Anemia Drugs

Question 1

Hematopoiesis

Answer 1

Formation of new blood cells
Red blood cells (RBCs)
White blood cells (WBCs)
Platelets

Question 2

RBCs

Manufactured in?

Immature RBCs are called

Lifespan is ___ days.

Answer 2

Manufactured in bone marrow

Immature RBCs are reticulocytes.

Lifespan is 120 days.

Question 3

More than one third of an RBC is made of?

Heme:

Globin:

Answer 3

More than one third of an RBC is made of hemoglobin.

Heme: red pigment; contains iron

Globin: protein chain

Question 4

Anemia:
Two Maturation defects

Answer 4

Cytoplasmic

Nuclear

Question 5

Excessive destruction of RBCs (hemolytic anemias)
Two types

Answer 5

Intrinsic RBC abnormalities

Extrinsic mechanisms

Question 6

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:

Answer 6

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

Question 7

Longer-acting form of epoetin is called?

Answer 7

darbepoetin (Aranesp®)

Question 8

Iron is an?

Function?

Stored in (three body parts)

Dietary sources

Must be converted by ______ before it can be absorbed

Answer 8

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.

Question 9

Some foods enhance iron absorption.

Answer 9

Orange juice
Veal
Fish
Ascorbic acid

Question 10

Some foods impair iron absorption.

Answer 10

Eggs*
Corn
Beans*
Cereal products containing phytates
* Also common dietary sources of iron.

Question 11

Supplemental iron

Answer 11

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®)

Question 12

Iron Indications

Answer 12

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.

Question 13

Iron: Adverse Effects

Answer 13

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.

Question 14

Iron Toxicity

nursing interventions

In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with ______________ is initiated.

Answer 14

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.

Question 15

Iron dextran (Dexiron, Infufer)

nursing considerations

Answer 15

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

Question 16

ferric gluconate (Ferrlecit)

indication

nursing consderations

doses higher than ____ are associated with?

Answer 16

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.

Question 17

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 ________

Answer 17

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.

Question 18

Cyanocobalamin (Vitamin B12)

Used to treat_______ or other_______

Answer 18

Used to treat pernicious anemia and other megaloblastic anemias

Administered orally or parentally.

Usually administered by deep intramuscular injection to treat pernicious anemia

Question 19

Nursing Implications

Answer 19

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.

Question 20

Nursing Implications

Answer 20

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.

Question 21

To avoid esophageal corrosion, patients should ___________________ after taking oral iron doses.

Patients should be encouraged to eat foods high in ___ and ______.

Answer 21

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.

Question 22

For iron dextran, a ______ should be given.

Administer the dose deeply into a large muscle mass, using the _______

Answer 22

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.

Question 23

Determine the cause of anemia before administering

Answer 23

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

Question 24

Monitor therapeutic responses.

Answer 24

Improved nutritional status

Increased weight, activity tolerance, well-being

Absence of fatigue