Anemia Drugs Flashcards
Hematopoiesis
Formation of new blood cells
Red blood cells (RBCs)
White blood cells (WBCs)
Platelets
RBCs
Manufactured in?
Immature RBCs are called
Lifespan is ___ days.
Manufactured in bone marrow
Immature RBCs are reticulocytes.
Lifespan is 120 days.
More than one third of an RBC is made of?
Heme:
Globin:
More than one third of an RBC is made of hemoglobin.
Heme: red pigment; contains iron
Globin: protein chain
Anemia:
Two Maturation defects
Cytoplasmic
Nuclear
Excessive destruction of RBCs (hemolytic anemias)
Two types
Intrinsic RBC abnormalities
Extrinsic mechanisms
epoetin alfa (Eprex®)
Used for treatment of? associated with?
Medication is ineffective without ____and _____
Most patients receiving epoetin alfa need to also receive an?
Contraindications? (hgb levels for cancer pts VS pt with KD)
Most frequent adverse effects:
Biosynthetic form of the natural hormone erythropoietin
Used for treatment of anemia associated with
* end-stage renal disease,
* chemotherapy-induced anemia,
* anemia associated with zidovudine therapy
Medication is ineffective without adequate body iron stores and bone marrow function.
Most patients receiving epoetin alfa need to also receive an oral iron preparation.
Contraindications:
* drug allergy; uncontrolled hypertension; hemoglobin levels that are above 100 mmol/L for cancer patients and 130 mmol/L for patients with kidney disease; head and neck cancers; risk of thrombosis
Most frequent adverse effects:
* hypertension, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction
Longer-acting form of epoetin is called?
darbepoetin (Aranesp®)
Iron is an?
Function?
Stored in (three body parts)
Dietary sources
Must be converted by ______ before it can be absorbed
Essential mineral in the body
Oxygen carrier in hemoglobin and myoglobin
Stored in the liver, spleen, and bone marrow
Deficiency results in anemia
Dietary sources: meats, certain vegetables and grains
Dietary iron must be converted by gastric juices before it can be absorbed.
Some foods enhance iron absorption.
Orange juice
Veal
Fish
Ascorbic acid
Some foods impair iron absorption.
Eggs*
Corn
Beans*
Cereal products containing phytates
* Also common dietary sources of iron.
Supplemental iron
may be given as a single drug or as part of a multivitamin preparation.
Oral iron preparations are available as ferrous salts.
-ferrous fumarate (Femiron®), ferrous gluconate, ferrous sulphate (FeSO4)
Parenteral
-iron dextran (Dexiron®, Infufer®)
-iron sucrose (Venofer®)
-ferric gluconate (Ferrlecit®)
-ferumoxytol (Feraheme®)
Iron Indications
Prevention and treatment of iron deficiency syndromes
Administration of iron alleviates the symptoms of iron deficiency anemia, but the underlying cause of the anemia should be corrected.
Iron: Adverse Effects
Most common cause of pediatric poisoning deaths
Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain
Causes black, tarry stools
Liquid oral preparations temporarily discolour teeth.
Injectable forms cause pain upon injection.
Iron Toxicity
nursing interventions
In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with ______________ is initiated.
Symptomatic and supportive measures
-Suction and maintenance of the airway; correction of acidosis; control of shock and dehydration with IV fluids or blood, oxygen, and vasopressors
In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with deferoxamine mesylate is initiated.
Iron dextran (Dexiron, Infufer)
nursing considerations
May cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis
A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of dose is given after 1 hour.
Used less frequently now; replaced by newer products ferric gluconate and iron sucrose
ferric gluconate (Ferrlecit)
indication
nursing consderations
doses higher than ____ are associated with?
Indicated for repletion of total body iron content in patients with iron deficiency anemia who are undergoing hemodialysis
Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required.
Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching.
Folic Acid is a?
Essential for?
Primary uses? Two
Most common cause of deficiency?
Nursing consideration
May mask symptoms of___________, which requires treatment other than folic acid. If this is untreated… can lead to ________
Water-soluble, B-complex vitamin
Essential for erythropoiesis
Primary uses
-Folic acid deficiency
-During pregnancy, to prevent neural tube defects
Malabsorption syndromes are the most common causes of deficiency.
Should not be used until actual cause of anemia is determined
May mask symptoms of pernicious anemia, which requires treatment other than folic acid
Untreated pernicious anemia progresses to neurological damage.
Cyanocobalamin (Vitamin B12)
Used to treat_______ or other_______
Used to treat pernicious anemia and other megaloblastic anemias
Administered orally or parentally.
Usually administered by deep intramuscular injection to treat pernicious anemia
Nursing Implications
Assess patient history and medication history, including drug allergies.
Assess potential contraindications.
Assess baseline laboratory values, especially hemoglobin, hematocrit, reticulocytes, and others.
Obtain nutritional assessment.
Nursing Implications
Ferrous salts are contraindicated for patients with ulcerative colitis, peptic ulcer disease, liver disease, and other gastrointestinal disorders.
Keep away from children, because oral forms may look like candy.
Iron dextran is contraindicated in all anemias except for iron-deficiency anemia.
For liquid iron preparations, follow the manufacturer’s guidelines on dilution and administration.
Instruct the patient to take liquid iron preparations through a straw to avoid staining tooth enamel.
Oral forms of iron should be taken between meals for maximum absorption but may be taken with meals if gastrointestinal distress occurs.
Oral forms should be given with juice but not with milk or antacids.
To avoid esophageal corrosion, patients should ___________________ after taking oral iron doses.
Patients should be encouraged to eat foods high in ___ and ______.
To avoid esophageal corrosion, patients should remain upright for up to 30 minutes after taking oral iron doses.
Patients should be encouraged to eat foods high in iron and folic acid.
For iron dextran, a ______ should be given.
Administer the dose deeply into a large muscle mass, using the _______
For iron dextran, a small test dose should be given.
If there is no reaction after 1 hour, the remainder of the dose can be given.
Administer the dose deeply into a large muscle mass, using the Z-track method.
Give IV doses of iron dextran carefully and according to the manufacturer’s instructions.
Have resuscitative equipment available in case of an anaphylactic reaction.
Determine the cause of anemia before administering
Determine the cause of anemia before administering folic acid.
Administer oral folic acid with food.
Folic acid is available for both oral and injectable use
Monitor therapeutic responses.
Improved nutritional status
Increased weight, activity tolerance, well-being
Absence of fatigue
