requiere control semanal de biometría hemática.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"63fe5947-9fb5-4c74-96f5-94fd73067723","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se asocia con la deferoxamina con uso a largo plazo?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipertensión arterial"},{"id":"B","text":"Trombosis venosa"},{"id":"C","text":"Neurotoxicidad y mayor susceptibilidad a infecciones"},{"id":"D","text":"Hepatotoxicidad grave"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La deferoxamina puede causar neurotoxicidad y mayor susceptibilidad a ciertas infecciones con uso a largo plazo.","helpful_links":[],"tags":["hierro","toxicidad"]},{"id":"df44c51b-1a22-4566-af42-cb2b79c1d863","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cómo se manifiesta la anemia por deficiencia de hierro en el laboratorio?","questionImage":null,"type":"single","options":[{"id":"A","text":"MCV >100 fL y MCHC normal"},{"id":"B","text":"MCV normal y MCHC bajo"},{"id":"C","text":"MCV <80 fL y MCHC <30%"},{"id":"D","text":"MCV >100 fL y MCHC elevado"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La anemia por deficiencia de hierro es microcítica hipocrómica con MCV <80 fL y MCHC <30%.","helpful_links":[],"tags":["hierro","diagnóstico"]},{"id":"2c189d4c-3401-43cc-834e-5cca4f14f13e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la causa más común de deficiencia de hierro en adultos?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ingesta dietética insuficiente"},{"id":"B","text":"Malabsorción intestinal"},{"id":"C","text":"Pérdida de sangre"},{"id":"D","text":"Aumento de requerimientos"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La causa más común de deficiencia de hierro en adultos es la pérdida de sangre, a menudo gastrointestinal o menstrual.","helpful_links":[],"tags":["hierro","etiología"]},{"id":"364f1ee9-edf3-4563-9d4b-42c7645570ee","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué se debe evaluar en pacientes con anemia por deficiencia de hierro inexplicada?","questionImage":null,"type":"single","options":[{"id":"A","text":"Insuficiencia renal"},{"id":"B","text":"Hemorragia gastrointestinal oculta"},{"id":"C","text":"Hipotiroidismo"},{"id":"D","text":"Diabetes mellitus"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Los pacientes con anemia por deficiencia de hierro inexplicada deben ser evaluados para detectar hemorragia gastrointestinal oculta.","helpful_links":[],"tags":["hierro","diagnóstico"]},{"id":"9074778f-3791-458f-851a-77ab7ad4abc9","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿En qué pacientes se prefiere la administración parenteral de hierro?","questionImage":null,"type":"single","options":[{"id":"A","text":"Pacientes con anemia leve"},{"id":"B","text":"Mujeres embarazadas"},{"id":"C","text":"Niños con dieta inadecuada"},{"id":"D","text":"Pacientes con enfermedad renal crónica avanzada en hemodiálisis con eritropoyetina"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"Se prefiere la vía parenteral en pacientes con enfermedad renal crónica avanzada que se someten a hemodiálisis y tratamiento con eritropoyetina.","helpful_links":[],"tags":["hierro","indicaciones"]},{"id":"062439a2-b4b7-4b3e-b13c-a739add601e1","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la vida media de la eritropoyetina después de administración intravenosa en insuficiencia renal crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"30 minutos"},{"id":"B","text":"4-13 horas"},{"id":"C","text":"24 horas"},{"id":"D","text":"3-4 días"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La eritropoyetina tiene una vida media sérica de 4-13 horas en pacientes con insuficiencia renal crónica.","helpful_links":[],"tags":["eritropoyetina","farmacocinética"]},{"id":"20ccaa07-9d12-4ae1-a1ff-0c3313d40656","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la vida media de la darbepoetina alfa comparada con la epoetina alfa?","questionImage":null,"type":"single","options":[{"id":"A","text":"Igual"},{"id":"B","text":"La mitad"},{"id":"C","text":"2-3 veces más larga"},{"id":"D","text":"10 veces más larga"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La darbepoetina alfa tiene una vida media 2-3 veces más larga que la epoetina alfa debido a su mayor glicosilación.","helpful_links":[],"tags":["eritropoyetina","farmacocinética"]},{"id":"8e1be89c-8336-4bf5-9884-9b8689c026c1","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Con qué frecuencia se administra el metoxi-polietilenglicol epoetina beta?","questionImage":null,"type":"single","options":[{"id":"A","text":"Tres veces por semana"},{"id":"B","text":"Diariamente"},{"id":"C","text":"Cada dos semanas o mensualmente"},{"id":"D","text":"Cada 6 meses"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El metoxi-polietilenglicol epoetina beta es una forma de acción larga que se administra cada dos semanas o mensualmente.","helpful_links":[],"tags":["eritropoyetina","farmacocinética"]},{"id":"b00f012c-c79d-4088-ae94-c60b9dace574","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción de la eritropoyetina?","questionImage":null,"type":"single","options":[{"id":"A","text":"Estimula la producción de neutrófilos"},{"id":"B","text":"Estimula la producción de plaquetas"},{"id":"C","text":"Inhibe la apoptosis de linfocitos"},{"id":"D","text":"Estimula la proliferación y diferenciación de progenitores eritroides"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"La eritropoyetina estimula la proliferación y diferenciación eritroide al interactuar con receptores en progenitores de eritrocitos.","helpful_links":[],"tags":["eritropoyetina","mecanismo"]},{"id":"eafda569-055a-49b4-88c8-93b579716951","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué receptor utilizan la eritropoyetina y el G-CSF para señalizar?","questionImage":null,"type":"single","options":[{"id":"A","text":"Receptor acoplado a proteína G"},{"id":"B","text":"Canal iónico"},{"id":"C","text":"JAK/STAT"},{"id":"D","text":"Receptor tirosina cinasa intrínseco"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Tanto el receptor de eritropoyetina como el de G-CSF son miembros de la superfamilia JAK/STAT de receptores de citocinas.","helpful_links":[],"tags":["eritropoyetina","G-CSF"]},{"id":"827c3dfe-cfcc-43ce-9317-52b161a8c17e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es una indicación clínica de la eritropoyetina?","questionImage":null,"type":"single","options":[{"id":"A","text":"Neutropenia por quimioterapia"},{"id":"B","text":"Trombocitopenia inmune"},{"id":"C","text":"Anemia asociada con insuficiencia renal crónica"},{"id":"D","text":"Anemia de células falciformes"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La eritropoyetina se usa de forma rutinaria en pacientes con anemia secundaria a enfermedad renal crónica.","helpful_links":[],"tags":["eritropoyetina","indicaciones"]},{"id":"6b778bf3-01d7-407e-8113-a9609da05b11","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso grave se asocia con los agentes estimulantes de la eritropoyesis (ESA)?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipoglucemia"},{"id":"B","text":"Hipertiroidismo"},{"id":"C","text":"Neuropatía periférica"},{"id":"D","text":"Eventos tromboembólicos y mortalidad"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"Los ESA aumentan el riesgo de eventos cardiovasculares graves, tromboembólicos y mortalidad cuando se administran para niveles de hemoglobina >11 g/dL.","helpful_links":[],"tags":["eritropoyetina","toxicidad"]},{"id":"3e9f5b8c-9136-4b45-bf22-fbf2258e0517","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el nivel de hemoglobina recomendado que no debe excederse en pacientes con enfermedad renal crónica tratados con ESA?","questionImage":null,"type":"single","options":[{"id":"A","text":"8 g/dL"},{"id":"B","text":"11 g/dL"},{"id":"C","text":"13 g/dL"},{"id":"D","text":"15 g/dL"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Se recomienda que el nivel de hemoglobina no exceda 11 g/dL en pacientes con enfermedad renal crónica que reciben un ESA.","helpful_links":[],"tags":["eritropoyetina","toxicidad"]},{"id":"074ae37a-3213-434b-8e91-9f734d6a40f2","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco es un inhibidor de la prolil hidroxilasa (PHD) que aumenta la hemoglobina?","questionImage":null,"type":"single","options":[{"id":"A","text":"Epoetina alfa"},{"id":"B","text":"Filgrastim"},{"id":"C","text":"Roxadustat"},{"id":"D","text":"Romiplostim"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El roxadustat es un inhibidor de PHD que estabiliza el HIF y aumenta la eritropoyesis; está en ensayos clínicos para anemia por nefropatía.","helpful_links":[],"tags":["eritropoyetina","fármacos"]},{"id":"e01b0274-f2c5-45d5-8731-f82725993ae4","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso raro se asocia con los ESA y anticuerpos neutralizantes?","questionImage":null,"type":"single","options":[{"id":"A","text":"Agranulocitosis"},{"id":"B","text":"Trombosis venosa"},{"id":"C","text":"Aplasia pura eritrocitaria"},{"id":"D","text":"Hepatotoxicidad"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Se han reportado casos raros de aplasia pura eritrocitaria (PRCA) con anticuerpos neutralizantes contra la eritropoyetina.","helpful_links":[],"tags":["eritropoyetina","toxicidad"]},{"id":"febd1c31-370a-4390-83b9-c0baccbec5ed","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción del filgrastim (G-CSF)?","questionImage":null,"type":"single","options":[{"id":"A","text":"Estimula receptores de eritropoyetina"},{"id":"B","text":"Actúa como antagonista de CXCR4"},{"id":"C","text":"Inhibe la tirosina cinasa SYK"},{"id":"D","text":"Estimula receptores de G-CSF en neutrófilos y sus progenitores"}],"correctOptions":["D"],"matches":[],"match_pairs":[],"explanation":"El G-CSF estimula la proliferación y diferenciación de progenitores de neutrófilos y activa la función fagocítica de neutrófilos maduros.","helpful_links":[],"tags":["G-CSF","mecanismo"]},{"id":"9469654b-ed30-4610-bf87-b4d33988c53c","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis típica de filgrastim para neutropenia inducida por quimioterapia?","questionImage":null,"type":"single","options":[{"id":"A","text":"50 mcg/kg/día"},{"id":"B","text":"5 mcg/kg/día"},{"id":"C","text":"0.5 mcg/kg/día"},{"id":"D","text":"500 mcg/kg/día"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La dosis típica de filgrastim es 5 mcg/kg/día por vía subcutánea o IV, comenzando 24-72 horas después de la quimioterapia.","helpful_links":[],"tags":["G-CSF","dosis"]},{"id":"fe39633d-9282-4c2d-8936-279114445504","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis de pegfilgrastim?","questionImage":null,"type":"single","options":[{"id":"A","text":"5 mcg/kg/día"},{"id":"B","text":"6 mg en dosis única por ciclo de quimioterapia"},{"id":"C","text":"50 mcg/kg/día"},{"id":"D","text":"100 mg/día"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El pegfilgrastim se administra en una sola dosis de 6 mg por ciclo de quimioterapia mielosupresora.","helpful_links":[],"tags":["G-CSF","dosis"]},{"id":"aaf03e20-8b10-49c0-8d74-88dfa583d9e5","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la ventaja del pegfilgrastim sobre el filgrastim?","questionImage":null,"type":"single","options":[{"id":"A","text":"Menor costo"},{"id":"B","text":"Administración oral"},{"id":"C","text":"Vida media más prolongada y administración única por ciclo"},{"id":"D","text":"Menos efectos adversos hematológicos"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El pegfilgrastim tiene una vida media más prolongada, lo que permite administrarlo una vez por ciclo de quimioterapia.","helpful_links":[],"tags":["G-CSF","farmacocinética"]},{"id":"48c21ecc-d0b1-4838-b826-4bd3e5c2fc39","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el efecto adverso más común del G-CSF?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipertensión"},{"id":"B","text":"Dolor óseo"},{"id":"C","text":"Trombosis venosa"},{"id":"D","text":"Hepatotoxicidad"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El dolor óseo es un efecto adverso común del G-CSF y pegfilgrastim, que desaparece al suspender el fármaco.","helpful_links":[],"tags":["G-CSF","toxicidad"]},{"id":"6f8096f5-7e01-475d-9ef5-9bcc9f7ae024","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso raro pero grave se asocia con el uso de G-CSF para movilización de PBSC?","questionImage":null,"type":"single","options":[{"id":"A","text":"Insuficiencia hepática"},{"id":"B","text":"Ruptura esplénica"},{"id":"C","text":"Nefritis intersticial"},{"id":"D","text":"Pancreatitis"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La ruptura esplénica es una complicación rara pero grave del uso de G-CSF para la movilización de células progenitoras de sangre periférica.","helpful_links":[],"tags":["G-CSF","toxicidad"]},{"id":"2b01f415-aeb9-49d2-9650-bdd8cb6fb6a9","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción del GM-CSF?","questionImage":null,"type":"single","options":[{"id":"A","text":"Solo estimula neutrófilos"},{"id":"B","text":"Inhibe la eritropoyesis"},{"id":"C","text":"Estimula progenitores granulocíticos, eritroides y megacariocitos"},{"id":"D","text":"Bloquea los receptores de citocinas"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El GM-CSF es un factor multipotencial que estimula la proliferación y diferenciación de progenitores granulocíticos, eritroides y megacariocitos.","helpful_links":[],"tags":["GM-CSF","mecanismo"]},{"id":"7c5a65ff-4e71-4d58-bdd2-7c33b089fd18","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis típica de GM-CSF (sargramostim)?","questionImage":null,"type":"single","options":[{"id":"A","text":"5 mcg/kg/día"},{"id":"B","text":"250 mcg/m²/día"},{"id":"C","text":"50 mcg/kg/día"},{"id":"D","text":"6 mg dosis única"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La dosis típica de GM-CSF es 250 mcg/m²/día por vía intravenosa o subcutánea.","helpful_links":[],"tags":["GM-CSF","dosis"]},{"id":"8f43a092-aa3d-4bcd-8afc-06e605cd1f2e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso es característico del GM-CSF pero menos común con G-CSF?","questionImage":null,"type":"single","options":[{"id":"A","text":"Dolor óseo"},{"id":"B","text":"Síndrome de fuga capilar"},{"id":"C","text":"Hipertensión"},{"id":"D","text":"Trombosis"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El GM-CSF puede causar fiebre, malestar, artralgias, mialgias y síndrome de fuga capilar, que es menos común con G-CSF.","helpful_links":[],"tags":["GM-CSF","toxicidad"]},{"id":"bf610d9c-e2ae-48b9-b095-d21eca751daa","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco se usa para movilizar células madre hematopoyéticas en combinación con G-CSF?","questionImage":null,"type":"single","options":[{"id":"A","text":"Romiplostim"},{"id":"B","text":"Plerixafor"},{"id":"C","text":"Eltrombopag"},{"id":"D","text":"Fostamatinib"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El plerixafor es un antagonista de CXCR4 que se usa con G-CSF para movilizar células CD34+ en pacientes con mieloma múltiple o linfoma no Hodgkin.","helpful_links":[],"tags":["G-CSF","movilización"]},{"id":"df0209ee-3ae9-4310-9b01-9a75848c6266","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción del plerixafor?","questionImage":null,"type":"single","options":[{"id":"A","text":"Agonista de MPL"},{"id":"B","text":"Antagonista de CXCR4"},{"id":"C","text":"Inhibidor de SYK"},{"id":"D","text":"Quelante de hierro"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El plerixafor es una molécula biciclamo que inhibe el receptor CXCR4, movilizando células CD34+ desde la médula ósea.","helpful_links":[],"tags":["G-CSF","mecanismo"]},{"id":"26407780-14e8-45e5-accc-89774c249236","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la principal vía de eliminación del plerixafor?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hepática"},{"id":"B","text":"Renal"},{"id":"C","text":"Biliar"},{"id":"D","text":"Pulmonar"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El plerixafor se elimina principalmente por vía renal y debe ajustarse la dosis en insuficiencia renal.","helpful_links":[],"tags":["G-CSF","farmacocinética"]},{"id":"61cfba18-315f-4778-9dab-693a451e5f4d","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el marcador utilizado para cuantificar células madre en el trasplante de PBSC?","questionImage":null,"type":"single","options":[{"id":"A","text":"CD4"},{"id":"B","text":"CD34"},{"id":"C","text":"CD8"},{"id":"D","text":"CD20"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El CD34 es un antígeno presente en células progenitoras tempranas y se usa como marcador para las células madre requeridas en el trasplante.","helpful_links":[],"tags":["G-CSF","trasplante"]},{"id":"a0df4edf-c2c6-4d5d-85dc-52d14c4423dd","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis de IL-11 (oprelvekin) para prevención de trombocitopenia?","questionImage":null,"type":"single","options":[{"id":"A","text":"5 mcg/kg/día"},{"id":"B","text":"50 mcg/kg/día"},{"id":"C","text":"500 mcg/kg/día"},{"id":"D","text":"0.5 mcg/kg/día"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La IL-11 se administra por inyección subcutánea a una dosis de 50 mcg/kg al día.","helpful_links":[],"tags":["trombopoyetina","dosis"]},{"id":"24051088-1d14-4d25-b144-2c6be5539ef4","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el mecanismo de acción de la IL-11?","questionImage":null,"type":"single","options":[{"id":"A","text":"Inhibe la trombopoyetina"},{"id":"B","text":"Estimula el crecimiento de progenitores megacariocíticos"},{"id":"C","text":"Bloquea los receptores de citocinas"},{"id":"D","text":"Quela el hierro"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La IL-11 estimula el crecimiento de múltiples células linfoides y mieloides, incluidos los progenitores de megacariocitos.","helpful_links":[],"tags":["trombopoyetina","mecanismo"]},{"id":"e3e75178-d970-4530-b4e7-995e70768156","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se asocia con el uso de oprelvekin (IL-11)?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipertensión"},{"id":"B","text":"Trombosis"},{"id":"C","text":"Retención de líquidos y arritmias auriculares"},{"id":"D","text":"Hepatotoxicidad"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La IL-11 puede causar fatiga, cefalea, mareos, anemia por hemodilución, disnea por acumulación de líquido y arritmias auriculares transitorias.","helpful_links":[],"tags":["trombopoyetina","toxicidad"]},{"id":"6f267570-9a3e-4532-83b2-40e3594c5bfd","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco es un agonista de trombopoyetina administrado por vía subcutánea?","questionImage":null,"type":"single","options":[{"id":"A","text":"Eltrombopag"},{"id":"B","text":"Romiplostim"},{"id":"C","text":"Avatrombopag"},{"id":"D","text":"Fostamatinib"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El romiplostim es un péptido agonista de trombopoyetina unido a fragmentos de anticuerpos que se administra por vía subcutánea.","helpful_links":[],"tags":["trombopoyetina","farmacocinética"]},{"id":"923dc6f3-ae86-405f-bc94-0c5094541e01","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la indicación aprobada para el romiplostim?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anemia por insuficiencia renal"},{"id":"B","text":"Neutropenia por quimioterapia"},{"id":"C","text":"Trombocitopenia inmune crónica"},{"id":"D","text":"Anemia de células falciformes"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El romiplostim está aprobado para el tratamiento de trombocitopenia inmune crónica en pacientes con respuesta inadecuada a otras terapias.","helpful_links":[],"tags":["trombopoyetina","indicaciones"]},{"id":"84e76039-32b3-41cd-bf39-756921fcd271","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la vida media del romiplostim?","questionImage":null,"type":"single","options":[{"id":"A","text":"7-8 horas"},{"id":"B","text":"3-4 días"},{"id":"C","text":"26-35 horas"},{"id":"D","text":"4-13 horas"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Después de la administración subcutánea, el romiplostim se elimina por el sistema reticuloendotelial con una vida media promedio de 3-4 días.","helpful_links":[],"tags":["trombopoyetina","farmacocinética"]},{"id":"aa1c6516-069c-40d2-95b8-14bd9522f5e7","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se asocia con el uso de romiplostim en pacientes con síndromes mielodisplásicos?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipoglucemia"},{"id":"B","text":"Aumento de blastos y progresión a leucemia"},{"id":"C","text":"Hipertiroidismo"},{"id":"D","text":"Neuropatía"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"En pacientes con síndromes mielodisplásicos, el romiplostim aumenta el recuento de blastos y el riesgo de progresión a leucemia mieloide aguda.","helpful_links":[],"tags":["trombopoyetina","toxicidad"]},{"id":"84ca5c01-10c6-48fa-9dc8-0131b8d3e4f7","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué agonista de trombopoyetina es activo por vía oral y se usa para trombocitopenia en enfermedad hepática crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"Romiplostim"},{"id":"B","text":"Avatrombopag"},{"id":"C","text":"Eltrombopag"},{"id":"D","text":"Oprelvekin"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El avatrombopag es un agonista oral de trombopoyetina aprobado para trombocitopenia en pacientes con enfermedad hepática crónica antes de procedimientos.","helpful_links":[],"tags":["trombopoyetina","indicaciones"]},{"id":"74540faf-a9ac-4a22-a3f9-3dd62395ba3c","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis de avatrombopag en pacientes con enfermedad hepática crónica y recuento de plaquetas menor de 40,000?","questionImage":null,"type":"single","options":[{"id":"A","text":"50 mg VO/día durante 5 días"},{"id":"B","text":"60 mg VO/día durante 5 días"},{"id":"C","text":"20 mg VO/día"},{"id":"D","text":"100 mg VO/día"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La dosis en pacientes con enfermedad hepática es de 60 mg VO/día durante cinco días cuando el recuento de plaquetas es menor de 40,000.","helpful_links":[],"tags":["trombopoyetina","dosis"]},{"id":"93698690-6b64-4db3-b579-f6929ef81afa","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis inicial de avatrombopag para trombocitopenia inmunitaria crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"60 mg/día"},{"id":"B","text":"50 mg/día"},{"id":"C","text":"20 mg/día"},{"id":"D","text":"100 mg/día"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Para pacientes con trombocitopenia inmunitaria con respuesta inadecuada a terapia previa, la dosis inicial es de 20 mg/día.","helpful_links":[],"tags":["trombopoyetina","dosis"]},{"id":"1a88e247-0750-48a3-b7a0-9d86ba2903b8","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco es un inhibidor de la tirosina cinasa SYK aprobado para trombocitopenia inmune crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"Romiplostim"},{"id":"B","text":"Eltrombopag"},{"id":"C","text":"Fostamatinib"},{"id":"D","text":"Avatrombopag"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El fostamatinib es un profármaco cuyo metabolito activo inhibe la tirosina cinasa SYK, reduciendo la destrucción de plaquetas.","helpful_links":[],"tags":["trombopoyetina","mecanismo"]},{"id":"01a59bf3-4590-46c7-bacb-b26a2f842ab3","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis inicial de fostamatinib para trombocitopenia inmune crónica?","questionImage":null,"type":"single","options":[{"id":"A","text":"50 mg una vez al día"},{"id":"B","text":"200 mg una vez al día"},{"id":"C","text":"100 mg dos veces al día"},{"id":"D","text":"20 mg dos veces al día"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La dosis inicial de fostamatinib es de 100 mg dos veces al día.","helpful_links":[],"tags":["trombopoyetina","dosis"]},{"id":"85c65001-6691-47d1-8d64-ca30662964a4","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se ha reportado con eltrombopag en pacientes con hepatitis C?","questionImage":null,"type":"single","options":[{"id":"A","text":"Nefrotoxicidad"},{"id":"B","text":"Hepatotoxicidad"},{"id":"C","text":"Cardiotoxicidad"},{"id":"D","text":"Neurotoxicidad"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El eltrombopag es potencialmente hepatotóxico y se debe monitorizar la función hepática, especialmente en pacientes con hepatitis C.","helpful_links":[],"tags":["trombopoyetina","toxicidad"]},{"id":"b8d7f5ea-c999-4326-a938-ad1ecb32c65c","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la función de la vitamina B12 en la conversión de homocisteína a metionina?","questionImage":null,"type":"single","options":[{"id":"A","text":"La adenosilcobalamina dona un grupo metilo"},{"id":"B","text":"La metilcobalamina sirve como intermediario en la transferencia de metilo"},{"id":"C","text":"La cianocobalamina actúa como cofactor"},{"id":"D","text":"La hidroxocobalamina inhibe la enzima"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La metilcobalamina sirve como intermediario en la transferencia de un grupo metilo del N5-metiltetrahidrofolato a la homocisteína para formar metionina.","helpful_links":[],"tags":["vitamina B12","metabolismo"]},{"id":"3adb96fa-0a80-4f78-b823-17909920fc29","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué reacción requiere vitamina B12 además de la síntesis de metionina?","questionImage":null,"type":"single","options":[{"id":"A","text":"Síntesis de dTMP"},{"id":"B","text":"Isomerización de metilmalonil-CoA a succinil-CoA"},{"id":"C","text":"Conversión de folato a THF"},{"id":"D","text":"Síntesis de purinas"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La vitamina B12 es necesaria para la isomerización de metilmalonil-CoA a succinil-CoA por la enzima metilmalonil-CoA mutasa.","helpful_links":[],"tags":["vitamina B12","metabolismo"]},{"id":"7ff332eb-3530-4694-a215-276bd649236c","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué metabolito se acumula en la deficiencia de vitamina B12 y se usa para el diagnóstico?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ácido fólico"},{"id":"B","text":"Ácido metilmalónico"},{"id":"C","text":"Metionina"},{"id":"D","text":"Glutatión"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"En la deficiencia de vitamina B12, se acumulan metilmalonil-CoA y ácido metilmalónico, que se miden en suero y orina para el diagnóstico.","helpful_links":[],"tags":["vitamina B12","diagnóstico"]},{"id":"59e22986-cbb6-4677-9944-ad349da19b75","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué otra sustancia se acumula en la deficiencia de vitamina B12?","questionImage":null,"type":"single","options":[{"id":"A","text":"Metionina"},{"id":"B","text":"Cisteína"},{"id":"C","text":"Homocisteína"},{"id":"D","text":"Glutatión"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La deficiencia de vitamina B12 causa acumulación de homocisteína debido a la reducción en la formación de metionina.","helpful_links":[],"tags":["vitamina B12","metabolismo"]},{"id":"ba66cfc4-ca9d-4f34-bc9a-bad8491e0c90","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la manifestación clínica más característica de la deficiencia de vitamina B12?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anemia microcítica hipocrómica"},{"id":"B","text":"Trombocitopenia"},{"id":"C","text":"Anemia macrocítica megaloblástica"},{"id":"D","text":"Neutropenia"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La deficiencia de vitamina B12 se manifiesta típicamente como anemia macrocítica megaloblástica, a menudo con leucopenia o trombocitopenia.","helpful_links":[],"tags":["vitamina B12","anemia"]},{"id":"7950e50d-b16a-4a90-a3fc-72a7601eeb74","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué síntomas neurológicos puede causar la deficiencia de vitamina B12?","questionImage":null,"type":"single","options":[{"id":"A","text":"Solo cefalea"},{"id":"B","text":"Parestesias y debilidad que progresan a espasticidad y ataxia"},{"id":"C","text":"Convulsiones tónico-clónicas"},{"id":"D","text":"Parálisis flácida ascendente"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El síndrome neurológico de la deficiencia de B12 comienza con parestesias en nervios periféricos y debilidad que progresa a espasticidad, ataxia y disfunción del SNC.","helpful_links":[],"tags":["vitamina B12","complicaciones"]},{"id":"a42e8319-763d-4499-bd1f-2559aeaf09f8","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el tratamiento inicial para la deficiencia de vitamina B12 con síntomas neurológicos?","questionImage":null,"type":"single","options":[{"id":"A","text":"1 mg de ácido fólico oral diario"},{"id":"B","text":"100-1000 mcg de vitamina B12 IM diario o cada dos días durante 1-2 semanas"},{"id":"C","text":"200-400 mg de hierro elemental oral"},{"id":"D","text":"50 mcg/kg de IL-11 subcutáneo"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La terapia inicial consiste en 100-1000 mcg de vitamina B12 por vía intramuscular diario o cada dos días durante 1-2 semanas para reponer reservas.","helpful_links":[],"tags":["vitamina B12","dosis"]},{"id":"d8efa01d-062c-4001-b699-439da985c9a9","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis de mantenimiento de vitamina B12 para pacientes con anomalías neurológicas?","questionImage":null,"type":"single","options":[{"id":"A","text":"100-1000 mcg IM una vez al mes"},{"id":"B","text":"100-1000 mcg IM cada 1-2 semanas durante 6 meses"},{"id":"C","text":"1 mg oral diario"},{"id":"D","text":"50 mcg/kg SC diario"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Si hay anomalías neurológicas, se administran inyecciones de mantenimiento cada 1-2 semanas durante seis meses antes de cambiar a inyecciones mensuales.","helpful_links":[],"tags":["vitamina B12","dosis"]},{"id":"da2685df-5b4f-4eb2-ac47-47329de81d8e","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la causa más común de deficiencia de vitamina B12 en adultos?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ingesta dietética insuficiente"},{"id":"B","text":"Malabsorción"},{"id":"C","text":"Aumento de requerimientos"},{"id":"D","text":"Pérdida renal"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La mayoría de los casos de deficiencia de vitamina B12 son causados por malabsorción, no por ingesta inadecuada.","helpful_links":[],"tags":["vitamina B12","etiología"]},{"id":"a0985a23-3979-4eaa-b474-e06f6a8b1eb0","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué condición se caracteriza por autoanticuerpos contra el factor intrínseco?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anemia de células falciformes"},{"id":"B","text":"Anemia perniciosa"},{"id":"C","text":"Talasemia"},{"id":"D","text":"Anemia por deficiencia de hierro"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La anemia perniciosa es causada por secreción defectuosa del factor intrínseco, a menudo con autoanticuerpos contra él.","helpful_links":[],"tags":["vitamina B12","enfermedad"]},{"id":"79b3aea7-8bd1-4130-9578-1523010a71d5","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué prueba se usaba históricamente para diagnosticar la anemia perniciosa?","questionImage":null,"type":"single","options":[{"id":"A","text":"Prueba de Coombs"},{"id":"B","text":"Prueba de Schilling"},{"id":"C","text":"Electroforesis de hemoglobina"},{"id":"D","text":"Mielograma"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La prueba de Schilling medía la absorción y excreción urinaria de vitamina B12 marcada radiactivamente, pero rara vez se usa hoy.","helpful_links":[],"tags":["vitamina B12","diagnóstico"]},{"id":"ddcf3854-da73-4465-b20b-d38d79f75ad4","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la consecuencia bioquímica de la deficiencia de vitamina B12 en el metabolismo del folato?","questionImage":null,"type":"single","options":[{"id":"A","text":"Aumento de tetrahidrofolato"},{"id":"B","text":"Trampa de metilfolato"},{"id":"C","text":"Disminución de homocisteína"},{"id":"D","text":"Aumento de metionina"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Sin vitamina B12, el N5-metiltetrahidrofolato se acumula, causando la \"trampa de metilfolato\" y deficiencia de tetrahidrofolato.","helpful_links":[],"tags":["vitamina B12","metabolismo"]},{"id":"94d50927-9625-4110-80c5-585bf3001e02","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto tiene la administración de ácido fólico en la deficiencia de vitamina B12?","questionImage":null,"type":"single","options":[{"id":"A","text":"Corrige el daño neurológico pero no la anemia"},{"id":"B","text":"Corrige la anemia pero no el daño neurológico"},{"id":"C","text":"Corrige ambos"},{"id":"D","text":"No corrige ninguno"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El ácido fólico puede corregir la anemia megaloblástica de la deficiencia de B12 pero no previene el daño neurológico.","helpful_links":[],"tags":["ácido fólico","vitamina B12"]},{"id":"a3c99022-8d4c-4d8e-9760-a637e48a9a5f","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la estructura química del ácido fólico?","questionImage":null,"type":"single","options":[{"id":"A","text":"Anillo porfirínico con cobalto"},{"id":"B","text":"Pteridina, ácido p-aminobenzoico y ácido glutámico"},{"id":"C","text":"Glucoproteína de 34-39 kDa"},{"id":"D","text":"Péptido no glicosilado de 175 aminoácidos"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El ácido fólico (ácido pteroilglutámico) se compone de un heterociclo pteridina, ácido p-aminobenzoico y ácido glutámico.","helpful_links":[],"tags":["ácido fólico","química"]},{"id":"7efe8072-fd8c-45d7-9bdb-0f50f6f84b2d","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Dónde se absorbe el ácido fólico inalterado?","questionImage":null,"type":"single","options":[{"id":"A","text":"Íleon distal"},{"id":"B","text":"Estómago"},{"id":"C","text":"Yeyuno proximal"},{"id":"D","text":"Colon"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"El ácido fólico inalterado se absorbe fácil y completamente en el yeyuno proximal.","helpful_links":[],"tags":["ácido fólico","farmacocinética"]},{"id":"36d8048c-6ba6-4fad-a670-9e3e94a678af","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué enzima convierte el ácido fólico en dihidrofolato?","questionImage":null,"type":"single","options":[{"id":"A","text":"Timidilato sintasa"},{"id":"B","text":"Dihidrofolato reductasa"},{"id":"C","text":"Metilmalonil-CoA mutasa"},{"id":"D","text":"Ferroportina"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El ácido fólico se reduce a dihidrofolato mediante la enzima dihidrofolato reductasa.","helpful_links":[],"tags":["ácido fólico","metabolismo"]},{"id":"d6003581-bd77-41cd-aba5-28e999abb665","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué reacción esencial requiere tetrahidrofolato para la síntesis de DNA?","questionImage":null,"type":"single","options":[{"id":"A","text":"Conversión de homocisteína a metionina"},{"id":"B","text":"Síntesis de dTMP a partir de dUMP"},{"id":"C","text":"Isomerización de metilmalonil-CoA"},{"id":"D","text":"Absorción de hierro"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"La timidilato sintasa cataliza la transferencia de un grupo metilo del N5,N10-metilentetrahidrofolato al dUMP para formar dTMP.","helpful_links":[],"tags":["ácido fólico","metabolismo"]},{"id":"c1fceb9f-bb81-4bf9-98e6-0378342030d7","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco inhibe la timidilato sintasa?","questionImage":null,"type":"single","options":[{"id":"A","text":"Metotrexato"},{"id":"B","text":"5-fluorouracilo"},{"id":"C","text":"Hidroxiurea"},{"id":"D","text":"Deferoxamina"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El 5-fluorouracilo, a través de su metabolito, inhibe la timidilato sintasa, bloqueando la síntesis de dTMP.","helpful_links":[],"tags":["ácido fólico","interacciones"]},{"id":"1427b2bc-a546-4e3b-878d-c578e1225f26","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la dosis típica de ácido fólico oral para tratar la anemia megaloblástica?","questionImage":null,"type":"single","options":[{"id":"A","text":"10 mg/día"},{"id":"B","text":"0.1 mg/día"},{"id":"C","text":"1 mg/día"},{"id":"D","text":"5 mg/semana"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Una dosis de 1 mg de ácido fólico por vía oral diario es suficiente para revertir la anemia megaloblástica.","helpful_links":[],"tags":["ácido fólico","dosis"]},{"id":"16a8e845-a6c6-4f93-9600-c34005753458","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué población tiene mayor riesgo de deficiencia de ácido fólico por aumento de requerimientos?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hombres ancianos"},{"id":"B","text":"Niños prematuros"},{"id":"C","text":"Mujeres embarazadas"},{"id":"D","text":"Deportistas"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Las mujeres embarazadas tienen mayores requerimientos de folato y pueden volverse deficientes, especialmente con dietas restrictivas.","helpful_links":[],"tags":["ácido fólico","poblaciones"]},{"id":"70e9a3ad-e1f5-437d-b042-ee2fa8dd32eb","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco inhibe la dihidrofolato reductasa y puede causar deficiencia de folato?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hidroxiurea"},{"id":"B","text":"Metotrexato"},{"id":"C","text":"Filgrastim"},{"id":"D","text":"Deferoxamina"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El metotrexato inhibe la dihidrofolato reductasa, lo que puede llevar a deficiencia de folato y anemia megaloblástica.","helpful_links":[],"tags":["ácido fólico","interacciones"]},{"id":"981b65c3-2872-48a7-9860-a92c7bd9b7ff","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué fármaco anticonvulsivante puede causar deficiencia de folato con terapia a largo plazo?","questionImage":null,"type":"single","options":[{"id":"A","text":"Carbamazepina"},{"id":"B","text":"Ácido valproico"},{"id":"C","text":"Fenitoína"},{"id":"D","text":"Lamotrigina"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La terapia a largo plazo con fenitoína puede ocasionar deficiencia de folato, aunque rara vez causa anemia megaloblástica.","helpful_links":[],"tags":["ácido fólico","interacciones"]},{"id":"ee26136f-2281-49bb-ab12-5370f3749fee","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué efecto adverso se asocia con niveles altos de ácido fólico según estudios observacionales?","questionImage":null,"type":"single","options":[{"id":"A","text":"Hipoglucemia"},{"id":"B","text":"Hipertensión"},{"id":"C","text":"Aumento del riesgo de cáncer colorrectal"},{"id":"D","text":"Neuropatía periférica"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"Estudios observacionales sugieren que niveles altos de ácido fólico pueden aumentar el riesgo de algunas enfermedades como el cáncer colorrectal.","helpful_links":[],"tags":["ácido fólico","toxicidad"]},{"id":"3016d3fa-fb63-4538-9c28-219cc3005a7a","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es el principal riesgo de la suplementación con ácido fólico en la población general?","questionImage":null,"type":"single","options":[{"id":"A","text":"Causar anemia hemolítica"},{"id":"B","text":"Enmascarar la deficiencia de vitamina B12 y permitir daño neurológico"},{"id":"C","text":"Producir hipoglucemia"},{"id":"D","text":"Aumentar el riesgo de trombosis"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"El ácido fólico puede corregir la anemia de la deficiencia de B12 pero no previene el daño neurológico, lo que retrasa el diagnóstico.","helpful_links":[],"tags":["ácido fólico","toxicidad"]},{"id":"2b8e0772-b8c4-4b40-a0b4-9641de3c6f08","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Qué vitamina se administra por vía intranasal como alternativa a la parenteral?","questionImage":null,"type":"single","options":[{"id":"A","text":"Ácido fólico"},{"id":"B","text":"Hierro"},{"id":"C","text":"Vitamina B12"},{"id":"D","text":"Eritropoyetina"}],"correctOptions":["C"],"matches":[],"match_pairs":[],"explanation":"La vitamina B12 se puede administrar por vía intranasal como aerosol o gel cuando la anemia perniciosa está en remisión después de terapia parenteral.","helpful_links":[],"tags":["vitamina B12","farmacocinética"]},{"id":"e938444a-8e97-45f6-84ac-c320418e8655","original_quiz_id":"6a9c7103f1d401406a25a69b","created":"$D2026-10-03T05:23:09.118Z","description":"","questionContent":"¿Cuál es la vida media de la vitamina B12 almacenada en el hígado?","questionImage":null,"type":"single","options":[{"id":"A","text":"1-6 meses"},{"id":"B","text":"Aproximadamente 5 años de reservas"},{"id":"C","text":"2 semanas"},{"id":"D","text":"10 años"}],"correctOptions":["B"],"matches":[],"match_pairs":[],"explanation":"Debido a las grandes reservas hepáticas, la anemia megaloblástica por deficiencia de B12 tarda aproximadamente 5 años en desarrollarse.","helpful_links":[],"tags":["vitamina 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1. Fármacos hematopoyéticos: Factores de crecimiento, minerales y vitaminas

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