Anemia Drugs

Question 1

Epoetin Alfa (Epogen)
(Chemical Classification)

Answer 1

Amino Acid Polypeptide

Question 2

Epoetin Alfa (Epogen)
(Mechanism of Action)

Answer 2

Erythropoietin is 1 factor controlling the rate of red cell production; product is developed by recombinant DNA technology

Question 3

Epoetin Alfa (Epogen)
(Uses)

Answer 3

Anemia caused by reduced endogenous erythropoietin production, primarily end-stage renal disease; to correct hemostatic defect in uremia; anemia due to AZT treatment in patients with HIV or those receiving chemotherapy; reduction of allogenic blood transfusion in surgery patients

Question 4

Epoetin Alfa (Epogen)
(Contraindications)

Answer 4

Hypersensitivity to mammalian-cell-derived products, human albumin; uncontrolled hypertension

Question 5

Epoetin Alfa (Epogen)
(Side Effect)

Answer 5

CNS: SEIZURES, coldness, sweating, headache
CV: Hypertension, HYPERTENSIVE ENCEPHALOPATHY, CHF, edema, DVT
INTEG: pruritus, rash, inj site reaction
MISC: iron deficiency
MS: bone pain
RESP: cough

Question 6

Epoetin Alfa (Epogen)
(Nursing Considerations)

Answer 6

ASSESS:

• Renal studies: urinalysis, protein, blood, BUN, creatininel I&O, report drop in output /=20%, ferritin >/=100ng/ml; Hct 2x/wk until stabilized in target range (30%-36%) then at regular intervals; those with endogenous erythropoietin levels of 12g/dl
• BP, check for rising BP as Hct rises, antihypertensives may be needed; hypertension may occur rapidly, leading to hypertensive encephalopathy
• CNS symptoms: coldness, sweating, pain in long bones; for seizures if Hct is increased within 2wk by 4pts
• Hypersensitivity reactions: skin rashes, urticaria (rare), antibody development does not occur
• PURE CELL APLASIA (PRCA) in absence of other causes; evaluate by testing sera for recombinant erythropoetin antibodies; any loss of response to epoetin should be evaluated
• Dialysis patients: thrill, bruit of shunts; monitor for circulation impairment
• SEIZURES: place patient on seizure precautions if increase of >/= 4 points HCT in 2wk, increased BP; more common in chronic renal failure during the first 90 days of treatment

Question 7

Folic Acid

Functional Classification

Answer 7

Vitamin B complex group, water-soluble vitamin

Question 8

Folic Acid 
(Mechanism of Action)

Answer 8

Needed for erythropoiesis; increases RBC, WBC, platelet formation with megaloblastic anemias

Question 9

Folic Acid

Uses

Answer 9

Megaloblastic or macrocytic anemia caused by folic acid deficiency; hepatic disease, alcoholism, hemolysis, intestinal obstruction, pregnancy to reduce risk for neural tube defects

Question 10

Folic Acid

Contraindications

Answer 10

Hypersensitivity

Question 11

Folic Acid

Side Effects

Answer 11

CNS: confusion, depression, excitability, irritability 
GI: anorexia, nausea
INTEG: pruritus, rash, erythema
RESP: BRONCHOSPASM 
SYST: ANAPHYLAXIS (RARE)

Question 12

Folic Acid

Nursing Considerations

Answer 12

ASSESS:

• Megaloblastic anemia: fatigue, dyspnea, weakness
• Hgb, Hct, reticulocyte count
• Nutritional status: bran, yeast, dried beans, nuts, fruits, fresh vegetables, asparagus
• Products currently taken: estrogen carBAMazepine, glucocorticoids, hydantoins; these products may cause increased folic acid use by body and contribute to deficiency if taking other neurotoxic products

Question 13

Epoetin Alfa (Epogen)
(Functional Classification)

Answer 13

Antianemic, biologic modifier, hormone