Growth Factors

Question 1

What labs are important to monitor when administering growth factors?

Answer 1

• RBC
• WBC
• Platelets

Question 2

What is the drug class of erythropoietin (epogen, Procrit)?

Answer 2

Biologic response modifier

Question 3

Describe the MOA of erythropoietin (epogen, Procrit)

Answer 3

Acts on bone marrow to increase RBC production (biosynthetic)

Question 4

What is the primary indication of erythropoietin (epogen, Procrit)?

Answer 4

Anemia due to CKD / chemotherapy (usually dosed three times per week - on dialysis days - for CKD and weekly for chemotherapy)

Question 5

What are the contraindications of erythropoietin (epogen, Procrit)?

Answer 5

• Uncontrolled hypertension
• Hgb > 11 g/dL

Question 6

What are the adverse effects of erythropoietin (epogen, Procrit)?

Answer 6

• Hypertension (more in those with CKD)
• Thrombotic event (MI, CVA) with Hgb > 11 g/dL or >, or increase > 1 g/dL in 2 weeks
• Seizures if counts raise too quickly
• DVT

Question 7

Describe the nursing considerations associated with erythropoietin (epogen, Procrit)

Answer 7

• Monitor BP - may need antihypertensives
• Monitor Hgb levels – HOLD if Hgb > 11 (goal hgb 10-11 g/dL) - decreased oxygen carrying capacity can cause fatigue
• Seizure precautions if Hgb increases too rapidly
• Monitor for DVT
• Report frequent or severe h/a – check BP (question if hypertension)
• Monitor iron, folic acid, & B12 levels – erythropoietin less effective without these (needed for RBC functioning)

Question 8

What is the drug class of filgrastim (Neupogen)?

Answer 8

Granulocyte colony stimulating factor

Question 9

Describe the MOA of filgrastim (Neupogen)?

Answer 9

• Acts on bone marrow to increase neutrophil production
• Synthetic analogue of human granulocyte colony-stimulating factor (G-CSF)

Question 10

What is the primary indication of filgrastim (Neupogen)?

Answer 10

Decrease risk of infection in patients with neutropenia

Question 11

What are the contraindications of filgrastim (Neupogen)?

Answer 11

• Hypersensitivity to E coli derived proteins
• 24 before or after cytotoxic chemo

Question 12

What are the adverse effects of filgrastim (Neupogen)?

Answer 12

• Splenomegaly & risk of rupture
• Pulmonary bleeding/alveolar hemorrhage, ARDS
• MI

Question 13

filgrastim (Neupogen) requires cautious use in patients with what conditions?

Answer 13

• Bone marrow cancer
• Sickle cell disease
• Respiratory disease
• Lactation
• Children

Question 14

Describe the nursing considerations associated with filgrastim (Neupogen)

Answer 14

• Monitor for bone pain
• Pain control with acetaminophen or opioid analgesic if not effective
• Monitor CBC twice a week
• Decrease dose if WBC > 100,000/mm3 /
  absolute neutrophil count > 10,000/mm3
• Monitor for LUQ abdominal pain or shoulder pain (splenomegaly/rupture)
• Do not agitate vial
• Do not mix with other medications
• Self-administration teaching if applicable