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Pharmacology Exam #3 > Anemia Agents > Flashcards

Anemia Agents Flashcards

1
Q

What are the basic steps of erythropoiesis?

A

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.

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2
Q

Why are Iron, Vitamin B12, Folic Acid, Essential Acids, and Carbohydrates essential to Healthy RBCs?

A

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

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3
Q

Causes of Iron Deficiency Anemia?

A

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)

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4
Q

Causes of Megaloblastic Anemia?

A

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)

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5
Q

Considerations for
Anemia Agents
In Children

A
  • 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
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6
Q

Considerations for
Anemia Agents
In Adults

A
  • Use appropriate measures to prevent constipation
  • Increased demand during pregnancy and lactation
  • Epoetin alfa/darbepoetin NOT recommended during pregnancy/lactaction
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7
Q

Considerations for
Anemia Agents
In Older Adults

A
  • Nutritional issues r/t aging increases risk of deficiencies
  • Bowel program for constipation
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8
Q

Erythropoiesis-Stimulating Agents
Drug Names

A

Epoetin Alfa

Darbopoetin Alfa

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9
Q

Erythropoiesis-Stimulating Agents
Mechanism of Action

A

Acts like the natural glycoprotein erythropoietin to stimulate production of RBCs in the bone marrow

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10
Q

Erythropoiesis-Stimulating Agents
Indications

A

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

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11
Q

Erythropoiesis-Stimulating Agents
Contraindications

A

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

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12
Q

Erythropoiesis-Stimulating Agents
Adverse Effects

A

🧠 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

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13
Q

Erythropoiesis-Stimulating Agents
Drug Interactions

A
  • Should NOT be mixed in an IV with other solutions (can cause precipitate)
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14
Q

Erythropoiesis-Stimulating Agents
Assessment

A

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

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15
Q

Erythropoiesis-Stimulating Agents
Implementation/Patient Teaching

A
  • 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
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16
Q

Erythropoiesis-Stimulating Agents
Nursing Diagnoses

A
  • 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
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17
Q

Iron Deficiency Anemia Agents
Drug Names

A

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

18
Q

Iron Deficiency Anemia Agents
Mechanism of Action

A
  • Elevates the IRON concentration in the blood
19
Q

Iron Deficiency Anemia Agents
Indications

A
  • Treatment of Iron Deficiency Anemia
  • Adjunctive Therapy to patients receiving Epoetin Alfa
20
Q

Iron Deficiency Anemia Agents
Contraindications

A

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)

21
Q

Iron Deficiency Anemia Agents
Adverse Effects

A
  • 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)
22
Q

Iron Deficiency Anemia Agents
Drug Interactions

A

Drugs:
* Numerous
* Antacids, Magnesium, Calcium

Food:
* Interfere with absorption: milk, eggs, coffee, tea
* Aid in absorption: Vitamin C

23
Q

Iron Deficiency Anemia Agents
Assessment

A

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

24
Q

Iron Deficiency Anemia Agents
Implementation/Patient Teaching

A
  • 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
25
Q

Antidote to Iron Toxicity

A

Chelating Agents
* deferasirox
* deferiprone
* deferoxamine mesylate

26
Q

Megaloblastic Anemia Agents
Drug Names

A

Folic Acid:
* Folic Acid
* Leucovorin
* Levoleucovorin

B12
* Hydroxocobalamin (injectable drug)
* Cyanocobalamin (nasal spray)

27
Q

Megaloblastic Anemia Agents
Mechanism of Action

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
28
Q

Megaloblastic Anemia Agents
Indications

A
  • 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)
29
Q

Megaloblastic Anemia Agents
Contraindications

A

Absolute:

Allergy

30
Q

Megaloblastic Anemia Agents
Adverse Effects

A

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

31
Q

Megaloblastic Anemia Agents
Drug Interactions

A

Relatively FEW
because they are essential

32
Q

Megaloblastic Anemia Agents
Assessment

A

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

33
Q

Megaloblastic Anemia Agents
Nursing Diagnoses/Conclusions

A
  • Impaired comfort (r/t injection or nasal irritation)
  • Risk for fluid volume imbalance (r/t CV effects)
  • Knowledge Deficit
34
Q

Megaloblastic Anemia Agents
Implementation/Patient Teaching

A
  • 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
35
Q

Sickle Cell Anemia Agents
Drug Name

A

Hydroxyurea

36
Q

Sickle Cell Anemia Agent: Hydroxyurea
Mechanism of Action

A
  • Increases amount of fetal hemoglobin produced in bone marrow
  • Dilutes formation of the abnormal hemoglobin S
37
Q

Sickle Cell Anemia Agent: Hydroxyurea
Contraindications

A

Absolute:
* Allergy
* Severe anemia or leukopenia (can cause further bone marrow depression)

Cautions:
* Pregnancy and lactation
* Impaired renal or liver function

38
Q

Sickle Cell Anemia Agent: Hydroxyurea
Adverse Effects

A
  • GI: constipation
  • Skin rash or erythema
  • Bone marrow depression
  • Increased cancer risk
  • Flu like symptoms
39
Q

Sickle Cell Anemia Agent: Hydroxyurea
Drug Interaction

A
  • Uricosuric Agents (can increase uric acid levels)
40
Q

Megaloblastic anemia is caused by:
A. Iron Deficiency
B. A mutation of hemoglobin
C. Magnesium deficiency
D. Folic Acid and Vitamin B12 deficiency

A

D. Folic Acid and Vitamin B12 deficiency

41
Q

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

A

D. Can cause rebound decreased erythropoietin

42
Q

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

A. You should report any increased confusion, lethargy, or if you feel your heart is racing because these are signs of toxicity

Pharmacology Exam #3 (6 decks)

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