Hematologic Drugs

Question 1

Ferrous Sulfate, Iron dextran

Answer 1

Tx: Iron deficiency
Iron dextran = IV
Ferrous Sulfate = PO
Antidote: Deferoxamine
S/S: GI distress, metallic taste (give with straw)
Administration: Vitamin C increases absorption, take on empty stomach; Use Z-track when giving IM

Question 2

Cyanocobalamin

Answer 2

Tx: Vitamin B12
S/S: Diarrhea, hypokalemia

Question 3

Folic Acid

Answer 3

Tx: folic acid deficiency
S/S of IV: flushing and warmth
S/S: GI distress (altered taste)
Usually given PO

Question 4

Factor VIII and IX

Answer 4

Factor VIII: hemophilia A
Factor IX: hemophilia B
Increased clotting, watch for PTT to return to normal range
S/S: anaphylaxis
Only celecoxib should be used instead of other NSAIDs

Question 5

Desmopressin

Answer 5

Short-term management of hemophilia A
S/S: fluid retention, hyponatremia
Assess for LOC changes

Question 6

What should I know about Thromboembolic Medication?

Answer 6

Assess for complications of bleeding!
Avoid herbal supplements that increase bleeding (3G’s = gingko, ginger, gingsi)

Question 7

Heparin, enoxaparin

Answer 7

Interfere with clotting process which prevents clotting
Used for acute situations
Monitor aPTT (1.5-2.5x normal)
Antidote: protamine sulfate
Heparin = IV
Enoxaparin = SQ

Question 8

Warfarin

Answer 8

Inhibits clotting
Monitor PT/INR (2-3)
Antidote: vitamin K (don’t limit, but don’t increase)
Monitor for bleeding, tachycardia, tarry stools, hypotension
Given with heparin until warfarin therapeutic effect is active

Question 9

Clopidogrel

Answer 9

Inhibits ATP receptor on platelets
S/S: hemorrhage, n/v, GI bleeding, THROMBOTIC THROMBOCYTOPENIC PURPURA
TTP = destruction of blood cells —> impaired perfusion —> organ damage
Monitor for petechiae and purpura
Should stop taking the medication 7-10 days before surgery

Question 10

Alteplase

Answer 10

Breaks down existing clots and prevents clotting
IV infusion given within 3hrs for stroke, 2hrs for MI
CONTRAINDICATED: presence of active bleeding, intracranial hemorrhage, structural abnormalities or trauma of CNS, stroke w/in 3 months, uncontrolled HTN, & head and facial trauma w/in 3 months
Perform baseline neuro check
Pressure on puncture sites for 20-30 minutes

Question 11

epoietin alfa

Answer 11

Increases RBC production
Hold if Hgb >10 for chemo, and >12 for non-chemo
S/S: increased clotting risk
Tx: chronic renal failure, anemia, chemotherapy, immunosuppressant drugs

Question 12

Filgrastim

Answer 12

Tx: bone marrow transplants and neutropenia
S/S: increased WBC —> fever, bone pain, splenomegaly

Question 13

Oprelvekin

Answer 13

Tx: thrombocytopenia, chemo, transplant protocol
S/S: increased viscosity of blood —> HTN and clotting, blood shot eyes expected, blurred vision typically resolves, dsyrhythmias, dyspnea (pulmonary HTN, pleural effusion)
Get regular CBCs and coagulation studies