Exam 2 - Pharmacology for Anemia

Question 1

vitamins and minerals

Answer 1

• iron (ferrous sulfate)
• vitamin B12
• folic acid

Question 2

erythropoiesis stimulating agents

Answer 2

• epoetin alfa

Question 3

drugs for treatment of iron deficiency anemia

Answer 3

• ferrous sulfate (oral)
• ferrous gluconate (oral)
• iron dextran (parenteral)

Question 4

indications for iron deficiency drugs

Answer 4

• treat and prevent iron deficiency anemia
• treat blood loss

Question 5

interactions of iron deficiency drugs

Answer 5

• decrease absorption with antacids
• increased absorption with vitamin C

Question 6

side effects of iron deficiency drugs

Answer 6

• GI upset
• metallic taste
• staining of teeth
• fatal iron toxicity (overdose in children causing liver failure)
• leading cause of poisoning death in children

Question 7

what is given to treat iron toxicity

Answer 7

• deferoxamine/desferal
• chelating agent

Question 8

oral administration of iron

Answer 8

• ferrous sulfate and ferrous gluconate
• best absorbed on an empty stomach
• do not crush or chew
• do not give with antacids or calcium supplements (decreased absorption)
• taking with food will decrease gastric irritation
• give with a straw and diluted in OJ to increase absorption
• monitor for teeth staining

Question 9

parenteral iron administration

Answer 9

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

Question 10

treatment of B12 deficiency

Answer 10

• injections of B12 (cyanocobalamin)
• diet: meat, fish, milk, dairy, eggs

Question 11

treatment of folate deficiency

Answer 11

• multivitamin supplements
• diet: green leafy vegetables, legumes, organ meats

Question 12

indications for B12 replacement

Answer 12

• low B12 levels
• pernicious anemia
• bariatric surgery patients
• surges where part or all of the stomach has been removed

Question 13

injectable B12 replacement

Answer 13

• cyanocobalamin
• IM weekly until levels are normal, then monthly
• more rapid improvement
• indicated for patients with severe deficiency or neurological
• well tolerated

Question 14

indications for folic acid supplements

Answer 14

• folic acid deficiency anemia
• pregnant women to prevent neural tube defects

Question 15

MOA: erythropoietin stimulating agents

Answer 15

• stimulates erythropoiesis
• increases hemoglobin and reticulocyte counts

Question 16

when is erythropoietin stimulating agents indicated

Answer 16

• when hemoglobin is less than 10g/dL unless on dialysis

Question 17

monitoring for patients on erythropoietin stimulating agents

Answer 17

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

Question 18

side effects of erythropoietin stimulating agents

Answer 18

• hypertension
• serious CV events (increased hematocrit = increased risk)
• progression of certain cancers
• infection site problems
• bone pain
• headache

Question 19

nursing implications for erythropoietin stimulating agents

Answer 19

• do not give if it has been shaken or frozen
• protect from light
• do not dilute or mix with other drugs
• black box warning

Question 20

when is erythropoietin stimulating agents contraindicated

Answer 20

• in patients with uncontrolled hypertension