Anemia Agents Flashcards by Jennifer Baker

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.

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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

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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)

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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)

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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

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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

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Considerations for
Anemia Agents
In Older Adults

Nutritional issues r/t aging increases risk of deficiencies
Bowel program for constipation

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Erythropoiesis-Stimulating Agents
Drug Names

Epoetin Alfa

Darbopoetin Alfa

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Erythropoiesis-Stimulating Agents
Mechanism of Action

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

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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

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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

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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

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Erythropoiesis-Stimulating Agents
Drug Interactions

Should NOT be mixed in an IV with other solutions (can cause precipitate)

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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

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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

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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

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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** * **defer**asirox * **defer**iprone * **defer**oxamine mesylate

**Megaloblastic Anemia Agents** Drug Names

**Folic Acid:** * Folic Acid * Leucovorin * Levoleucovorin **B12** * Hydroxo**cobalamin** *(injectable drug)* * Cyano**cobalamin** *(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**