Anemia Pharm

Question 1

treatment of iron deficiency anemia

Answer 1

-ferrous sulfate (oral)
-iron dextran (parenteral)

Question 2

ferrous sulfate and iron dextran indications

Answer 2

-treat and prevent iron deficiency anemia
-treat blood loss

Question 3

ferrous sulfate and iron dextran interactions

Answer 3

-decrease absorption with antacids
-increased absorption with vitamin C

Question 4

ferrous sulfate and iron dextran adverse effects

Answer 4

-GI- nausea, heartburn, constipation
-metallic taste
-staining of teeth (oral)
-fatal iron toxicity (OD in children causing liver failure)
-leading cause of poisoning death in children

Question 5

chelating agent

Answer 5

deferoxamine/desferal: drug given to treat iron toxicity

Question 6

administration of oral iron

Answer 6

-best absorbed on empty stomach
-taking with food however decreases the gastric irritation many people have with oral iron
-do not give with antacids or calcium
-do not crush or chew
-liquid form: give with a straw and diluted in OJ to increase absorption

Question 7

parenteral iron administration

Answer 7

-give test dose
-black box warning: have epi available for possible allergic reaction
-IM form- use 1.5 inch needle with z-track method to prevent skin staining

Question 8

treatment of B12 deficiency

Answer 8

-injections of cyanocobalamin
-diet: meat, salmon and cod, milk and other dairy products, eggs

Question 9

treatment of folate deficiency

Answer 9

-diet: increase consumption of leafy greens, legumes and organ meats
-multivitamin
-OTC folic acid supplements

Question 10

cyanocobalamin indications

Answer 10

-low B12 levels- pernicious anemia; bariatric patients need 1 mg B12 daily indefinitely; surgeries where all parts of the stomach are removed

Question 11

cyanocobalamin

Answer 11

-diet: increase meat, fish, eggs, milk
-oral- 1-2 mg daily
-injectable: IM weekly until levels are near normal, then monthly
-tolerated well- may have redness or pain at injection site

Question 12

folic acid supplement indications

Answer 12

to treat folic acid deficiency anemia, in pregnant women to prevent neural tube defects
-diet: increase fortified grains, fresh fruits and veggies

Question 13

erythropoiesis stimulating agent

Answer 13

epoetin alfa

Question 14

epoetin alfa MOA

Answer 14

stimulates erythropoiesis; increases hgb and reticulocyte counts: only indicated when hgb is less than 10 g/dL UNLESS on dialysis

Question 15

epoetin alfa route

Answer 15

IV and Subq

Question 16

erythropoietin stimulating agents indication

Answer 16

treatment of anemia due to CKD, HIV patient on the drug zidovudine, people on chemo, autoimmune hemolytic anemia

Question 17

erythropoietin stimulating agents monitoring

Answer 17

-blood tests weekly to monitor hgb with goal of less than 11 g/dL to decrease risk for clotting
-evaluate iron status before and during treatment-usually need iron supplementation

Question 18

erythropoietin stimulating agents side effects

Answer 18

-HTN and serious CV events
-progression of certain cancers
-injection site problems, bone pain, headache

Question 19

erythropoietin stimulating agents Nursing Implications

Answer 19

-do not give epogen that has been shaken or frozen
-protect from light
-do not dilute or mix with other drugs
-epogen is contraindicated in patients with uncontrolled HTN
-levels of Hgb typically begins to rise in about 2 weeks
-black box warning: in controlled trials patients experienced greater risks for death, serious adverse CV reactions, and stroke when administered ESAs to a target hemoglobin >11 g/dL