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Pathophysiology and Pharmacology > Anemia Drugs > Flashcards

Anemia Drugs Flashcards

1
Q

Hematopoiesis

A

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

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2
Q

Anemias concern which cell?

A

erythrocytes

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3
Q

erythropoietin

A

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

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4
Q

Reticulocytes

A

immature erythrocytes = take 24-36H to mature

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5
Q

Lifespan of erythrocytes

A

120 days

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6
Q

Four types of anemia

A

RBC Maturation Defect:

  1. Cytoplasmic
  2. Nuclear

Excessive RBC Destruction (Hemolytic):

  1. Intrinsic RBC Abnormalities
  2. Extrinsic Mechanisms
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7
Q

Cytoplasmic Anemia

A

◦ 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

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8
Q

Nuclear Anemia

A

◦ 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

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9
Q

Intrinsic RBC Abnormalities (Anemia)

A

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

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10
Q

Extrinsic Mechanisms (Anemia)

A

◦ 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

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11
Q

Anemia of Chronic Disease

A

◦ 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

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12
Q

Anemia Drugs to know

A

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

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13
Q

Is iron an essential mineral in the body

A

yes

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14
Q

What is iron used for in the body mainly?

A

Oxygen carrier in hemoglobin and myoglobin

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15
Q

Where is iron stored?

A

liver, spleen, and bone marrow

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16
Q

Deficiency in iron results in what?

A

anemia

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17
Q

Dietary sources of iron

A

meats, certain vegetables and grains

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18
Q

Which foods enhance iron absorption?

A

Orange juice, Veal, Fish, Ascorbic acid

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19
Q

In which form are oral iron preparations available in?

A

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

20
Q

Parental iron preparations

A

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

21
Q

Iron Classification

A

Iron

22
Q

Iron Movement

A

varies depending on particular formulation

23
Q

Iron Action

A

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

24
Q

Iron Nursing Considerations

A

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

25
Q

Iron Indication

A

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.

26
Q

Iron administration

A

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

27
Q

Iron Nursing Implications and assessments

A

◦ 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.

28
Q

Folic Acid (Vitamin B9) Classification

A

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

29
Q

Folic Acid (Vitamin B9) Movement

A

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

30
Q

Folic Acid (Vitamin B9) Action

A

Essential for erythropoiesis and synthesis of RNA and DNA

31
Q

Folic Acid (Vitamin B9) Nursing Considerations

A

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

32
Q

Folic Acid (Vitamin B9) Indications

A

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

33
Q

Folic Acid (Vitamin B9) Administration

A

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

34
Q

Cyanocobalamin(Vitamin B12) Classification

A

water soluble B complex vitamin that contain cobalt

35
Q

Cyanocobalamin(Vitamin B12) Movement

A

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

36
Q

Cyanocobalamin(Vitamin B12) Action

A

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

37
Q

Cyanocobalamin(Vitamin B12) Nursing consideration

A

Contraindications: allergy

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

38
Q

Cyanocobalamin(Vitamin B12) Indication

A

Used to treat pernicious anemia and other megaloblastic anemias

39
Q

Cyanocobalamin(Vitamin B12) Administration

A

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

40
Q

Epoetin Alpha Classification

A

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

41
Q

Epoetin Alpha Movement

A

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

42
Q

Epoetin Alpha Action

A

biosynthetic erythropoietin - stimulates synthesis of erythrocytes

43
Q

Epoetin Alpha Nursing Considerations

A

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

44
Q

Epoetin Alpha Indication

A

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

45
Q

Epoetin Alpha Administration

A

SC or IV; performance enhancing drug - ‘doping’

Pathophysiology and Pharmacology (17 decks)

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