Anemia Agents

Question 1

Use of drugs to treat anemias across the lifespan: CHILDREN

Answer 1

-Ensure proper nutrition
-Safety and efficacy not established for epoetin alpha
-Based on age and weight
-Drink iron through straw because it can stain teeth
-Iron can be toxic- keep out of reach of children
-It can take six months before results are seen
-Monitor for signs and symptoms of iron toxicity such as: nausea, vomiting, diarrhea, abdominal pain, fatigue, cyanosis, and if severe enough, shock.

-folic acid replacement is best if done through diet, and children can receive monthly shots or nasal sprays of vitamin B12

Question 2

Use of drugs to treat anemias across the lifespan: ADULTS

Answer 2

-oral iron replacement can cause G.I. upset so drink plenty of water.
-Pregnant and lactating individuals cannot meet the increased demand for iron and folic acid so prenatal vitamins are almost always prescribed.
-use appropriate measures to prevent constipation during iron replacement therapy.

-Epoetin alfa/darbepoetin are not recommended during pregnancy/lactation because of the potential adverse effect on the baby.

Question 3

Use of drugs to treat anemias across the lifespan: OLDER ADULTS

Answer 3

-more likely to have iron deficiency related to decreased ability to absorb it, because they are more likely to have chronic illnesses that contribute to anemia.
-more likely to experience constipation with iron supplementation
(suggest exercise, small, frequent meals, hydrating and increasing their fiber)

Question 4

Drug class: Erythropoietin-stimulating agents
What are the suffixes or names of drugs?

Answer 4

“Poetin”
-Epoetin alfa
-Darbopoetin alfa

Question 5

Drug class: Erythropoietin-stimulating agents
What are the indications?

Answer 5

Epoetin- Given 2-3 times a week
treat anemia associated with renal failure and aids, decreases need for blood transfusions in patients undergoing surgery
(Produces an excess of red blood cells prior to the expected loss of red blood cells from surgery)

Darbopoetin alfa- Given once a week
treats anemia associated with chronic renal failure, including patients on dialysis and anemia from chemotherapy
(Helps combat the bone marrow suppression from chemotherapy)

Question 6

Drug class: Erythropoietin-stimulating agents
What are the actions?

Answer 6

Overall, both of these drugs are essentially mimicking erythropoietin, which is not being produced officially in the body on its own.
-since a erythropoietin comes from the kidneys, those with kidney problems are the patients that will benefit the most from these drugs

Question 7

Drug class: Erythropoietin-stimulating agents
What are the contraindications?

Answer 7

increasing the number of red blood cells in the body can also increase blood pressure

• Therefore those with pre-existing hypertension, that is not well-controlled should not take erythropoietin stimulating agents.
• Pregnancy/lactation
• Allergy

Question 8

Drug class: Erythropoietin-stimulating agents
What are the cautions?

Answer 8

-because erythropoietin stimulates cell growth certain cancers can become worse if patients are given these types of drugs
-if patients have normal renal function and are given these medication, they can actually make the anemia more severe
-if patients have adequate erythropoietin levels and normal kidney functioning, but still have anemia, erythropoietin stimulating agents can cause a rebound decrease in erythropoietin

Question 9

Drug class: Erythropoietin-stimulating agents
What are the adverse effects?

Answer 9

• the most common adverse effects are going to be related to the central nervous system: headache, fatigue, Espia, dizziness, and seizure*

-nausea, vomiting, and diarrhea
-CV: hypertension, edema possible chest pain increased risk of DVT when Hgb is greater than 11 /dL

(increasing the amount of circulating of red blood cells can worsen edema, hypertension, and cause blood clots, which can lead to chest pain and deep vein thrombosis)

Question 10

Drug class: Erythropoietin-stimulating agents
What are the drug-drug interactions?

Answer 10

-Should not be mixed in solution with other drugs
Never mix these medication’s with other medication‘s and an IV solution because it can cause the drugs to work differently and you can also create precipitation.

Question 11

Nursing considerations for erythropoietin- simulating agents
Assessment:

Answer 11

-get a baseline central nervous system assessment in case they have a reaction to the medication
-check to see if they already have edema so we know if it develops or gets worse
-lungs are needed in case they start exhibiting signs of a thrombus like tachypnea or diminished lung sounds or shortness of breath.
-baseline labs to monitor, renal function, complete blood count, hematocrit, iron concentration, and electrolyte levels.
(Monitoring for improvement in the H&H or decline and kidney function)

Question 12

Drug class: Erythropoietin-stimulating agents
Nursing diagnoses:

Answer 12

-nausea related to adverse G.I. effects
-diarrhea related to GIF effects
-injury risk related to CNS effects
-altered fluid related to CV effects

Question 13

Drug class: Erythropoietin-stimulating agents
Implementation:

Answer 13

before implementing these medication, we want to assess whether this medication is appropriate for this patient; if we give this drug and their kidneys have normal function, their kidneys could adapt and produce less erythropoietin

-confirm the chronic, renal nature of the patient’s anemia before administering the drug
-provide the patient with the calendar of days when they’re supposed to get treatment
-do not mix with other drug solution
-monitor lines for clotting
-(LABS FIRST) ensure that prescribed laboratory testing such as hematocrit levels is completed before administration anticipate a target hemoglobin of 11 gdL
-evaluate iron stores before and periodically during therapy
-monitor blood pressure due to the risk for hypertension
-maintain seizure precautions on standby

Question 14

Drug class: Erythropoietin-stimulating agents
Evaluation:

Answer 14

-when we’re evaluating this medication, we want to be looking at a lot of labs, namely the hemoglobin hematocrit and renal labs
-Monitor patient response to the drug if there is alleviation of anemia
-Monitor for adverse effects such as headache, hypertension, nausea, vomiting, seizures, and dizziness

Question 15

Drug class: Common agents used for iron deficiency anemia
What are the names of drugs in this category?

Answer 15

• Ferrous asparate
• Ferrous fumarate
• Ferrous gluconate
• Ferrous sulfate
• Iron dextran
• Iron sucrose

Question 16

Drug class: Common agents used for iron deficiency anemia
What are the actions?

Answer 16

Elevate the serum iron concentration

for patients who are experiencing iron deficiency anemia, they can take any of these medications to increase their iron intake along with an iron sufficient diet

Question 17

Drug class: Common agents used for iron deficiency anemia
What are the indications?

Answer 17

Treatment of iron deficiency anemia, and they also be used as adjunctive therapy and patients receiving Epoetin alfa (further increases red blood cell production)

Question 18

Drug class: Common agents used for iron deficiency anemia
What are the contraindications?

Answer 18

-an allergy to iron medication is a more serious contraindication than usual because severe allergic reactions have been reported when patients receive iron parentally.
-hemochromatosis is when a Persian has too much iron in their blood (if we get more iron to a patient who already has too much that can cause toxicity)
-if given to a patient with normal iron levels, the drug will pass through the body and be wasted.
-anemia that are not iron deficient anemias
-Iron can be very irritating to the stomach and intestines so patients are already experiencing intestinal inflammation it can be made worse with this information
(peptic, ulcers, colitis, or regional enteritis)

Question 19

Drug class: Common agents used for iron deficiency anemia
What are the adverse effects?

Answer 19

the most common adverse effect is G.I. upset, which includes nausea, vomiting, and anorexia, diarrhea, and dark stools (remember to tell patients about that side effect, and remember it for yourself)

-CNS toxicity (if iron levels become too high, which could cause coma and eventually death)
-parental iron is associated with severe anaphylactic reactions, local irritation, staining of the tissues and phlebitis
(S/S = cough, shortness of breath, fever, and even irritation at the IV site)

Question 20

Drug class: Common agents used for iron deficiency anemia
What are the drug-drug interactions?

Answer 20

-Numerous
Most common: antacids, substances with calcium and magnesium

Question 21

Drug class: Common agents used for iron deficiency anemia
What are the food interactions?

Answer 21

-eggs, milk, coffee, tea
-vitamin C rich foods

Question 22

Nursing considerations for iron preparations
Assessment:

Answer 22

-we need to look at labs and see what their iron level currently is and make sure the patient doesn’t have hyperchromatosis
-inspector skin of mucous membranes; skin integrity of the intended parental administration site
-assess level of orientation affect and reflexes
-monitor pulse, blood pressure, perfusion, respirations, and adventitious sounds
-monitor, complete blood clot, hematocrit, hemoglobin and serum for ferritin assays
-monitor vitals because those will be early signs of toxicity
-perform an abdominal assessment in case of a G.I. adverse effect

Question 23

Nursing considerations for iron preparations
Nursing diagnoses:

Answer 23

-impaired comfort related to CNS or G.I. effects of parenteral administration
-nausea related to adverse G.I. effects
-constipation related to adverse G.I effects
-altered body image related to drug staining of the skin from parenteral injections
-Injury risk related to CNS effects

Question 24

Nursing considerations for iron preparations
Implementation:

Answer 24

we want to check to make sure that our patient actually has iron deficiency anemia, and not some other form of anemia

-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, or tea
-caution the patient but stools may be dark 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.

• patient should report any changes of disorientation or trouble breathing*

Question 25

Nursing considerations for iron preparations
Evaluation:

Answer 25

• when evaluating these patients, you’ll be looking to see if the treatment is working; are their iron levels up, has the hemoglobin and rheumatic rate increased, is the patient experiencing any constipation or abdominal pain?*

Question 26

What is the antidote for iron toxicity?

Answer 26

Chelating agents = deferasirox, deferiprone, deferoxamine

Question 27

Drug class: Common agents for megaloblastic anemias
What are the drug names or suffixes?

Answer 27

Folic acid:
-Folic acid
“-covorin”
-Lueucovorin
-Levoleucovorin

B12:
-Hydroxocobalamin - injectable drug
-Cyanocobalamin - nasal spray

Question 28

Drug class: Common agents for megaloblastic anemias
What is the action:

Answer 28

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

Question 29

Drug class: Common agents for megaloblastic anemias
What are the indications?

Answer 29

-megaloblastic anemia
-replacement therapy for dietary deficiencies and high demand states (like pregnancy)
-folic acid is used as a rescue drug for cells exposed to some toxic chemotherapeutic agents

Question 30

Drug class: Common agents for megaloblastic anemias
What are the contraindications?

Answer 30

Known allergy

Question 31

Drug class: Common agents for megaloblastic anemias
What are the adverse effects?

Answer 31

most common adverse effect is related to their administration
-pain and discomfort at the injection site
-nasal irritation with intro, nasal spray

(Make sure to assess for ulcers in the nose or other size of irritations as this can affect how the drug is absorbed)

Hydroxocobalamin has been linked to itching, rash, peripheral edema, and heart failure.

Question 32

Drug class: Common agents for megaloblastic anemias
What are the drug-drug interactions?

Answer 32

-relatively few since they are essential

Question 33

Nursing considerations for megaloblastic anemia agents
Assessment:

Answer 33

vitamin B12 is a part of the myelin sheath formation so deficiencies can lead to neuropathy and decreased muscle coordination

-perform a neuro assessment assessing for affect, orientation, reflexes
-patients with anemia will need a respiratory assessment because their bodies aren’t getting enough oxygen so check for respirations and adventitious sounds
-monitor complete blood count, hematocrit, vitamin B 12 fully, and iron levels
(signs of vitamin B12 deficiency include a beefy, red tongue, pour and neuropathy, which will be the tingling or numbness in the hands or feet)
-because of the increase in red blood cells, there may be an increase in blood pressure as well so check for blood pressure and perfusion

Question 34

Nursing considerations for megaloblastic anemia agents
Nursing diagnoses:

Answer 34

-impaired comfort related to injection or nasal irritation
-risk for fluid volume and balance related to CV effects

Question 35

Nursing considerations for megaloblastic anemia agents
Implementation:

Answer 35

before trading any anemia we will want to confirm the diagnosis and make sure the patient being treated is being treated appropriately

-confirm the nature of the megaloblastic anemia
-give both types of drugs in cases of pernicious anemia (you’ll be giving both folic acid and vitamin B 12 replacements because if there isn’t enough folic acid, the vitamin B12 will not get used, they have to work together to form red blood cells)
-parenteral vitamin B 12 must be given each day for 5 to 10 days and then once a month for life (include in patients teaching)
-arrange for nutritional consult
-monitor for the possibility of hypersensitivity reactions
-arrange for hematocrit readings before and periodically during therapy

Question 36

Nursing considerations for megaloblastic anemia agents
Evaluation:

Answer 36

-Monitor for patient response to the drug if there is an alleviation of anemia
-Monitor for adverse effects, such as nasal irritation, pain at the injection site, nausea
-Evaluate the effectiveness of the teaching plan; knowing to report any increase numbness or tingling, skin, irritation, or shortness of breath and that they will have to take B12 for the rest of their life.

Question 37

Drug class: sickle cell anemia agents
What are the drug names in this class?

Answer 37

Hydroxyurea

Question 38

Drug class: sickle cell anemia agents
What are the actions and indications?

Answer 38

-increases amount of fetal hemoglobin produced in bone marrow
-dilutes formation of the abnormal hemoglobin S (allows for more of the normal normal shaped red blood cells to form, this reduces the amount of incidences of small blood vessels, getting occluded, therefore reducing the pain)

Question 39

Drug class: sickle cell anemia agents
What are the contraindications?

Answer 39

-known allergy
-severe anemia or leukopenia (can cause further bone marrow suppression)

Question 40

Drug class: sickle cell anemia agents
What are the cautions?

Answer 40

caution should be taken if we’re giving these to patients with kidney or liver problems because excretion of the drug can be affected
-should only be used in pregnancy in cases were benefits far outweigh the risks.
-this drug can cross into the placenta and to human milk so other forms of feeding is encouraged

Question 41

Drug class: sickle cell anemia agents
What are the adverse effects?

Answer 41

hydroxyaurea is cytotoxic, particularly to cells with a high turnover rate, which means the skin and bone marrow, and this leads to skin, rash and bone marrow depression

-the cytotoxic affect also means that there is an increased risk of developing cancer
-GI: nausea, vomiting, anorexia, diarrhea, or constipation
-Flu like symptoms like headache, chills, and malaise (most likely linked to cytotoxicity)

Question 42

Drug class: sickle cell anemia agents
What are the drug-drug interactions?

Answer 42

Uricosuric agets