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NURS 2266 > chapter 55 anemia drugs - week 3 > Flashcards

chapter 55 anemia drugs - week 3 Flashcards

1
Q

hematopoiesis

A

Formation of new blood cells
Red blood cells (RBCs)
White blood cells (WBCs)
Platelets

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2
Q

rbcs

A
  • Manufactured in bone marrow
  • Immature RBCs are reticulocytes.
  • Lifespan is 120 days.
    More than one third of an RBC is made of hemoglobin.
    Heme: red pigment; contains iron
    Globin: protein chain
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3
Q

anemias

A

Maturation defects
* Cytoplasmic
* Nuclear
* Excessive destruction of RBCs (hemolytic anemias)
* Intrinsic RBC abnormalities
* Extrinsic mechanisms

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4
Q

erythropoiesis stimulating agents

A

epoetin alfa (Eprex®)
* Biosynthetic form of the natural hormone erythropoietin
* Used for treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and anemia associated with zidovudine therapy
* Medication is ineffective without adequate body iron stores and bone marrow function.
* Most patients receiving epoetin alfa need to also receive an oral iron preparation.
* Longer-acting form of epoetin is called darbepoetin (Aranesp®)
* Contraindications: drug allergy; uncontrolled hypertension; hemoglobin levels that are above 100 mmol/L for cancer patients and 130 mmol/L for patients with kidney disease; head and neck cancers; risk of thrombosis
* Most frequent adverse effects: hypertension, fever, headache, pruritus, rash, nausea, vomiting, arthralgia, and injection site reaction

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5
Q

iron

A
  • Essential mineral in the body
  • Oxygen carrier in hemoglobin and myoglobin
  • Stored in the liver, spleen, and bone marrow
  • Deficiency results in anemia
  • Dietary sources: meats, certain vegetables and grains
  • Dietary iron must be converted by gastric juices before it can be absorbed.
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6
Q

foods that enchance iron absorption

A
  • Orange juice
  • Veal
  • Fish
  • Ascorbic acid
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7
Q

some food impair iron absorption

A
  • Eggs
  • Corn
  • Beans
  • Cereal products containing phytates
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8
Q

supplemental irons

A
  • Supplemental iron may be given as a single drug or as part of a multivitamin preparation.
  • Oral iron preparations are available as ferrous salts.
  • ferrous fumarate (Femiron®), ferrous gluconate, ferrous sulphate (FeSO4)
    Parenteral
  • iron dextran (Dexiron®, Infufer®)
  • iron sucrose (Venofer®)
  • ferric gluconate (Ferrlecit®)
  • ferumoxytol (Feraheme®)
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9
Q

iron indications

A
  • Prevention and treatment of iron deficiency syndromes
  • Administration of iron alleviates the symptoms of iron deficiency anemia, but the underlying cause of the anemia should be corrected.
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10
Q

iron adverse effects

A
  • Most common cause of pediatric poisoning deaths
  • Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain
  • Causes black, tarry stools
  • Liquid oral preparations temporarily discolour teeth.
  • Injectable forms cause pain upon injection.
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11
Q

iron toxicity

A
  • Symptomatic and supportive measures
  • Suction and maintenance of the airway; correction of acidosis; control of shock and dehydration with IV fluids or blood, oxygen, and vasopressors
  • In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, chelation therapy with deferoxamine mesylate is initiated.
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12
Q

prenatal iron

A

Iron dextran (Dexiron, Infufer)
* May cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis
* A test dose of 25 mg of iron dextran is administered before injection of the full dose, and then the remainder of dose is given after 1 hour.
* Used less frequently now; replaced by newer products ferric gluconate and iron sucrose

ferric gluconate (Ferrlecit)
* Indicated for repletion of total body iron content in patients with iron deficiency anemia who are undergoing hemodialysis
* Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required.
* Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching.

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13
Q

folic acid

A
  • Water-soluble, B-complex vitamin
  • Essential for erythropoiesis
  • Primary uses
  • Folic acid deficiency
  • During pregnancy, to prevent neural tube defects
  • Malabsorption syndromes are the most common causes of deficiency
  • Should not be used until actual cause of anemia is determined
  • May mask symptoms of pernicious anemia, which requires treatment other than folic acid
  • Untreated pernicious anemia progresses to neurological damage.
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14
Q

cyanocobalamin (vitamin B12)

A
  • Used to treat pernicious anemia and other megaloblastic anemias
  • Administered orally or parentally.
  • Usually administered by deep intramuscular injection to treat pernicious anemia
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15
Q

nursing assessment

A
  • Assess patient history and medication history, including drug allergies.
  • Assess potential contraindications.
  • Assess baseline laboratory values, especially hemoglobin, hematocrit, reticulocytes, and others.
  • Obtain nutritional assessment.
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16
Q

ferrous salts considerations

A
  • Ferrous salts are contraindicated for patients with ulcerative colitis, peptic ulcer disease, liver disease, and other gastrointestinal disorders.
  • Keep away from children, because oral forms may look like candy.
  • Iron dextran is contraindicated in all anemias except for iron-deficiency anemia.
17
Q

liquid irons considerations

A
  • For liquid iron preparations, follow the manufacturer’s guidelines on dilution and administration.
  • Instruct the patient to take liquid iron preparations through a straw to avoid staining tooth enamel.
18
Q

oral forms of iron nursing considerations

A
  • Oral forms of iron should be taken between meals for maximum absorption but may be taken with meals if gastrointestinal distress occurs.
  • Oral forms should be given with juice but not with milk or antacids.
  • avoid esophageal corrosion, patients should remain upright for up to 30 minutes after taking oral iron doses.
  • Patients should be encouraged to eat foods high in iron and folic acid.
19
Q

iron dextran nursing considerations

A
  • For iron dextran, a small test dose should be given, If there is no reaction after 1 hour, the remainder of the dose can be given.
  • Administer the dose deeply into a large muscle mass, using the Z-track method.Give IV doses of iron dextran carefully and according to the manufacturer’s instructions.
  • Have resuscitative equipment available in case of an anaphylactic reaction.
20
Q

folic acid nursing considerations

A
  • Determine the cause of anemia before administering folic acid.
  • Administer oral folic acid with food.
  • Folic acid is available for both oral and injectable use
21
Q

other nursing considerations

A
  • Monitor therapeutic responses.
  • Improved nutritional status
  • Increased weight, activity tolerance, well-being
  • Absence of fatigue
  • Monitor adverse effects.v

NURS 2266 (12 decks)

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