Anemia Drugs

Question 1

Hematopoiesis

Answer 1

formation of new blood cells (myeloid tissue or bone marrow) - erythrocytes, leukocytes, thrombocytes

Question 2

Anemias concern which cell?

Answer 2

erythrocytes

Question 3

erythropoietin

Answer 3

Erythrocytes formation is driven by erythropoietin (hormone produced by the kidneys)

Question 4

Reticulocytes

Answer 4

immature erythrocytes = take 24-36H to mature

Question 5

Lifespan of erythrocytes

Answer 5

120 days

Question 6

Four types of anemia

Answer 6

RBC Maturation Defect:

1. Cytoplasmic
2. Nuclear

Excessive RBC Destruction (Hemolytic):

3. Intrinsic RBC Abnormalities
4. Extrinsic Mechanisms

Question 7

Cytoplasmic Anemia

Answer 7

◦ Fe deficiency (blood loss, surgery, childbirth, GIB, menstrual blood loss)
◦ Thalassemia (genetic disorder – defective globulin synthesis)
◦ Cell are :
◦ microcytic (small) decreased MCV
◦ hypochromic (pale) decreased MCHC

Question 8

Nuclear Anemia

Answer 8

◦ Defects in DNA or protein synthesis
◦ Deficit in Vitamin B12 and/or Folate (Vitamin B9) (both required for DNA and protein synthesis)
◦ Pernicious Anemia (lack of intrinsic factor in
stomach which inhibits absorption of Vitamin B12)
◦ Megaloblastic Anemia (due to deficient intake of
Vitamin B12 and/or Folate)
◦ Cells are:
◦ Macrocytic (large) increased MCV
◦ Normochromic (normal colour) normal MCHC

Question 9

Intrinsic RBC Abnormalities (Anemia)

Answer 9

◦ Genetic defect
◦ Sickle cell anemia, hereditary spherocytosis
◦ Erythrocytes appear as spherocytes

Question 10

Extrinsic Mechanisms (Anemia)

Answer 10

◦ Drugs induce antibodies that target and destroy RBCs
◦ Septic shock resulting in disseminated intravascular coagulation (DIC)
◦ Mechanical forces of certain medical devices
◦ Erythrocytes appear as spherocytes

Question 11

Anemia of Chronic Disease

Answer 11

◦ Caused by chronic inflammation, autoimmune, infectious or malignant diseases
◦ Primarily immune driven – cytokines cause retention of Fe by macrophages
◦ Underproduction of erythrocytes and mild shortening of lifespan
◦ Erythrocytes are normocytic, normochromic and hypoproliferative
◦ Typically a mild anemia, occasionally severe requiring blood transfusion
◦ Treatment aimed at treating underlying cause
◦ Characterized by increased ferritin, normal folate, and cobalamin

Question 12

Anemia Drugs to know

Answer 12

◦Iron
◦Folate (Vitamin B9)
◦Cyanocobalamin(Vitamin B12)
◦Epoetin Alfa

Question 13

Is iron an essential mineral in the body

Answer 13

yes

Question 14

What is iron used for in the body mainly?

Answer 14

Oxygen carrier in hemoglobin and myoglobin

Question 15

Where is iron stored?

Answer 15

liver, spleen, and bone marrow

Question 16

Deficiency in iron results in what?

Answer 16

anemia

Question 17

Dietary sources of iron

Answer 17

meats, certain vegetables and grains

Question 18

Which foods enhance iron absorption?

Answer 18

Orange juice, Veal, Fish, Ascorbic acid

Question 19

In which form are oral iron preparations available in?

Answer 19

Feeous salts, such as ferrous fumarate (Femiron), ferrous gluconate, ferrous sulphate (FeSO4)

Question 20

Parental iron preparations

Answer 20

◦ iron dextran (Dexiron, Infufer)
◦ iron sucrose (Venofer)
◦ ferric gluconate (Ferrlecit)
◦ ferumoxytol (Feraheme)

Question 21

Iron Classification

Answer 21

Iron

Question 22

Iron Movement

Answer 22

varies depending on particular formulation

Question 23

Iron Action

Answer 23

absorbed in small amount in small intestine; transformed into ferrous form, bound to transporter and moves into bloodstream; Fe is used in bone marrow to make Hgb; excess is stored as ferritin in

Question 24

Iron Nursing Considerations

Answer 24

Most common cause of pediatric poisoning deaths; Contraindications: allergy; hemochromatosis (Fe
overload), hemolytic anemia or other anemia not associated with Fe deficiency; Adverse effects: nausea,
vomiting, diarrhea, constipation, and stomach cramps and pain; black, tarry stools (also a sign of GIB –
educate); Liquid oral preparations temporarily discolor teeth; Injectable forms cause pain upon injection

Question 25

Iron Indication

Answer 25

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 26

Iron administration

Answer 26

PO or IV, doses vary; Some foods enhance iron absorption: Orange juice, Veal, Fish, Ascorbic acid

Question 27

Iron Nursing Implications and assessments

Answer 27

◦ 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. ◦ 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 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 28

Folic Acid (Vitamin B9) Classification

Answer 28

Water-soluble, B-complex vitamin; Essential for erythropoiesis; aka Folate

Question 29

Folic Acid (Vitamin B9) Movement

Answer 29

onset unknown, peak 60-90min, ½ life unknown, duration unknown

Question 30

Folic Acid (Vitamin B9) Action

Answer 30

Essential for erythropoiesis and synthesis of RNA and DNA

Question 31

Folic Acid (Vitamin B9) Nursing Considerations

Answer 31

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 Contraindications – allergy, anemias other than folic acid deficiency; adverse reactions - rare

Question 32

Folic Acid (Vitamin B9) Indications

Answer 32

Folic acid deficiency; Malabsorption syndromes are the most common causes of deficiency; given during pregnancy, to prevent neural tube defects

Question 33

Folic Acid (Vitamin B9) Administration

Answer 33

Administer oral folic acid with food; Folic acid is available for both oral and injectable use

Question 34

Cyanocobalamin(Vitamin B12) Classification

Answer 34

water soluble B complex vitamin that contain cobalt

Question 35

Cyanocobalamin(Vitamin B12) Movement

Answer 35

onset unknown, peak 8-12H, ½ life 6 D, duration unknown

Question 36

Cyanocobalamin(Vitamin B12) Action

Answer 36

required coenzyme for many metabolic pathways – fate and CHO metabolism and protein synthesis

Question 37

Cyanocobalamin(Vitamin B12) Nursing consideration

Answer 37

Contraindications: allergy | adverse effects: only at large doses – itching, diarrhea, fever

Question 38

Cyanocobalamin(Vitamin B12) Indication

Answer 38

Used to treat pernicious anemia and other megaloblastic anemias

Question 39

Cyanocobalamin(Vitamin B12) Administration

Answer 39

Administered orally or parentally; given IM until normal serum levels achieved, then oral route now preferred – given daily once Vitamin B12 levels are normal; maintenance doses: 50-100mcg PO daily, 100 mcg/month IM

Question 40

Epoetin Alpha Classification

Answer 40

epoetin alpha (Eprex); Longer-acting form of epoetin is called darbepoetin (Aranesp)

Question 41

Epoetin Alpha Movement

Answer 41

onset 7-10d peak 5-24H, ½ life 4-13H, duration variable (Eprex

Question 42

Epoetin Alpha Action

Answer 42

biosynthetic erythropoietin - stimulates synthesis of erythrocytes

Question 43

Epoetin Alpha Nursing Considerations

Answer 43

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; Adverse Effects: hypertension, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction

Question 44

Epoetin Alpha Indication

Answer 44

treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and anemia associated with zidovudine therapy

Question 45

Epoetin Alpha Administration

Answer 45

SC or IV; performance enhancing drug - ‘doping’