Anemia meds Flashcards
What types of medications can we use for Anemia treatment?
Erythropoiesis Stimulating Agents and Vitamins and Minerals
What med is an erythropoiesis stimulating agent?
Epoetin alfa (Epogen and Procrit)
What Vitamins and Minerals do we use for anemia?
Iron (Ferrous sulfate), Vitamin B12, and Folic Acid
MOA of epoetin alfa
Mimics the human erythropoietin to stimulate RBC production
Epoetin is approved to maintain RBC for who?
Chronic kidney failure pt, HIV infections on drug therapy, Anemia second to chemotherapy in certain cancers, and pre-operative patients with anemia
Where does RBC production occur?
Red bone marrow - common in iliac crest
At what point of production does Epoetin alfa affect?
Colony-forming unit-erythroid cells and Proerythroblasts
Formation of a RBC
Pluripotent stem cell –> BFU-E –> CFU-E –> Proerythroblasts –> Erythroblasts –> Reticulocytes –> RBC
Problems with Epoetin alfa
Chronic kidney disease - increased mortality and serious cardiovascular events
Cancer - increased mortality and tumor progression
Surgery Patients - increased thromboembolic events and mortality.
When do you stop epoetin alfa or not start?
If Hgb is greater than 10
Nursing implications for epoetin alfa
Monitor BP before and during therapy, monitor Hgb levels - stop if above 10
Dietary iron
Found in two forms - heme and non-heme iron
Heme-iron
Found in meat, poultry and fish. Where we get about 40% of our iron
Non-heme iron
Animal tissue, fruits, vegetables, grains, nuts
Not absorbed as well as heme-iron
Iron rich vegetables
Collard greens, bok choy, tomatoes, green beans, brussels sprouts, broccoli, kale, and spinach
Iron Therapy med
Ferrous sulfat
Ferrous Sulfate MOA
Taken up by bone marrow cells to make Hgb
AE of ferrous sulfate
GI disturbances, teeth staining with liquid form, tarry stools
Dosage issues of iron therapy
Ferrous sulfate only contains 20% elemental iron by weight (elemental is 100% absorbed)
Interactions with iron therapy
Antacids reduce absorption, food helps to prevent GI SE but it also decreases absorption by 50-70%
Signs of toxicity with iron therapy
Stomach pain, N/V/D
Parenteral Iron Therapy med
Iron Dextran
Indication for Iron Dextran
Clear diagnosis of iron deficiency, oral iron is intolerable or ineffective
AE of iron dextran
potentially fatal anaphylaxis
Safety implications for iron dextran (parenteral iron)
Only use when you absolutely have to, keep epinephrine and CPR equipment available, do a small test dose and monitor for five minutes before full administration, monitor for 15 minutes after administration
Disadvantages of Iron Dextran IM
Persistent pain, discoloration, tumors, risk of anaphylaxis
Why is it important to use the Z track method with Iron Dextran?
To reduce the discoloration. Iron can leak from the muscle into the tissue and cause discoloration.
Vitamin B12 med
Cyanocobalamin
Route for B12
Oral
AE of B12 (Cyanocobalamin)
Hypokalemia
Why are we cautious when we use B12 and folic acid together?
Folic acid corrects the anemia through stimulating RBC production, but can mask the B12 deficiency
Folic Acid MOA
Converts the active form of folic acid after administration
Indications for Folic Acid
Treatment of folic acid deficiency anemia, prophylaxis of folate deficiency, initial treatment of severe anemia from B12 deficiency
AE of folic acid
none
