Drugs Affecting the Vascular System and Blood Flashcards
HMG-CoA reductase inhibitors (statins) - inhibit cholesterol synthesis in the liver
Prototype: - Antilipemic drug classifications
Bile acid sequestrants
Cholesterol absorption inhibitors
Fibrates
Vitamin B
Omega-3 fatty acids
Others to help lower cholesterol; sometimes on multiple drugs - Antilipemic drug classifications
Blocks HMG-CoA (enzyme helps facilitate synthesis of cholesterol) reductase from completing synthesis of cholesterol in the liver - effective way reduce cholesterol levels in pats with hyperlipidemia; block production of cholesterol
MoA: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)
At HS (highest rates cholesterol synthesis at HS) - most effective
Admin: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)
renal impairment, liver disease - works directly in liver so more dangerous affect to those who have underlying liver disease so if have impairment needs be cautious, heavy alcohol use, pregnancy category X - need lot cholesterol/essential for adequate fetal development
Caution: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)
GI effects (cramping, diarrhea, constipation), potential for liver damage (LFTs done periodically; q1yr), myalgias (muscle pain - mild (not notice them) to severe: severe = concerned; ask about muscle pains; in multiple areas of the body; present is sign statins causing muscle breakdown and release myoglobin and puts risk for developing rhabdomyolysis - prob is myoglobin put in bloodstream and sent to kidneys and really toxic to kidneys and put into AKI; must report immediately anything above mild); Toxic: rhabdomyolysis with AKI; lot have no issues
AE: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)
monitor liver and kidney function (toxicity) - LFTs and kidney func periodically to make sure not damaging liver, risk for AKI; teach to report myalgias for further assessment, no grapefruit juice (interacts where statins not metabolized - increases levels in blood - higher risk for rhabdomyolysis), lifestyle modification for high cholesterol
Nursing: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)
Block platelet plug; affect where form platelet plug; inhibit platelets from sticking together - harder to form plug
More preventative measures - mild drugs that affect coag
Antiplatelet agents
Block products of clotting cascade
More potent drugs; used for variety conditions; used for treatment blood clots
Anticoag
Inhibit platelet aggregation (COX inhibitor)
MoA: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)
Prevention of MI, TIA, ischemic CVA in high-risk populations (primary or secondary prevention); most pats taking aspirin to prevent or at high risk of CV events
Indication: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)
81-325 mg PO daily (81 mg is a “baby aspirin”)
Dose: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)
GI irritation (N/V, epigastric pain); bleeding - GI bleeding, hematuria, easy bruising; tinnitus (with toxicity)
AE: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)
take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)
Nursing: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)
Inhibit platelet aggregation (alters signaling to platelets that crucial aiding in wanting to stick together)
MoA: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)
prevent blood clot w/hx of MI, ischemic stroke, or PAD - prevent another CV event and prevent arterial blood clot for PAD pats; prevent blood clot with cardiac stent or bypass graft - prevent platelets sticking together to stent/graft - not long-term use, used until tissue grown over stent put in to decrease risk of clot
Indications: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)
Bleeding - major AE - not forming platelet plug means easier bleeding - can be fatal, flulike syndrome, dizziness, easy bruising, rash, pruritus
AE: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)
hold 5 days prior to procedure - higher risk for more bleeding, bleeding precautions - soft bristel toothbrush used, electric razor, avoid injury/trauma
Nursing: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)
Indication for medication (usually prevention blood clots associated with CV events, stent placement, PAD)
Clinical manifestations of bleeding/easy bruising notice with pats
Assessment:- Nursing considerations/antiplatelet agents
Bleeding precautions
Avoid injury and falls
Hold prior to procedure/surgery
Educate patient on medication - imp; need understand sig of taking it
Interventions:- Nursing considerations/antiplatelet agents
Disrupt clotting cascade making it difficult for blood to clot; inhibits clotting cascade; harder for blood to clot
Already have clot: used so blood clot not further extended, clot not move to other areas of body, body can take care of clot on its own; DOES NOT BREAK UP A CLOT
Anticoags:
Complication: ischemic stroke (embolus)
Treatment goals for disorder: prevent blood clot in atria
clots can form in atria because dysonchrous sequencing of squeeze so high risk for strokes
Drug therapy: warfarin, rivaroxaban
Chronic atrial fibrillation - Common Clotting disorders/comps/treatment goals
Complication: tissue hypoxia/death
Treatment goals for disorder: clot lysis; restore perfusion
Drug therapy: alteplase - thrombolytic - restores perfusion quickly
Ischemic stroke - Common Clotting disorders/comps/treatment goals
Complication: PE
Treatment goals for disorder: slow clot growth; inhibit propagation; inhibit new clots
fine if stays where is; prob if moves
Drug therapy: SQ heparin/enoxaparin, warfarin, rivaroxaban - anticoag; lot options for drugs
Deep vein thrombosis (DVT) - Common Clotting disorders/comps/treatment goals
Complication: tissue hypoxia/death
Treatment goals for disorder: slow clot growth; inhibit new glots; clot lysis; surgical
Serious condition
Drug therapy: IV heparin drip, alteplase - treatment variable
Pulmonary embolism (PE) - Common Clotting disorders/comps/treatment goals
Measure diff parts of clotting cascade
Ref range: 11-12.5 sec
Significance of pharmacology: prolonged: warfarin therapy
For warfarin
Time takes for blood to clot
Prothrombin time (PT) - Diagnostics lab: clotting time
Measure diff parts of clotting cascade
Ref range: 0.7-1.8
Significance of pharmacology: standard measure for PT; measurement for adjusting warfarin therapy
Therapeutic goal: 2.0-3.0
For warfarin
adjust warfarin dosing; standarized; therapeutic goal - harder for body form blood clot so want prolonged bleeding time; if under goal - means not have prolonged bleeding time
Time takes for blood to clot
International normalized ratio (INR) - Diagnostics lab: clotting time
Measure diff parts of clotting cascade
Ref range: 21-35 sec
Significance of pharmacology: prolonged: heparin therapy; measurement for adjusting heparin therapy
Therapeutic goal: 45-70 sec
Time takes for blood to clot
Activated partial thromboplastin time (aPTT) - Diagnostics lab: clotting time
All anticoagulants have adverse effect of bleeding (non-fatal and fatal)
Reduce risk for injury and falls when given these drugs - fall because if hits their head; worry about a brain bleed
Implement bleeding precautions
Contraindications:
Drug-drug:
anticoags/thrombolytics: gen nursing considerations
Primary AE of drug - extension of MoA; high alert drugs due to bleeding; need give right doses to pats
Non-fatal: Hematuria, epistaxis, bruising
Fatal: Hemorrhagic stroke (bleeding in brain), internal bleeding, GI bleeding (older adult high risk)
All anticoagulants have adverse effect of bleeding (non-fatal and fatal)
Pregnancy (except heparin/enoxaparin - molecules to large to pass through fetal/placental barrier so those are drugs of choice), hx bleeding disorders - exacerbates prob, hx of bleed/bleeding disorders - exacerbates prob, thrombocytopenia (low platelets - bleed easier)
Contraindications:
antiplatelet agents (increase risk for bleeding because inhibit ability clot through diff pathways), NSAIDs (risk for bleeding, esp GI bleeding), herbals (all increase bleeding when taken together)
Drug-drug:
Disrupts clotting cascade; prolongs bleeding time
MoA: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
Prevent or treat DVT (SQ - 3 injections); treat PE (IV drip)
Indications: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
Pork allergy; Pork abstention religion (Judaism, Muslim) - heparin and enoxaparin (LMWH) derived from pigs
Contraindication: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
Bleeding, heparin-induced thrombocytopenia (HIT - platelet counts lowered because heparin therapy), bruising at injection site (SQ)
AE: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
Rotate/monitor injection sites for SQ (do not admin IM - absorb quicker and higher risk for suffering more AE), monitor platelet count; monitor aPTT (therapeutic 45-70 sec)
Nursing: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
protamine sulfate (heparin short half-life, stop infusion; reverse heparin; most OD on heparin on drip - usually just stop drip and short half-life get out body within hours so usually no need for reversal agent)
Reversal agent: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin
Disrupts clotting cascade; prolongs bleeding time; molecule smaller than helparin and longer action time; adv: admin less often - just two injections
MoA: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
prevention or treatment of DVT
Indications: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
Pork allergy; Pork abstention religion (Judaism, Muslim)
Contraindication: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
bleeding; bruising at injection site
AE: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
Adm. deep SQ; do not aspirate or massage site; do not remove air bubble from prefilled syringe - seals medication in; rotate/monitor injection sites; monitoring of clotting time not necessary; not need monitor labs - affects clotting cascade in diff area; weight based doses; not admin with heparin
Nursing: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
protamine sulfate
Reversal agent: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)
GI effects (n/v since PO), bleeding
AE: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
antibiotics (monitor INR during therapy - causes prolonged bleeding time, more warfarin stays in bloodstream then need so higher risk for bleeding; draw this to monitor to make sure not too prolonged and not at risk for bleed), amiodarone (increased risk of bleeding), herbals (increased risk of bleeding)
Drug-drug: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
Monitor PT/INR (therapeutic goal INR 2.0-3.0); see special considerations; first oral anticoagulant drug on market; time onset delayed; not admin with rivaroxaban; will bridge with enoxarpin as tyring to get to therapeutic level
Nursing: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
vitamin K - liver K to work with and produces clotting factors - supercede action warfarin and allow blood clot faster and reverse action warfarin because too high
Reversal agent: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
Interfere with hepatic synthesis of vitamin K-dependent clotting factors - liver synthesizes lot clotting factors and this interferes ones that are vit-K dependent; prolongs bleeding time; more for maintenance
MoA: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
Chronic a-fib (most often used); artificial heart valves; prevent/treat DVT, PE - outpat option
Indications: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)
Daily (usually in the evening or HS)
If INR is greater than 3.0: HOLD med and call prescribing provider - pat at risk for bleeding
Expect an order for Vitamin K if INR is greater than 4.0 (PO or SQ) - prescribed dependent on how high INR
Dosing: - Warfarin special considerations
Dose change = next lab draw in 3 days - warfarin onset time is delayed; 36+ hours for changes to coag to take effect; dangerous if not check it again
Long term monitoring (INR stable) = INR drawn weekly or monthly
Lab draws: - Warfarin special considerations
Teach patient to maintain consistent intake (avoid) vitamin K-containing foods (high intake may decrease warfarin effect) - since inhibiting vitamin K clotting factors; impacts INR so dose on intake taking
Diet: - Warfarin special considerations
Kale
Collard greens
Spinach
Brussel sprouts
Broccoli
Asparagus
Sauerkraut
Soybeans
Edamame
Foods high in Vit K - GREEN
St. John’s Wart
Garlic
Gingko
Ginger root
Chamomile
Herbals to avoid with Warfarin
Disrupt clotting cascade; prolongs bleeding time
MoA: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
PO
Route: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
chronic a-fib; prevent DVT and PE
Indications: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
bleeding
AE: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
no blood monitoring required; no dietary considerations; much easier for pat take; risk for fatal bleeding less
Nursing: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
Andexxa (coag factor Xa (recombinant))
Reversal agent: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)
Assessment:
Interventions:
Too much always let prescriber know and let HCP know what seeing
Initial management anticoag OD
Clinical manifestations of bleeding and vital signs (HR/BP/O2 sat - unstable with internal bleeding) - esp if know given too much
Assessment: - Initial management anticoag OD
Notify provider - let know VS and what seeing
Draw labs as ordered: Hemoglobin/hematocrit (worried about bleeding), platelets if on heparin therapy (bleeding, HIT); clotting times (PT/INR, aPTT)
Administer fluids (normal saline) and/or packed-red blood cells as ordered - blood transfusion
Administer reversal agent as ordered
Interventions: - Initial management anticoag OD
Local fibrinolysis (acute clot lysis); break up the clot
MoA: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)
Systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI); Local: central venous catheter occlusion - no major AE because not going into pat just sitting in line
Indications: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)
bleeding, hypotension, bradycardia, tachycardia
AE: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)
many; when used systemically sig assessment that appropriate for pat because can have detrimental effects because potent
Contraindications: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)
Physical assessment with focus on cardiovascular and s/s bleeding
Labs: aPPT, PT/INR, H/H, platelets
Major Drug-drug: more than 1 anticoagulant/antiplatelet (ie; ASA, warfarin), herbal supplements, antibiotic therapy
Assessment - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes
Risk for injury
Ineffective tissue perfusion
Nursing Diagnosis - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes
Therapeutic effect with limited adverse effects (ie; absence of DVT, PE, stroke) - absence of blood clots
Client understanding of drug therapy, adverse effects, safety
Expected Outcomes - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes
Bleeding precautions
Reduce risk for falls
Hold for procedures
Educate client: s/s bleeding; lab monitoring and diet if indicated
Nursing: drugs affecting blood coag: interventions
Therapeutic response: absence of blood clots, restored perfusion
Adverse effects: monitor s/s bleeding most important!
Teaching (was it effective?)
Nursing: drugs affecting blood coag: eval
The onset of warfarin is 36-48 hours. The patient will not be anticoagulated during this time. The diagnosis of a DVT warrants the need for more immediate anticoagulation to reduce the risk of complications, such as PE. The patient will be prescribed enoxaparin because it achieves anticoagulation quickly (onset 3-5 hours; duration 12 hours) and will provide anticoagulation until the warfarin’s action takes effect. When the patient’s INR is therapeutic on warfarin (2.0-3.0), the enoxaparin will be discontinued. This entire process is referred to as “bridging”.
The nurse on a medical-surgical unit is caring for a client who has just been diagnosed with a deep vein thrombosis (DVT) in the right lower extremity. The primary care provider has prescribed enoxaparin 70 mg SQ every 12 hours with the first dose STAT. In addition, the provider has prescribed warfarin 5 mg PO daily and a PT/INR draw in 3 days. Why has the primary care provider prescribed both medications simultaneously?
In which situation could a thrombolytic agent be safely used?
A.CVA within the last 2 months
B.Acute MI within the last 3 hours
C.Recent, serious GI bleeding
D.Obstetrical delivery
Answer: B
Rationale: Blood clots can cause myocardial infarction and alteplase can be used to dissolve the clot. Other answers are contraindications to thrombolytic agents.
Antiplatelet drugs would be useful in which of the following? Select all that apply.
A.Maintaining the patency of grafts
B.Decreasing the risk of fatal MI
C.Preventing re-infarction after MI
D.Dissolving a PE
E.Preventing thromboembolic stroke
Answer: A, B, C, E
Rationale: Antiplatelet drugs are used for the prevention of cardiovascular events. Thrombolytic agents are used to dissolve blood clots which are the cause of a pulmonary embolism.
A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin.
1.The patient asks, “will the warfarin dissolve the clot in my leg?” What is the nurse’s best response?
Warfarin will not dissolve the existing clot, but it will help prevent additional clot formation.
A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin.
2.The nurse plans to assess the patient’s lab work before administering the warfarin. What blood test(s) are important to monitor for patients taking warfarin, and what is the therapeutic range?
When a patient is taking warfarin, the nurse should closely monitor INR and PT levels to verify they are in normal range to prevent bleeding complications. Specifically, the therapeutic range for INR is between 2.0 to 3.0 depending upon the indication.
A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin.
3.The nurse knows that the patient will need to monitor his diet when taking warfarin. What dietary instructions should be provided to the patient?
Dietary instructions should be provided to maintain a consistent intake of foods high in vitamin K like leafy green vegetables. Daily changes in intake of foods that are high in vitamin K will influence the effectiveness of warfarin, as well as the patient’s INR levels used to maintain the warfarin levels in therapeutic range.
A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin.
4.The nurse plans to provide patient education regarding this newly prescribed medication. Outline education topics to cover with this high-risk medication.
Patient education should emphasize bleeding precautions, avoidance of NSAIDs and aspirin, the need for routine therapeutic monitoring, and when to call the provider with signs of increased bleeding
A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin.
5.What is the reversal agent for warfarin?
The reversal agent for warfarin is vitamin K
RBCs carry O2
Decreased RBCs -> decreased Hgb synthesis -> decreased blood flow -> hemorrhage -> increased O2 consumption by tissues
Kidneys O2 sensor - sense decreased O2 and release EPO to stim production RBC
Review normal erythropoiesis
provides Erythropoietin factor controlling rate of RBC production to stimulate body to produce RBC
MoA: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
Disorders of RBC formation to decrease need for blood transfusions; renal failure (kidneys O2 sensory and have ESRD and kidneys not functioning not make RBC normally because missing stim from kidneys), antineoplastic treatments/agents (chemo for cancer; AE: decreasing RBC count)
Indications: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
IV/SQ (mostly SQ)
Route: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
Angina, caution in CHF
Contraindications: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
Fatigue, bone pain, edema, hypertension (HTN) - too much med start overcrowd sys with volume, headache, fever (DVT, CVA, MI has occurred)
AE: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
Monitor CBC weekly (track Hbg and RBC (both should go up but not too much) - dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal Hgb above 10 - adequate levels so not symptomatic with anemia; hold if Hgb > 12 because not want overshoot too far
Nursing: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)
Replace iron losing to get more Fe stores; required for hemoglobin formation
MoA: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate
Iron deficiency, iron-deficiency anemia - replace Fe losing to help low Hgb and anemia occurring
Indications: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate
antacids/dairy reduce absorption sig - not getting Fe need
Drug-Drug/Food: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate
GI upset (HARD ON GI SYS), dark tarry stools (can look like upper GI bleed - look at med list and up to HCP on what want to do), constipation (teach: adequte fluids and exercise): see these common
AE: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate
monitor labs (Hgb, iron); take w/o food for best absorption - cannot if cannot tolerate given full glass water or something curb nausea; take with Vit C to increase absorption; Do not take within one hour of bedtime (GERD); Do not crush or empty capsules; reassess Hgb after 3 months initiating therapy - not frequent labs; Keep out of reach of children-fatal if overdosed (toxic to GI sys and cause multiorgan sys failure when very severe)
Nursing: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate
Replaces vitamin B12; required for Hgb formation
MoA: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)
B12 deficiency anemia, pernicious anemia
Indications: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)
Monthly SQ/IM (pernicious anemia); not PO since cannot absorb it originally
Dosage/Route: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)
rare; usually well tolerated; not usually OD on and cause Hgb way elevated; not worry about if take as prescribed
AE: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)
monitor labs for therapeutic response (Hgb, B12 if relevant); Teach pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for lifetime because no cure
Nursing: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)
Required for erythropoiesis
MoA: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid
Folic acid deficiency anemia (if diet changes ineffective), alcoholism/liver disease, pregnancy prevention of neural tube defects so take to ensure have enough
Indications: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid
urine turns bright yellow
AE: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid
monitor H/H, nutritional status, therapeutic response
Nursing: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid
What instructions should the nurse include in teaching a client about ferrous sulfate? Select all that apply.
A.Take with milk to avoid GI upset
B.This medication may cause constipation
C.Keep away from children
D.Stools may turn green
E.Periodic blood tests needed to evaluate effect
Answer: B, C, E
Rationale: Ferrous sulfate will not turn stool green but can cause black, tarry stools. Dairy products can reduce the absorption of ferrous sulfate and should be avoided. Ferrous sulfate can cause constipation, is fatal to children if overdosed, and Hgb will be monitored for therapeutic effects.
