Anemia Pharm Flashcards
2 classes for Anemia treatment
erythropoiesis stimulating agents
vitamins and minerals
erythropoiesis stimulating agent prototype drug
epoetin alfa (Epogen, Procrit)
MOA of epoetin alfa (Epogen, Procrit)
Mimics human erythropoietin
epoetin alfa is 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
route of epoetin alfa
sub-Q
What needs to be weighed with epoetin alfa
RISKS vs BENEFITS
What is increased in chronic kidney disease with epoetin alfa
Increased mortality and serious cardiovascular events
What is increased in cancer with epoetin alfa
Increased mortality and tumor progression
what is increased in surgery patients with epoetin alfa
Increased thromboembolic events and mortality
When do we not initiate epoetin alfa therapy
Hgb >= 10
dosing of epoetin alfa
lowest dose possible to reduce the need for transfusion
2 nursing implications for epoetin alfa
Monitor BP before and during therapy
Monitor Hgb levels
Where is Dietary Iron found
collard greens choy tomatoes green beans brussel sprouts broccoli kale spinach
2 forms of dietary iron
heme
non heme
heme iron
40 percent of the iron in meat, poultry, and fish
Well absorbed
non heme iron
Non-heme iron
60 percent of iron in animal tissue
All the iron in plants (fruits, vegetables, grains, nuts)
Less well absorbed
Iron therapy prototype drug
Ferrous Sulfate
indications for ferrous sulfate
Iron deficiency / Prevention
MOA for Ferrous Sulfate
Taken up by bone marrow cells to make hemoglobin
A/E of Ferrous Sulfate
GI disturbances
Teeth staining
Tarry Stools
dosage issues for iron therapy
Ferrous sulfate only contains 20% elemental iron by weight
Elemental iron - available for absorption
Interactions for Iron Therapy
Antacids reduce absorption
Food helps prevent GI side effects
Food decreases absorption by 50-70%
Toxicity of Iron Therapy
Risk of overdose
Stomach pain, N & V, diarrhea
Parenteral Iron (IM/IV) prototype drug
Iron Dextran (DexFerrum)
Indication of Iron Dextran
Clear diagnosis of iron deficiency
Oral iron is intolerable or ineffective
black box warning of Iron Dextran
potentially fatal anaphylaxis
Safety implications of Iron Dextran
Only use when absolutely necessary
Epinephrine and CPR equipment
Small “test” dose before each full dose
Disadvantages of Iron Dextran (IM)
Persistent pain
Discoloration
Tumors
Risk of anaphylaxis
Vitamin B12 prototype
Cyanocobalamin
Indication for B12 therapy
B12 deficiency
route of Vitamin B12
Oral
Adverse effects of vitamin b12
hypokalemia
MOA of folic Acid
Converts to the active form of folic acid after administration
Indications of Folic Acid
Treatment of folic acid deficiency anemia
Prophylaxis of folate deficiency
Initial treatment of severe anemia from vitamin B12 deficiency
Adverse effects of folic acid
none
Folic acid can do what to b12
mask deficiency
vitamins and minerals for anemia
Iron (ferrous sulfate)
Vitamin B12
Folic acid
