Anemia and hematopoietic agents

Question 1

ferrous sulfate moa

Answer 1

-

Question 2

ferrous sulfate adverse effects

Answer 2

-GI, NVD, heartburn, bloating, teeth staining, dark green or black stool color
-iron poisoning leading to overdose: NVD and shock, acidosis, gastric necrosis, hepatic failure, pulmonary edema, vasomotor collapse

Question 3

ferrous sulfate nursing considerations

Answer 3

-interaction of iron with other meds affecting absorption
-co-admin with Vitamin C to increase absorption but watch for increased GI adverse effects
-can use IV or IM if PO doesn’t work/intolerable
-assessment of anemia s/s and diagnostics

Question 4

ferrous sulfate indications

Answer 4

iron deficiency anemia
also used as prevention

Question 5

Cyanocobalamin moa

Question 6

Cyanocobalamin indications

Answer 6

-Vitamin B12/megaloblastic anemia
-impaired absorption
-reduced gastric acid secretion from med use
-lack of intrinsic factor

Question 7

Cyanocobalamin adverse effects

Answer 7

-generally free from AE
-hypokalemia (muscle weakness, irregular heartbeat) from increased erythrocyte production

Question 8

Cyanocobalamin nursing considerations

Answer 8

-pt edu on med adherence: lifelong monthly injections
-assess food consumption and improve nutrition
-post admin assessment of anemia s/s and diagnostics

Question 9

Folic Acid MOA

Question 10

Folic Acid indications

Answer 10

-folic acid/megaloblastic anemia
-prophylaxis, especially during pregnancy and lactation
-initial tx of severe B12 deficiency and anemia

Question 11

Folic Acid adverse effects

Answer 11

-generally free from AE
-long term moderate dosing may have slight increase in risk for some cancers (prostate and colorectal)

Question 12

Folic Acid nursing considerations

Answer 12

-pt edu on med adherence
-assess food and alcohol consumption
promote intake of folate-rich foods and counseling for alcoholism
-part of banana bag (supportive tx for alcohol withdrawal)

Question 13

Epoetin Alfa MOA

Answer 13

stimulates bone marrow to increase production of RBC

Question 14

Epoetin Alfa indication

Answer 14

-anemia of CRF
-palliative of chemo-induced anemia of non-myeloid malignancies
-HIV pt with zidovudine
-pre-op for anemic pt prior to elective surgery

Question 15

Epoetin Alfa adverse effects

Answer 15

-htn related to increase in hematocrit
-increased risk for MI, CVA, and HF

Question 16

Epoetin Alfa nursing consideration

Answer 16

-dont agitate vial before prepping med
-monitor CV status, CMP, and Fe panel
-monitor CBC, hemoglobin (greater than or equal to 10-11)
-monitor under REMS

Question 17

Filgrastim MOA

Answer 17

-stimulates bone marrow to increase production of neutrophils

Question 18

Filgrastim indications

Answer 18

-myelosuppressive chemotherapy
-chemo + BMT of non myeloid origin
-severe chronic neutropenia

Question 19

Filgrastim adverse effects

Answer 19

-bone pian mild- moderate
-leukocytosis

Question 20

Filgrastim nursing consideration

Answer 20

-dont agitate vial before prepping
-monitor for pain and utilize appropriate analgesics PRN
monitor CBC and d/c once ANC reaches 10,000

Question 21

Romiplostim MOA

Answer 21

increases platelet counts by binding to and activating human thrombopoietin receptor

Question 22

Romiplostim indications

Answer 22

minimizing thrombocytopenia in pt undergoing myelosuppressive radiation and immune thrombocytopenia

Question 23

Romiplostim adverse effects

Answer 23

-ab pain
-dizziness & headache
-arthralgia
-oropharyngeal pain
-thromboembolism
-progression of existing MDS to AML

Question 24

Romiplostim nursing consideration

Answer 24

-careful dosage cal needed, syringe with 0.01ml graduations
-monitor CBC, PLT should increase