Drugs for anemia chapter 49 Flashcards
Describe rbc normally and in anemia ?
RBCs:
* carry oxygen to tissues
* remove carbon dioxide
(transport to lungs to exhale)
* Disorder with too few or
ineffective RBCs
* Results from alteration in
erythropoiesis
What can help produce healthy rbc ?
Adequate amounts of iron
* To form hemoglobin rings
Minute amounts of vitamin B12 and folic acid
* To form supporting structure
Essential amino acids and carbohydrates
* To complete the hemoglobin rings, cell membrane, and basic structure
What are different types of anemia ?
- Iron Deficiency Anemia
Megaloblastic Anemias
* Insufficient folic acid or vitamin B12 to create the stromal structure needed in a healthy RBC
Pernicious Anemia
* gastric mucosa cannot produce intrinsic factor needed for B12 absorption
Folate deficiency
* Folate – essential for cell division in all types of tissues
What is Erythropoietin – glycoprotein
- Released from kidney in response to:
- Decreased blood flow
- Decreased oxygen in kidneys
What is epoetin alfa (Epogen)
Erythropoiesis-stimulating agent
What are therapeutic actions of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- Stimulates production of RBCs
What are indications of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- Anemias associated with renal failure and AIDS; decreases need for blood transfusions in patients undergoing surgery
What are pharmacokinetics of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- IV or SC
What are adverse effects of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- CNS effects – HA, arthralgia, fatigue
- CV effects –> r/t increase in RBC, balance within CV system
htn,edema, chest pain
What are contras of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- Uncontrolled hypertension( pressure in vascular system increases when rbc increase so it can worsen htn)
- Allergy to human albumin
- Lactation
What are cautions of epoetin alfa (Epogen)?
Erythropoiesis-stimulating agent
- Follow Hgb and HCT
Who is at risk for iron deficiency ?
- Menstruating women who lose RBCs monthly
- Pregnant and nursing women
- Rapidly growing adolescents
- Persons with GI bleeding
What is ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
What are therapeutic actions of ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
* Elevate serum iron concentrations
What are indications of ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
- May also be used as adjunctive therapy in
patients receiving epoetin alfa - Pregnancy/ lactation -> meet increased demands of iron
What are pharmacokinetics of ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
- Absorbed in the small intestines
- Can take 2-3 weeks to see improvement
- Oral form preferred
to reduce the risk of subcutaneous staining and irritation
What are adverse effects of ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
GI effects N/V, dark stools, constipation
* CNS
* Parenteral associated with anaphylaxis
reactions
* Consider Z track for IM injections
* Liquid stains teeth
What are contras of ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
* Allergies
* Hemochromatosis(excessive iron) & hemolytic anemia( anemias that aren’t iron anemia)
* Peptic ulcer, colitis( could cause exacerbation)
What are drug interactions ferrous sulfate (Feosol)?
Agents for iron deficiency anemia
-Iron absorption decreases if iron preparations are taken with antacids, substances with calcium and magnesium
-Iron is not absorbed well if taken with antacids, eggs, milk, other calcium-containing substances, coffee, or tea. These substances should not be administered concurrently. Vitamin C may enhance the absorption of iron but also may increase the GI side effects.
Describe chelating agents
- Heavy metal buildup/ toxicity
- Iron, lead, arsenic, mercury, copper, gold
- Chelating agents – drugs that counteract metal toxicity
- hold metal so it can be transported out of the body before it harms tissue
What is deferoxamine mesylate (Desferal)
Chelating agent
What are indications of deferoxamine mesylate (Desferal)?
Chelating agent
Indicated for high levels of iron
What are contras/cautions of deferoxamine mesylate (Desferal)?
Chelating agent
Vision changes, rash, pain at injection site
What is MEGALOBLASTIC ANEMIAS?
Folate Deficiencies
* Secondary to increased demand
* Absorption problems
* Drugs that cause folate deficiencies
* Secondary to the malnutrition of alcoholism
Vitamin B12 Deficiencies
* Poor diet or increased demand
* Lack of intrinsic factor in the stomach
