Anemia meds

Question 1

What types of medications can we use for Anemia treatment?

Answer 1

Erythropoiesis Stimulating Agents and Vitamins and Minerals

Question 2

What med is an erythropoiesis stimulating agent?

Answer 2

Epoetin alfa (Epogen and Procrit)

Question 3

What Vitamins and Minerals do we use for anemia?

Answer 3

Iron (Ferrous sulfate), Vitamin B12, and Folic Acid

Question 4

MOA of epoetin alfa

Answer 4

Mimics the human erythropoietin to stimulate RBC production

Question 5

Epoetin is approved to maintain RBC for who?

Answer 5

Chronic kidney failure pt, HIV infections on drug therapy, Anemia second to chemotherapy in certain cancers, and pre-operative patients with anemia

Question 6

Where does RBC production occur?

Answer 6

Red bone marrow - common in iliac crest

Question 7

At what point of production does Epoetin alfa affect?

Answer 7

Colony-forming unit-erythroid cells and Proerythroblasts

Question 8

Formation of a RBC

Answer 8

Pluripotent stem cell –> BFU-E –> CFU-E –> Proerythroblasts –> Erythroblasts –> Reticulocytes –> RBC

Question 9

Problems with Epoetin alfa

Answer 9

Chronic kidney disease - increased mortality and serious cardiovascular events
Cancer - increased mortality and tumor progression
Surgery Patients - increased thromboembolic events and mortality.

Question 10

When do you stop epoetin alfa or not start?

Answer 10

If Hgb is greater than 10

Question 11

Nursing implications for epoetin alfa

Answer 11

Monitor BP before and during therapy, monitor Hgb levels - stop if above 10

Question 12

Dietary iron

Answer 12

Found in two forms - heme and non-heme iron

Question 13

Heme-iron

Answer 13

Found in meat, poultry and fish. Where we get about 40% of our iron

Question 14

Non-heme iron

Answer 14

Animal tissue, fruits, vegetables, grains, nuts
Not absorbed as well as heme-iron

Question 15

Iron rich vegetables

Answer 15

Collard greens, bok choy, tomatoes, green beans, brussels sprouts, broccoli, kale, and spinach

Question 16

Iron Therapy med

Answer 16

Ferrous sulfat

Question 17

Ferrous Sulfate MOA

Answer 17

Taken up by bone marrow cells to make Hgb

Question 18

AE of ferrous sulfate

Answer 18

GI disturbances, teeth staining with liquid form, tarry stools

Question 19

Dosage issues of iron therapy

Answer 19

Ferrous sulfate only contains 20% elemental iron by weight (elemental is 100% absorbed)

Question 20

Interactions with iron therapy

Answer 20

Antacids reduce absorption, food helps to prevent GI SE but it also decreases absorption by 50-70%

Question 21

Signs of toxicity with iron therapy

Answer 21

Stomach pain, N/V/D

Question 22

Parenteral Iron Therapy med

Answer 22

Iron Dextran

Question 23

Indication for Iron Dextran

Answer 23

Clear diagnosis of iron deficiency, oral iron is intolerable or ineffective

Question 24

AE of iron dextran

Answer 24

potentially fatal anaphylaxis

Question 25

Safety implications for iron dextran (parenteral iron)

Answer 25

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

Question 26

Disadvantages of Iron Dextran IM

Answer 26

Persistent pain, discoloration, tumors, risk of anaphylaxis

Question 27

Why is it important to use the Z track method with Iron Dextran?

Answer 27

To reduce the discoloration. Iron can leak from the muscle into the tissue and cause discoloration.

Question 28

Vitamin B12 med

Answer 28

Cyanocobalamin

Question 29

Route for B12

Answer 29

Oral

Question 30

AE of B12 (Cyanocobalamin)

Answer 30

Hypokalemia

Question 31

Why are we cautious when we use B12 and folic acid together?

Answer 31

Folic acid corrects the anemia through stimulating RBC production, but can mask the B12 deficiency

Question 32

Folic Acid MOA

Answer 32

Converts the active form of folic acid after administration

Question 33

Indications for Folic Acid

Answer 33

Treatment of folic acid deficiency anemia, prophylaxis of folate deficiency, initial treatment of severe anemia from B12 deficiency

Question 34

AE of folic acid

Answer 34

none