Anemia Agents Flashcards
What are the basic steps of erythropoiesis?
Negative Feedback Loop
* Blood lacks Oxygen, which spurs kidneys to release erythropoietin
* Erythropoietin stimulates bone marrow to make more red blood cells
* RBCs begin as hemocytoblasts
* Needed to form mature erythrocytes: amino acids, lipids, carbohydrates, Vitamin B12, Folic Acid, Iron
* Mature RBCs circulate for 120 days
* Without a nucleus, they breakdown (hemolysis) in the liver, spleen, and bone marrow
* Byproducts: Iron & Vitamin B12 –> recycled to make more RBCs
* Byproduct: Bilirubin –> excreted through bile.
Why are Iron, Vitamin B12, Folic Acid, Essential Acids, and Carbohydrates essential to Healthy RBCs?
Iron: Forms hemoglobin rings to carry the oxygen
Vitamin B12 & Folic Acid: Form a supporting structure that can survive being battered through blood vessels for 120 days
Essential Amino Acids & Carbohydrates: Needed to complete the hemoglobin rings, cell membrane, and basic structure
Causes of Iron Deficiency Anemia?
Negative Balance of Iron
* Menstruating women who lose RBCs monthly
* Pregnant and nursing women who have increased demands for iron
* Rapidly growing adolescents (especially with poor diets)
* People with GI bleeding (usually related to NSAID use)
Causes of Megaloblastic Anemia?
Folate deficiency
* Malabsorption
* Malnutrition r/t alcoholism
* Repeated pregnancies
* Long term use of certain antisiezure drugs
Vitamin B12 deficiency
* Strict vegetarian diet
* Inability of GI tract to absorb Vitamin B12 (insufficient Intrinsic Factor)
Considerations for
Anemia Agents
In Children
- Ensure proper nutrition
- Safety and efficacy NOT established for epoetin alfa
- Dosage based on age and weight
- Iron stains teeth - so drink through a straw
- Iron can be toxic - keep out of reach of children
- Monitor closely for iron toxicity
Considerations for
Anemia Agents
In Adults
- Use appropriate measures to prevent constipation
- Increased demand during pregnancy and lactation
- Epoetin alfa/darbepoetin NOT recommended during pregnancy/lactaction
Considerations for
Anemia Agents
In Older Adults
- Nutritional issues r/t aging increases risk of deficiencies
- Bowel program for constipation
Erythropoiesis-Stimulating Agents
Drug Names
Epoetin Alfa
Darbopoetin Alfa
Erythropoiesis-Stimulating Agents
Mechanism of Action
Acts like the natural glycoprotein erythropoietin to stimulate production of RBCs in the bone marrow
Erythropoiesis-Stimulating Agents
Indications
Epoetin Alfa: Anemia associated with renal failure and AIDs, decreases need for blood transfusions in patients undergoing surgery
Darbopoetin Alfa: Anemia associated with chronic renal failure, including pts on dialysis; anemia from chemotherapy
Erythropoiesis-Stimulating Agents
Contraindications
Absolute:
* Allergy
* Uncontrolled hypertension
* Pregnancy & Lactation
Cautions:
* Some cancers (can stimulate tumor growth)
* NORMAL renal function (normal erythropoietin levels): can cause rebound decrease in erythropoietin
Erythropoiesis-Stimulating Agents
Adverse Effects
🧠 CNS: Headache, fatigue, asthenia (weakness), dizziness, seizure
🤢 GI: Nausea, vomiting, diarrhea
💓 CV: Hypertension, edema, chest pain, increased risk of DVT when Hgb is >11 g/dL
Erythropoiesis-Stimulating Agents
Drug Interactions
- Should NOT be mixed in an IV with other solutions (can cause precipitate)
Erythropoiesis-Stimulating Agents
Assessment
History:
* Check for: pregnancy, lactation, hypertension, cancer, renal function, allergy
Physical:
* CNS: affect, orientation, muscle strength
* CV: vitals, edema
* Respiratory: rate and lung sounds
Labs:
* Renal Function Tests
* CBC (hematocrit, hemoglobin)
* Iron concentration
* Transferrin levels
* Electrolyte levels
Erythropoiesis-Stimulating Agents
Implementation/Patient Teaching
- Confirm the chronic renal nature of pt’s anemia before adminstering drug (won’t work for other types of anemia)
- Use barrier contraceptives
- Provide calendar with marked days for drug infusions
- Do NOT mix with any other solution
- Monitor IV lines for clotting
- Ensure labs are drawn BEFORE drug administration: anticipate a target hemoglobin of 11g/dL
- Evaluate iron levels before and during therapy
- Monitor blood pressure risk r/t adverse effect
- Maintain seizure precautions on standby
Erythropoiesis-Stimulating Agents
Nursing Diagnoses
- Nausea (r/t GI effects)
- Diarrhea (r/t GI effects)
- Injury Risk (r/t CNS effects)
- Altered Fluid Volume (r/t CV effects)
- Knowledge deficit
Iron Deficiency Anemia Agents
Drug Names
Ferrous Asparate
Ferrous Fumarate
Ferrous Gluconate
Ferrous Sulfate
Iron Dextran
Iron Sucrose
Iron Deficiency Anemia Agents
Mechanism of Action
- Elevates the IRON concentration in the blood
Iron Deficiency Anemia Agents
Indications
- Treatment of Iron Deficiency Anemia
- Adjunctive Therapy to patients receiving Epoetin Alfa
Iron Deficiency Anemia Agents
Contraindications
Absolute:
* Allergy
* Hemochromatosis (genetic disorder causing the body to absorb too much iron from food: Iron overload)
* Anemias that are NOT iron deficiency anemias
* NORMAL iron balance
* Peptic ulcer, colitis, or regional enteritis (iron can damage the GI mucosal tract and make these worse)
Iron Deficiency Anemia Agents
Adverse Effects
- CNS: toxicity (stupor, coma, seizures, lightheadedness, tongue numbness, metallic taste, restlessness, perioral paresthesias, slurred speech, and excitability or drowsiness)
- Oral Irritation & teeth staining
- GI Irritation: nausea, vomiting, constipation, dark stools
- Parenteral Iron: severe anaphylactic reactions (SOB, cough), local irritation, staining of tissues, phlebitis (inflamed veins)
Iron Deficiency Anemia Agents
Drug Interactions
Drugs:
* Numerous
* Antacids, Magnesium, Calcium
Food:
* Interfere with absorption: milk, eggs, coffee, tea
* Aid in absorption: Vitamin C
Iron Deficiency Anemia Agents
Assessment
History:
* Check for: allergy, hemochromatosis, non iron deficiency anemias, peptic ulcer, colitis, regional enteritis
Physical:
* Skin: integrity at intended parenteral administration site
* CNS: affect, orientation, reflexes
* CV: Pulse, BP, perfusion
* Respiratory: Lung sounds, rate
* GI: abdominal distension, bowel sounds
Labs:
* CBC (Hematocrit/Hemoglobin)
* Serum Ferritin assays
Iron Deficiency Anemia Agents
Implementation/Patient Teaching
- Ensure IRON deficiency anemia is confirmed before drug administration
- Do not take oral form with eggs, milk, coffee, or tea
- Teach patient that stools may be dark or green
- Iron can stain teeth: take liquid form through a straw if possible
- Administer IM form by the Z-track technique
- Take measures to alleviate constipation
- Monitor Hematocrit and hemoglobin before and during therapy
- Report trouble breathing or changes in orientation to provider immediately
Antidote to Iron Toxicity
Chelating Agents
* deferasirox
* deferiprone
* deferoxamine mesylate
Megaloblastic Anemia Agents
Drug Names
Folic Acid:
* Folic Acid
* Leucovorin
* Levoleucovorin
B12
* Hydroxocobalamin (injectable drug)
* Cyanocobalamin (nasal spray)
Megaloblastic Anemia Agents
Mechanism of Action
- 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
Megaloblastic Anemia Agents
Indications
- Megaloblastic Anemia
- Replacement therapy for dietary deficiencies and high demand states (ie pregnancy)
- Folic acid is used as a rescue drug for cells exposed to some toxic chemotherapeutic agents (methotrexate)
Megaloblastic Anemia Agents
Contraindications
Absolute:
Allergy
Megaloblastic Anemia Agents
Adverse Effects
Relatively few
- Pain and discomfort at the injection site
- Nasal irritation with the nasal spray
- Not common: diarrhea
Hydroxocobalamin: itching, rash, peripheral edema, heart failure
Megaloblastic Anemia Agents
Drug Interactions
Relatively FEW
because they are essential
Megaloblastic Anemia Agents
Assessment
Physical:
* CNS: affect, orientation, reflexes
* CV: pulse, blood pressure, perfusion
* Respiration rate and lung sounds
Labs:
* CBC (hematocrit & hemoglobin)
* Vitamin B12 level
* Folate level
* Iron levels
Megaloblastic Anemia Agents
Nursing Diagnoses/Conclusions
- Impaired comfort (r/t injection or nasal irritation)
- Risk for fluid volume imbalance (r/t CV effects)
- Knowledge Deficit
Megaloblastic Anemia Agents
Implementation/Patient Teaching
- Confirm nature of megaloblastic anemia
- Give BOTH types of drugs for Pernicious anemia
- Parenteral Vitamin B12 must be given IM each day for 5-10 days and then 1x monthly for LIFE
- Arrange for nutritional consult
- Monitor for hypersensitivity
- Check hematocrit before and during therapy (CBC)
- Strongly encourage follow up appointments
Sickle Cell Anemia Agents
Drug Name
Hydroxyurea
Sickle Cell Anemia Agent: Hydroxyurea
Mechanism of Action
- Increases amount of fetal hemoglobin produced in bone marrow
- Dilutes formation of the abnormal hemoglobin S
Sickle Cell Anemia Agent: Hydroxyurea
Contraindications
Absolute:
* Allergy
* Severe anemia or leukopenia (can cause further bone marrow depression)
Cautions:
* Pregnancy and lactation
* Impaired renal or liver function
Sickle Cell Anemia Agent: Hydroxyurea
Adverse Effects
- GI: constipation
- Skin rash or erythema
- Bone marrow depression
- Increased cancer risk
- Flu like symptoms
Sickle Cell Anemia Agent: Hydroxyurea
Drug Interaction
- Uricosuric Agents (can increase uric acid levels)
Megaloblastic anemia is caused by:
A. Iron Deficiency
B. A mutation of hemoglobin
C. Magnesium deficiency
D. Folic Acid and Vitamin B12 deficiency
D. Folic Acid and Vitamin B12 deficiency
Why is normal renal function a caution for erythropoiesis-stimulating agents?
A. Can cause renal toxicity
B. Can cause hyperkalemia
C. Can cause urinary retention
D. Can cause rebound decreased erythropoietin
D. Can cause rebound decreased erythropoietin
What education would you give to a patient who is recieving iron for iron deficiency anemia?
A. You should report any increased confusion, lethargy, or if you feel your heart is racing - these are signs of toxicity
B. You should have food with the iron; eggs and milk are good choices.
C. There is no need for follow appointments
D. If you notice changes in your stool, you should call 911 immediately
A. You should report any increased confusion, lethargy, or if you feel your heart is racing because these are signs of toxicity
