Anemia mod 1

Question 1

Pharmacotherapy of Anemia

Answer 1

Erythropoiesis Stimulating Agents
- epoetin alfa (Epogen, Procrit)

Vitamins and minerals

• Iron (ferrous sulfate)
• Vitamin B12
• Folic acid

Question 2

Erythropoiesis Stimulating Agent

epoetin alfa (Epogen, Procrit)

Answer 2

MOA: Mimics human erythropoietin

FDA-approved to maintain RBC counts in patients with:
Chronic kidney failure
HIV infection on drug therapy
Anemia 2° chemotherapy in certain cancers
Pre-operative in patients with anemia

Drug delivery: Sub Q

Question 3

SE erythropoiesis-stimulating agents

Answer 3

Chronic kidney disease:
Increased mortality and serious cardiovascular events
Cancer:
Increased mortality and tumor progression
Surgery patients:
Increased thromboembolic events and mortality

FDA Recommendations:
Weigh the risks versus benefits
Do not initiate therapy if Hgb ≥10
Use the lowest dose possible to reduce the need for transfusion
Other nursing implications
Monitor BP before and during therapy
Monitor Hgb levels

Question 4

iron therapy

Ferrous Sulfate

Answer 4

Indications
- Iron deficiency / Prevention

MOA
- Taken up by bone marrow cells to make hemoglobin

Adverse effects

• GI disturbances
• Teeth staining
• Tarry Stools

dosing issues - contains only 20% iron

interactions

• Antacids reduce absorption
• Food helps prevent GI side effects
• Food decreases absorption by 50-70%

toxicity

• Risk of overdose
• Stomach pain, N & V, diarrhea

Question 5

Parenteral Iron (IM or IV)

Iron Dextran (DexFerrum)

Answer 5

Indication:

• Clear diagnosis of iron deficiency
• Oral iron is intolerable or ineffective

Adverse effects:
***Black box warning: Potentially fatal anaphylaxis

Safety implications:

• Only use when absolutely necessary
• Epinephrine and CPR equipment
• Small “test” dose before each full dose

Disadvantages of IM:

• Persistent pain
• Discoloration
• Tumors
• Risk of anaphylaxis

Question 6

vitamin B-12

Cyanocobalamin

Answer 6

Indication for therapy:
- B12 deficiency

Preferred route: Oral

Adverse effects:
- Hypokalemia

Use caution with folic acid. Why?
- folic acid can mask B-12 deficiency

Question 7

folic acid

Answer 7

MOA: Converts to the active form of folic acid after administration

Indications:
Treatment of folic acid deficiency anemia
Prophylaxis of folate deficiency
Initial treatment of severe anemia from vitamin B12 deficiency

Adverse effects: None

Warning: Remember it can mask B12 deficiency!