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Pharmacology Exam 3 > Agents to Treat Anemia > Flashcards

Agents to Treat Anemia Flashcards

1
Q

Explain Anemia

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2
Q

What is Aplastic Anemia?

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3
Q

What are Erythrocytes?

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4
Q

What is Erythopoiesis?

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5
Q

What is Erythrpoietin?

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6
Q

What is Hemolytic anemia?

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7
Q

What is Iron deficiency anemia?

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8
Q

What is Megaloblastic anemia?

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9
Q

What is Pernicious anemia?

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10
Q

What is Plasma?

A

The liquid part of blood; contains proteins essential for the immune response and blood clotting

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11
Q

What is Reticulocytes?

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12
Q

What is Sickle Cell Anemia?

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13
Q

What is Thalassemia?

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14
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

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15
Q

Explain the process of Erythropoiesis?

A
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16
Q

In the formation of healthy RBCs, why is it important to have adequate amounts of iron?

A

To form hemoglobin rings to carry the oxygen

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17
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

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18
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

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19
Q

What are the 3 types of Anemia?

A

Iron Deficiency Anemia
Megaloblastic Anemia
Sickle Cell Anemia

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20
Q

What are some causes of Iron Deficiency Anemia?

A

Menstruating women who lose RBCs monthly
Pregnant and nursing women who have increased demands for iron
Rapidly growing adolescents, especially those who do not have a nutritious diet
Persons with GI bleeding

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21
Q

What are some causes of Megaloblastic Anemia r/t folate deficiency?

A

◦ Malabsorption
◦ Malnutrition that accompanies alcoholism
◦ Repeated pregnancies
◦ Long-term use of certain antiepileptic drugs

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22
Q

What are some causes of Megaloblastic Anemia r/t Vitamin B12 deficiency ?

A

◦ Strict vegetarian diet
◦ Inability of GI tract to absorb vitamin B12

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23
Q

What are some lifespan considerations to take into account when prescribing antianemia agents to children?

A

◦ Ensure proper nutrition
◦ Safety and efficacy not established for epoetin alfa
◦ Dosage based on age and weight
◦ Drink iron through straw
◦ Iron can be toxic- keep out of reach of children
◦ Monitor for iron toxicity

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24
Q

What are some lifespan considerations to take into account when prescribing antianemia agents to adults ?

A

◦ 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

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25
Q

What are some lifespan considerations to take into account when prescribing antianemia agents to older adults ?

A

◦ Nutritional problems related to aging increases the risk of deficiencies
◦ Bowel program for constipation

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26
Q

Which are the two Erythropoiesis-Stimulating Agents that we need to know?

A

Epoetin Alfa
Darbopoetin Alfa

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27
Q

What does Erythropoiesis-Stimulating Agents do?

A

Stimulate the bone marrow to make more RBC’s

28
Q

What does Epoetin Alfa do?

A

Treats anemia associated with renal failure and AIDS, decreases need for
blood transfusions in patients undergoing surgery

29
Q

What does Darbopoetin Alfa do?

A

◦ Treats anemia associated with chronic renal failure, including patients on dialysis
◦ Anemia from chemotherapy

30
Q

What are the MOA’s of Erythropoiesis-Stimulating Agents?

A

Acts like the natural glycoprotein erythropoietin to stimulate the production of RBC’s in the bone marrow.

31
Q

Why do we give patients Erythropoiesis-Stimulating Agents?

A

Because it treats anemia associated with chronic renal failure or kidney disease.

32
Q

What conditions would contraindicate the use of Erythropoiesis-Stimulating Agents?

A

◦ Uncontrolled hypertension
◦ Allergy
◦ Pregnancy and lactation

33
Q

What conditions would prompt us to exhibit increased caution when giving patients Erythropoiesis-Stimulating Agents?

A

◦ Some cancers
◦ Normal renal function (normal erythropoietin levels)

34
Q

What are some adverse reactions related to the use of Erythropoiesis-Stimulating Agents?

A

◦ CNS – Headache, fatigue, asthenia, dizziness, and seizure
◦ Nausea, vomiting, and diarrhea
◦ CV – Hypertension, edema, possible chest pain, increased risk of
DVT when Hgb >11 g/dL

35
Q

What are the known DDI’s to Erythropoiesis-Stimulating Agents?

A

Should not be mixed in solution with other drugs

36
Q

What should we be assessing for prior to giving patients Erythropoiesis-Stimulating Agents?

A

◦ 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

37
Q

What Nursing diagnoses can we anticipate prior to administering Erythropoiesis-Stimulating Agents?

A

◦ 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

38
Q

What implementations would we expect to do during and after administration of Erythropoiesis-Stimulating Agents?

A

◦ 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
◦ Provide thorough patient teaching

39
Q

What are the names of the agents used to treat Iron Deficiency Anemia?

A

Ferrous Asparate
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
Iron Dextran
Iron Sucrose

40
Q

How does agents used to treat Iron Deficiency Anemia work?

A

Elevate the serum iron concentration

41
Q

Why would we give a patient Iron Deficiency Anemia agents?

A

Treatment of iron deficiency anemias and may also be used as adjunctive therapy in
patients receiving Epoetin Alfa.

42
Q

What conditions would contraindicate the use of Iron Deficiency Anemia agents?

A

◦ Allergy
◦ Hemochromatosis
◦ Anemias that are not iron deficiency anemias
◦ Normal iron balance
◦ Peptic ulcer, colitis, or regional enteritis

43
Q

What are some adverse reactions to the use of Iron Deficiency Anemia agents?

A

◦ CNS toxicity
◦ Oral - GI irritation
◦ Parental iron is associated with severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis

44
Q

What are the known DDI’s for Iron Deficiency Anemia agents?

A

Numerous

45
Q

Are there any food interactions with Iron Deficiency Anemia agents?

A

◦ Eggs, milk, coffee, tea
◦ Vitamin C-rich foods

46
Q

What are some patient assessments that we need to do prior to giving patients Iron Deficiency Anemia agents?

A

◦ Assess for contraindications or cautions
◦ Perform a physical assessment
◦ Inspect the skin and mucous membranes; skin integrity of the 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

47
Q

What nursing diagnoses can be anticipated prior to giving patients Iron Deficiency Anemia agents?

A

◦ 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

48
Q

What implementations should we be prepared to do during and after treating patients with Iron Deficiency Anemia agents?

A

◦ Ensure that iron deficiency anemia is confirmed before administering drugs
◦ Consult with the physician to arrange for the treatment of the underlying cause of
anemia if possible
◦ 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

49
Q

What are the names that we need to know for the Chelating Agents?

A

Deferasirox
Deferiprone
Deferoxamine mesylate

50
Q

What are some causes for Folate Deficiencies?

A

◦ Secondary to increased demand
◦ Absorption problems in the small intestine
◦ Drugs that cause folate deficiencies
◦ Secondary to the malnutrition of alcoholism

51
Q

What are some causes of Vitamin B12 Deficiencies?

A

◦ Poor diet or increased demand
◦ Lack of intrinsic factor in the stomach

52
Q

What are the agents that we need to know for Megaloblastic Anemias?

A

Folic Acid
◦ Folic acid
◦ Leucovorin
◦ Levoleucovorin

B12
◦ Hydroxocobalamin, injectable drug
◦ Cyanocobalamin, nasal spray

53
Q

What does Agents for Megaloblastic Anemias do?

A

◦ Essential for cell growth and division for the production of a strong
stroma in RBCs
◦ B12 is also necessary for the maintenance of the myelin sheath in nerve
tissues

54
Q

Why would we give a patient Agents for Megaloblastic Anemias other than for Megaloblastic Anemia?

A

◦ 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

55
Q

What would contraindicate the use of Agents for Megaloblastic Anemias in a patient?

A

Allergy

56
Q

Are there any adverse reactions that may occur when a patient is taking Agents for Megaloblastic Anemias?

A

◦ Relatively few
◦ Pain and discomfort at the injection site
◦ Nasal irritation with intranasal spray

57
Q

What are some known DDI’s with Agents for Megaloblastic Anemias?

A

Relatively few since they are essential

58
Q

Prior to giving a patient Agents for Megaloblastic Anemia, what are some things that we should be assessing for?

A

Assess for contraindications or cautions:
◦ Perform physical exam
◦ Assess affect, orientation, and reflexes; pulse, blood pressure,
and perfusion; respirations and adventitious sounds
◦ Monitor complete blood count, hematocrit, vitamin
B12, folate, and iron levels

59
Q

Prior to administering Agents for Megaloblastic Anemia, what ae some nursing diagnoses that we should expect and be prepared for?

A

◦ Impaired comfort related to injection or nasal irritation
◦ Risk for fluid volume imbalance related to CV effects
◦ Knowledge deficit regarding drug therapy

60
Q

When giving / after giving patients Agents for Megaloblastic Anemia, what ae some nursing implementations that we should be doing?

A

◦ Confirm the nature of the megaloblastic anemia
◦ Give both types of drugs in cases of pernicious anemia
◦ Parenteral vitamin B12 must be 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
◦ Arrange for hematocrit readings before and periodically during therapy
◦ Provide thorough patient teaching

61
Q

What agent would we give for Sickle Cell Anemia?

A

Hydroxyurea

62
Q

What are the actions of Hydroxyurea?

A

◦ Increases amount of fetal hemoglobin produced in bone marrow
◦ Dilutes formation of the abnormal hemoglobin S

63
Q

What would contraindicate the use of Hydroxyurea in patients?

A

◦ Known allergy
◦ Severe anemia or leukopenia

64
Q

What conditions should prompt for increased caution when giving Hydroxyurea?

A

◦ Impaired liver or renal function
◦ Pregnancy and lactation

65
Q

What are some known adverse reactions that may happen to patients taking Hydroxyurea?

A

GI effects, skin rash or erythema, and bone marrow depression, increased cancer risk

66
Q

Are there any DDI’s to Hydroxyurea, and if so, what are they?

A

Uricosuric agents

Pharmacology Exam 3 (11 decks)

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