Agents to Treat Anemia Flashcards
1
Q
Explain Anemia
A
When there is not enough RBC’s to carry sufficient oxygen throughout the body, or a defect with the RBC that cause inability to carry oxygen through the body.
2
Q
What is Aplastic Anemia?
A
Bone Marrow Disorder affecting production of WBC’s, Platelets & RBC’s
3
Q
What are Erythrocytes?
A
RBC’s - carry oxygen to the tissues in exchange for CO2
4
Q
What is Erythopoiesis?
A
Process of creating RBC’s & destroying them after 120 days while recycling some parts.
5
Q
What is Erythrpoietin?
A
Glycoprotein secreted by the kidneys that stimulate RBC production when low oxygen or blood flow is detected.
6
Q
What is Hemolytic anemia?
A
Condition that prematurely destroys RBC’s
7
Q
What is Iron deficiency anemia?
A
Lack of sufficient iron in the body leading to reduced hemoglobin and consequently RBC reduction.
8
Q
What is Megaloblastic anemia?
A
Vitamin B12 & Folic acid deficiency that causes reduction in RBC’s and their lifespan.
9
Q
What is Pernicious anemia?
A
Type of Megaloblastic Anemia due to lack of B12 r/t decrease intrinsic factor in GI cells. IM & Nasal spray treatment with B12. PO cannot be absorbed through GI tract.
10
Q
What is Plasma?
A
The liquid part of blood; contains proteins essential for the immune response and blood clotting. Contains water, plasma proteins, glucose and electrolytes.
11
Q
What is Reticulocytes?
A
Baby RBC - has entered blood stream but is not fully matured.
12
Q
What is Sickle Cell Anemia?
A
Inherited hemolytic anemia. Categorized by abnormal hemoglobin which causes RBC to take on a sickle shape, making it difficult to pass through the vessels which may cause occlusions which damages the vessels and are painful.
13
Q
What is Thalassemia?
A
Inherited disorder which causes hemoglobin alterations in RBCs often leading to hypochromic microcytic hemolytic anemia, which is when RBCs are smaller and die prematurely.
14
Q
What allows blood to be liquid?
A
Plasma. It carries components to prevent injuries such as platelets, prevent infection (WBCs), and deliver oxygen throughout the body within the RBCs.
15
Q
What component are the oxygen delivery system in the blood?
A
The RBCs
16
Q
What are the Formed Elements of Blood? What are their functions?
A
◦ Leukocytes (WBCs): Part of the immune system
◦ Erythrocytes (RBCs): Carry oxygen to the tissues and remove carbon dioxide
◦ Platelets: Part of clotting system
17
Q
Explain the process of Erythropoiesis?
A
1) Erythropoietin stimulates stem cells in bone marrow (can be increased if kidney notices decreases blood flow or oxygen)
2) Erythroblasts turn into mature RBCs called Reticulocytes.
3) Reticulocytes circulates for 120 days then either lyse or die.
4) they lyse in the liver, spleen or bone marrow & some parts return to the bone marrow to make new RBCs
18
Q
What components are essential for formation of RBC’s?
A
Amino acids, lipids, carbs, vitamin B12, folic acid and iron.
19
Q
Can RBC’s reproduce?
A
No, they do not contain a nucleus.
20
Q
Can Bilirubin be reused?
A
No, it is excreted via bile in urine or feces.
21
Q
What are the 4 causes of anemia?
A
Blood loss
Excessive Hemolysis
Low Production of RBCs
Bone Marrow Failure
22
Q
In the formation of healthy RBCs, why is it important to have adequate amounts of iron?
A
To form hemoglobin rings to be able to carry oxygen.
23
Q
In the formation of healthy RBCs, why is it important to have adequate (minute) amounts of Vitamin B12 and Folic Acid ?
A
To form a supporting structure that can survive being battered through blood vessels for 120 days
24
Q
In the formation of healthy RBCs, why is it important to have adequate Essential Amino Acids and Carbohydrates ?
A
To complete the hemoglobin rings, cell membrane, and basic structure
25
Can renal failure cause low RBC production?
Yes, because a failing kidney cannot produce erythropoietin to stimulate and increase in RBC production.
26
What determines what type of anemia a person has?
The type of RBC nutrient component missing.
27
What are the 3 types of Anemia?
Iron Deficiency Anemia - Not enough iron to make RBC's
Megaloblastic Anemia - Not enough folic acid or B12
Sickle Cell Anemia - cause by mutation in beta hemoglobin chain.
28
What are some causes of Iron Deficiency Anemia?
Menstruating women who lose RBCs monthly
Pregnant and nursing women who have increased demands for iron
Teenagers, especially those who do not have a nutritious diet
Persons with GI bleeding - may happen from NSAID use.
29
Why does Iron anemia cause fatigue?
RBC's cannot adequately carry enough oxygen around the body.
30
What are some causes of Megaloblastic Anemia r/t Folate efficiency ?
RBC are produced larger and there is no more room for more RBCs. Deficiency can be caused by :
◦ Malabsorption
◦ Malnutrition that accompanies alcoholism
◦ Repeated pregnancies
◦ Long-term use of certain antiepileptic drugs
31
what type of food contains good sources of Folate?
Eggs, Liver, Milk and Leafy Greens.
32
What are some causes of Megaloblastic Anemia / Pernicious anemia r/t Vitamin B12 deficiency ?
◦ Strict vegetarian diet or Inability of GI tract to absorb vitamin B12 (due to lack of intrinsic factor)
33
How come patients with Pernicious anemia often complain about fatigue, numbness, tingling, lack of coordination and other CNS effects?
B12 is part of creating the myelin sheaths and lack of it will decrease conduction.
34
What type of foods are good sources of B12?
Eggs, Cheese, Seafood and Meat. - which explains why vegans are at risk of deficiency.
35
what is a Sickle Cells crisis?
An acute exacerbation of Sickle cell anemia cause by an infection.
36
What are some lifespan considerations to take into account when prescribing antianemia agents to children?
◦ Ensure proper nutrition
◦ Safety and efficacy not established for epoetin alfa
◦ Dosage based on age and weight
◦ Drink iron through straw for PO due to risk of teeth staining,
◦ Iron can be toxic- keep out of reach of children
◦ Monitor for iron toxicity
* B12 shots or nasal spray
37
what are signs of Iron toxicity symptoms?
Nausea, Vomiting, Diarrhea, Abdominal pain, Fatigues, Cyanosis and if severe, shock.
38
What are some lifespan considerations to take into account when prescribing antianemia agents to adults ?
◦ Use appropriate measures to prevent constipation for iron replacement
◦ Increased demand during pregnancy/lactation; may need supplementation
◦ Epoetin alfa/darbepoetin not recommended during pregnancy/lactation
39
What are some lifespan considerations to take into account when prescribing antianemia agents to older adults ?
◦ Nutritional problems related to aging increases the risk of deficiencies
◦ Bowel program for constipation
40
What controls the rate of Blood Cell Production?
Erythropoiesis.
41
Explain how the body signals the production of RBCs.
1) Given oxygen is used up
2) Decreased oxygen lvl will signal to kidneys to release erythropoietin.
3) Which will cause and increase in RBC production in bone Marrow
4) Increased RBC = Increased oxygen in blood.
5) increased oxygen = kidneys ceasing to release erythropoietin
6) cycle continues
42
How come people at higher altitude have higher Hemoglobin and Hematocrit levels?
Due to decreased blood oxygen levels.
43
Which are the two Erythropoiesis-Stimulating Agents that we need to know?
Epoetin Alfa
Darbopoetin Alfa
44
What does Erythropoiesis-Stimulating Agents do?
Stimulate the bone marrow to make more RBC’s by using exogenous erythropoietin, when their bodies cannot produce it themselves.
45
What does Epoetin Alfa do?
Treats anemia associated with renal failure and AIDS, decreases need for
blood transfusions in patients undergoing surgery.
Surgery - Producing excess RBC's to counter blood loss from surgery.
Renal failure - kidney cannot produce erythropoietin
AIDS - AIDS & its treatment can cause anemia.
46
What does Darbopoetin Alfa do?
◦ Treats anemia associated with chronic renal failure, including patients on dialysis
◦ Anemia from chemotherapy
47
How often is Darbopoetin Alfa given?
Once a week
48
How often is Epoetin Alfa given?
2-3 times a week.
49
What are the MOA's of Erythropoiesis-Stimulating Agents?
Both drug mimics erythropoietin when the body cannot produce this hormone on its own,
50
Which patients will benefit the most from treatment with Erythropoiesis-Stimulating Agents?
Patients with kidney failure or disease since erythropoietin is released from the kidneys.
51
Why do we give patients Erythropoiesis-Stimulating Agents?
Because it treats anemia associated with chronic renal failure or kidney disease.
52
Will increasing RBC's increase or lower BP?
Increase
53
What conditions would contraindicate the use of Erythropoiesis-Stimulating Agents?
◦ Uncontrolled hypertension
◦ Allergy
◦ Pregnancy and lactation
54
What conditions would prompt us to exhibit increased caution when giving patients Erythropoiesis-Stimulating Agents?
◦ Some cancers - due to drug stimulating cell growth (RBC's)
◦ Normal renal function (normal erythropoietin levels) - may make the anemia more severe due to rebound effect.
55
What are some adverse reactions related to the use of Erythropoiesis-Stimulating Agents?
◦ CNS – Headache, fatigue, asthenia, dizziness, and seizure - due to cellular response to medication,
◦ Nausea, vomiting, and diarrhea
◦ CV – Hypertension, edema, possible chest pain, increased risk of DVT when Hgb >11 g/dL due to increased amount of RBC's
56
What does an increase of Hemoglobin more than 11g per dl increase the risk of?
Deep Vein Thrombosis and Cancer.
57
Can you mix Erythropoiesis-Stimulating Agents with other medications when administering IV?
No, It can cause precipitation (solid particles in the solution)
58
What is Erythropoiesis-Stimulating Agents made from?
Hamster ovary cells and recombinant DNA technology.
59
What are the known DDI's to Erythropoiesis-Stimulating Agents?
Should not be mixed in solution with other drugs
60
What should we be assessing for prior to giving patients Erythropoiesis-Stimulating Agents?
◦ Assess for contraindications or cautions
◦ Perform a physical assessment
◦ Assess affect, orientation, and muscle strength
◦ Monitor vital signs and assess CV status; inspect lower extremities for evidence of edema
◦ Assess respirations and auscultate lung sounds
◦ Monitor renal function tests, complete blood count, hematocrit, iron concentration,
transferrin, and electrolyte levels
61
What Nursing diagnoses can we anticipate prior to administering Erythropoiesis-Stimulating Agents?
◦ Nausea related to adverse GI effects
◦ Diarrhea related to GI effects
◦ Injury risk related to CNS effects
◦ Altered fluid volume related to CV effects
◦ Knowledge deficit regarding drug therapy
62
What implementations would we expect to do during and after administration of Erythropoiesis-Stimulating Agents?
◦ Confirm the chronic, renal nature of the patient’s anemia before administering the drug
◦ Provide the patient with a calendar of marked days
◦ Do not mix with any other drug solution
◦ Monitor lines for clotting
◦ Ensure that prescribed laboratory testing, such as hematocrit levels, is completed
before drug administration. Anticipate a target hemoglobin of 11 g/dL.
◦ Evaluate iron stores before and periodically during therapy
◦ Monitor blood pressure due to risk for hypertension
◦ Maintain seizure precautions on standby due to potential CNS effect.
◦ Provide thorough patient teaching
63
Why should we advise patients to keep a planner and mark their medication days with Erythropoiesis-Stimulating Agents?
Medication is not given everyday and marking a calendar can help confusion regarding dosing days,
64
What are the names of the agents used to treat Iron Deficiency Anemia?
Ferrous Asparate
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
Iron Dextran
Iron Sucrose
65
How does agents used to treat Iron Deficiency Anemia work?
Elevate the serum iron concentration
66
Why would we give a patient Iron Deficiency Anemia agents?
Treatment of iron deficiency anemias and may also be used as adjunctive therapy in
patients receiving Epoetin Alfa.
67
What conditions would contraindicate the use of Iron Deficiency Anemia agents?
◦ Allergy - especially with IV admin.
◦ Hemochromatosis - too much Iron in the blood.
◦ Anemias that are not iron deficiency anemias - can lead to iron toxicity
◦ Normal iron balance - iron will be wasted
◦ Peptic ulcer, colitis, or regional enteritis - can be exacerbated.
68
What are some adverse reactions to the use of Iron Deficiency Anemia agents?
◦ Oral - GI irritation most common - N,V,D and dark stools.
◦ CNS toxicity if Iron levels get too high
◦ Parental iron is associated with severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis
69
What are the known DDI's for Iron Deficiency Anemia agents?
Numerous
Antacids
Substances with calcium & magnesium
70
Are there any food interactions with Iron Deficiency Anemia agents?
◦ Eggs, milk, coffee, tea
◦ Vitamin C-rich foods
71
What are some patient assessments that we need to do prior to giving patients Iron Deficiency Anemia agents?
◦ Assess for contraindications or cautions
◦ Perform a physical assessment
◦ Inspect the skin and mucous membranes; skin integrity of intended parenteral administration site
◦ Assess level of orientation, affect, and reflexes
◦ Monitor pulse, blood pressure, perfusion, respirations, and adventitious sounds
◦ Inspect the abdomen for distention and auscultate bowel sounds
◦ Monitor complete blood count, hematocrit, hemoglobin, and serum ferritin assays
72
What nursing diagnoses can be anticipated prior to giving patients Iron Deficiency Anemia agents?
◦ Impaired comfort related to CNS or GI effects or parenteral administration
◦ Nausea related to adverse GI effects
◦ Constipation related to adverse GI effects
◦ Altered body image related to drug staining of the skin from parenteral injection
◦ Injury risk related to CNS effects
◦ Knowledge deficit regarding drug therapy
73
What implementations should we be prepared to do during and after treating patients with Iron Deficiency Anemia agents?
◦ Ensure that iron deficiency anemia is confirmed
◦arrange for the treatment of the underlying cause of anemia
◦ Administer the oral form with meals that do not include eggs, milk, coffee, and tea
◦ Caution the patient that stools may be dark or green
◦ Take measures to help alleviate constipation
◦ Administer IM only by the Z-track technique
◦ Arrange for hematocrit and hemoglobin measurements before administration and
periodically during therapy
◦ Provide thorough patient teaching
74
What are the names that we need to know for the Chelating Agents?
Deferasirox
Deferiprone
Deferoxamine mesylate
75
what are Chelating agents used for?
As an antidote for Iron toxicity.
76
How does Chelating agentes work?
They bind to heavy metal molecules presenting them from binding to cells. Once the agents bind to the heavy metal it is then able to be cleared out by the kidneys.
77
What are some causes for Folate Deficiencies?
* Times when body is growing rapidly (pregnancy/puberty)
◦ Absorption problems in the small intestine
◦ Drugs that cause folate deficiencies
◦ Poor diet related to alcoholism
78
What are some causes of Vitamin B12 Deficiencies?
◦ Poor diet or increased demand
◦ Lack of intrinsic factor in the stomach - B12 cannot be absorbed.
79
What are the agents that we need to know for Megaloblastic Anemias?
Folic Acid
◦ Folic acid
◦ Leucovorin
◦ Levoleucovorin
B12
◦ Hydroxocobalamin, injectable drug
◦ Cyanocobalamin, nasal spray
80
What does Agents for Megaloblastic Anemias do?
◦ Foliate and B12 are essential for production of RBCs, DNA, WBCs and Platelets.
◦ B12 is also necessary for the maintenance of the myelin sheath in nerve
tissues
Agents replenishes Folate and B12 levels in patients who are deficient & reduction of toxicity in patients receiving methotrexate which is a chemotherapy drug.
81
Why would we give a patient Agents for Megaloblastic Anemias other than for Megaloblastic Anemia?
◦ Replacement therapy for dietary deficiencies and high demand states
◦ Folic acid is used as a rescue drug for cells exposed to some toxic
chemotherapeutic agents
82
What would contraindicate the use of Agents for Megaloblastic Anemias in a patient?
Allergy
83
Are there any adverse reactions that may occur when a patient is taking Agents for Megaloblastic Anemias?
◦ Relatively few - most related to administration :
◦ Pain and discomfort at the injection site
◦ Nasal irritation with intranasal spray
84
What are some known DDI's with Agents for Megaloblastic Anemias?
Relatively few since they are essential
85
what are some physical signs of B12 deficiency?
Beefy red tongue, pallor and neuropathy (tingling or numbness in hands or feet)
86
Prior to giving a patient Agents for Megaloblastic Anemia, what are some things that we should be assessing for?
Assess for c&c cautions:
physical exam : Neuro : affect, orientation, and reflexes - due to reduction in myelin sheath
CV: pulse, blood pressure, perfusion
Resp : respirations and adventitious sounds - body not getting enough oxygen.
Monitor CBC, hematocrit, B12, folate, and iron levels - to ensure improvement.
87
Prior to administering Agents for Megaloblastic Anemia, what ae some nursing diagnoses that we should expect and be prepared for?
◦ Impaired comfort related to injection or nasal irritation
◦ Risk for fluid volume imbalance related to CV effects
◦ Knowledge deficit regarding drug therapy
88
When giving / after giving patients Agents for Megaloblastic Anemia, what are some nursing implementations that we should be doing?
◦ Confirm the nature of the megaloblastic anemia
◦ Give both types of drugs in cases of pernicious anemia - otherwise RBC production will not happen.
◦ Parenteral vitamin B12 given IM each day for 5 to 10 days and then once a month for life
◦ Arrange for nutritional consultation
◦ Monitor for the possibility of hypersensitivity reactions
◦ hematocrit readings before and periodically during therapy
◦ Provide thorough patient teaching
89
What agent would we give for Sickle Cell Anemia?
Hydroxyurea
90
What did we previously treat Sickle Cell anemia with?
Pain medication to the anoxia to the tissues. the anoxia would also lead to infection of the damaged tissues.
91
What give Sickle Cells their shape?
The formation of Hemoglobin S.
92
What are the actions of Hydroxyurea?
◦ Dilutes formation of the abnormal hemoglobin S - allowing for more normal shaped RBC's to be produced - reduces amount of small blood vessels being occluded - reducing pain.
◦ Increases amount of fetal hemoglobin produced in bone marrow
93
What would contraindicate the use of Hydroxyurea in patients?
◦ allergy
◦ Severe anemia or leukopenia - can cause further bone marrow suppression.
94
What conditions should prompt for increased caution when giving Hydroxyurea?
◦ Impaired liver or renal function
◦ Pregnancy and lactation
95
What are some known adverse reactions that may happen to patients taking Hydroxyurea?
Cytotoxic particularly to cells with a high turnover rate such as skin and bone marrow - can lead to skin rash & bone marrow depression and increases the risk of developing cancer.
GI : N,V,D, anorexia or constipation.
Flu -like symptoms : HA, fever, chills & malaise - linked to the cytotoxicity.
96
Are there any DDI's to Hydroxyurea, and if so, what are they?
Uricosuric agents - uric acid levels can be increased. dose adjustments if taken together.
