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hematologic medications Flashcards

1
Q

What are the three anemias?

A

iron
pernicious (b12)
megaloblastic

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2
Q

low iron or globin

A

. Cytoplasmic-

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3
Q

low Vit B12 or folic acid

A

Nuclear

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4
Q

What are the three anemias?

A

iron deficiency
pernicious
megaloblastic

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5
Q

What medications are given for iron deficiency anemia?

A

ferrous sulfate
iron dextran

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6
Q

what medications are given for pernicious anemia?

A

vitamin b12
cyanocobalamin

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7
Q

what medications are given for megaloblastic anemia?

A

folic acid
vitamin b12 and cyanocobalamin too

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8
Q

what are the two RBC maturation defects ?

A

cytoplasmic -low iron or globin
nuclear -low vitamin b12 or folic acid

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9
Q

excessive RBC destruction is also known as?

A

hemolytic anemia

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10
Q

what are the two subcategories of excessive RBC destruction?

A

intrinsic RBC abnormalities
extrinsic mechanisms

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11
Q

can be caused by:

blood loss
decreased dietary iron
decreased absorption of iron
blood loss
surgery
child birth
GI bleeding
menstral blood loss
extreme hemorrhoids

A

iron deficiency anemia

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12
Q

______ red blood cells are dark red

A

normal

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13
Q

person with iron deficiency anemia has ______ and more ______ blood cells

A

smaller, pale

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14
Q

What are the two megaloblastic anemias?

A

pernicious anemia
folic acid deficiency

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15
Q

this is when you make large cells, but there aren’t enough of them, and they’re immature

A

megaloblastic anemia

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16
Q

______ or ______ can be due to not getting enough in your diet (folic acid or b12) or your body can be improperly absorbing it
intrinsic factor missing that causes them not to asorb them in their stomach can cause this anemia (gastric bypass can actually cause this)
infants can get it due to a lack of dietary intake
pregnancy (folic acid) can cause this anemia too

A

pernicious, folic acid deficiency anemia

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17
Q

______ anemias are where the cells are being destroyed

A

hemolytic

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18
Q

sickle cell anemia is a ?

A

hemolytic anemia

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19
Q

desire to eat ice (laundry detergent, dirt)

A

pika

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20
Q

What are the three major s/s of anemia?

A

low iron levels -check labs
imbalance between O2 delivery and demand
rapid loss of blood may be present

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21
Q

what are symptoms of imbalance between O2 deliver and demand?

A

fatigue, weakness, abnormal HR or BP, decreased exercise or activity level, dyspnea, weight at or below normal for age, height, and body build, discoloration of the nails and skin, fissures on the lips

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22
Q

what color can nails be with anemia?

A

pale

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23
Q

t/f: anemia can cause you to bruise more eaisly?

A

true

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24
Q

is SHOB a symptom of anemia?

A

yes

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25
Q

What do you need to draw along with your CBC when checking for anemias?

A

iron levels

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26
Q
A

fissures on on the lips or splits in the sides of the mouth are signs/symptoms related to anemia

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27
Q
A

fissured tongue is also a symptom of anemia

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28
Q

When is giving iron (ferrous sulfate or Iron dextram) contraindicated?

A

type of anemia not associated with iron deficiency
iron overload
drug allergy

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29
Q

if they have iron deficiency anemia, what do you need to investiage?

A

you need to figure out why they’re having an iron deficiency. Is it menstrual, GI bleed? diet lacks iron? you need to figure out what is really going on

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30
Q

What is the normal HGB lab for adult males?

A

13-18 g/ 100mL

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31
Q

What is the normal HGB lab for adult females?

A

12-16 g/ 100mL

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32
Q

what are dietary sources high in iron?

A

muscle meats
liver
egg yolks
yeast

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33
Q

What should you take along with iron to increase absorption?

A

Vitamin C

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34
Q

What should you not give PO iron with as it interferes with absorption?

A

antacids

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35
Q

do mens’ vitamin supplements have iron in them?

A

no, they do not usually

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36
Q

What is the normal HCT (hematocrit) level for an adult male?

A

45-52%

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37
Q

What is the normal HCT (hematocrit) level for an adult female?

A

37-48%

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38
Q

should iron be taken with food?

A

yes, it can cause a lot of GI problems such as constipation and tarry stools

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39
Q

GI related
Staining
Anaphylaxis _________
IV Route is safer than IM
1st = Give test dose first
2nd = Give second dose slowly12.4 mg/min
Hypotension (Parenteral Route)
Elderly respond better to lower doses
Lower doses = lower adverse effects

A

Side effects of iron
Iron Dextran

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40
Q

may have to take something for constipation

can cause abdominal upset, nausea

Staining is related to the injections

if they have IV it can cause staining as well, will be there a very long time

if there is an increased need, they will received it IV or IM

A

side effects of iron

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41
Q

what do you need to do before giving iron IM?

A

do a test dose

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42
Q

t/f: lower doses of iron have lower adverse effects?

A

true

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43
Q

GI symptoms melena (dark bloody stools), hematoemesis, N/V, diarrhea
Can lead to acidosis
Shock  hypotension, tachypnea, pallor then cyanosis, coma

A

S/S of iron poisoning/toxicity

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44
Q

what are s/s of iron poisoning/toxicity

A

GI symptoms- melena (dark bloody stools), hematoemesis, N/V, diarrhea
Can lead to acidosis
Shock -hypotension, tachypnea, pallor then cyanosis, coma

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45
Q

What are side effects of iron?

A

GI
staining
anaphylaxis to iron dextran
hypotension (parenteral route)

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46
Q

how is an overdose of iron treated?

A

bowel irrigation
chelating agent: deferoxamine

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47
Q

When is iron contraindicated?

A

hemolytic anemia
hemochromatosis
hemosiderosis

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48
Q

What are cautions for iron?

A

peptic ulcer disease
ulcerative colitis
severe hepatic and/or renal impairment

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49
Q

can you crush iron?

A

NO, you cannot crush iron

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50
Q

are dosages sometimes confusing with iron?

A

yes

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51
Q

pernicious anemia is a type of ______ anemia

A

megaloblastic

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52
Q

you would have to take a lot of ______ to actually cause problems, there is not really toxicity associated with it

A

b12

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53
Q

cyanocobalamin nascobal is administered how and for what?

A

intranasal, pernicious anemia

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54
Q

cyanocobalamin injection is given how?
is used to treat what condition?

A

SQ or IM
pernicious anemia

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55
Q

Skin and mucous membranes affected
(GI disturbances)
Neurological changes
(Numbness, tingling, CNS damage)
Dysrhythmias, heart failure, infection, bleeding
Signs of anemia
(Fatigue, pallor)

A

signs of b12 deficiency

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56
Q

what are signs of b12 deficiency?

A

Skin and mucous membranes affected
(GI disturbances)
Neurological changes
(Numbness, tingling, CNS damage)
Dysrhythmias, heart failure, infection, bleeding
Signs of anemia
(Fatigue, pallor)

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57
Q

What are cardinal signs for pernicious anemia?

A

beefy red tongue
pallor
neuropathy

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58
Q

what are the normal levels for b12?

A

200-900

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59
Q

What does this sign indicate?

A

pernicious anemia (beefy red tongue which is a cardinal sign of pernicious anemia)

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60
Q

What causes b12 deficiency?

A

malabsorption (lack intrinsic factor)
poor dietary intake

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61
Q

What are some side effects of b12 deficiency ?

A

itching
diarrhea
fever
hypokalemia

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62
Q

will folate (B9) treat pernicious anemia ?

A

no it will not

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63
Q

dairy, fortified cereals, and meats all contain?

A

b12

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64
Q

What labs do you need to get for B12 deficiency?

A

B12, Hgb, Hct, RBC, reticulocyte counts

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65
Q

anticonvulsants, aminoglycoside antibiotics, folic acid, and long acting potassium supplements

A

Decrease the effectiveness of oral b12

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66
Q

Wait ______ hour before or______ hour after eating before administering intranasal form of b12

A

1, 2

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67
Q

injections do not cause issues like iron injections

A

b12 injections

68
Q

–shows how quickly new red blood cells are being made

A

reticulocyte count

69
Q

Improvement of reticulocyte count
(0.8-2.5%)
Absence of megaloblasts in bone marrow
Normal or increased Hgb and Hct levels (part of CBC)
Improvement of neurological symptoms (tingling in hands and feet)

A

goals for anemia treatment

70
Q

Folate and B9 are?

A

folic acid

71
Q

required for:
DNA, Erythropoiesis
Prevent neural defects in fetus
Treat malabsorption syndrome

A

folic acid

72
Q

Treats megaloblastic anemias

A

folic acid

73
Q

pallor, fatigue, palpitations, paresthesia (tingling feeting)

A

Signs of deficiency of folic acid

74
Q

women who are at the age of wanting to get pregnant

treats megaloblastic anemias but the ones related to folic acid

mostly related with neural tube defects

A

folic acid

75
Q

side effects of folic acid?

A

rare, localized rashes

76
Q

Contraindications/Caution for folic acid

A

Indiscriminate use with any anemia not r/t folic acid deficiency

77
Q

Sulfonamides
Sulfasalazine
Methotrexate
(last two are used with auto immune disorders)

A

These meds decrease folate levels:

78
Q

normal lab range for folic acid?

A

6-15 mcg/ml

79
Q

Risk factors
Baseline and periodic labs
Folic Acid, RBC, reticulocyte counts, & Hgb/Hct

A

assessment for folic acid

80
Q

Signs/symptoms of anemia improve
Absence of neural tube defects in newborns

A

success with folic acid deficiency

81
Q

Rare genetic disorder
Natural coagulation and hemostasis factors are limited or absent.

A

hemophilia

82
Q

Patients with __________ can bleed to death if coagulation factors are not given.

A

hemophilia,

83
Q

can bleed to death with an injury that the rest of us would survive (often have to come get whatever factor at the hospital that theyre defieient in to clot)

A

hemophilia

84
Q

most common type of hemophilia?

A

hemophilia A

85
Q

Genetic
Caused by missing or defective factor VIII (a clotting protein)

A

hemophilia A

86
Q

hemophilia A is missing which clotting factor?

A

factor VIII, factor 8

87
Q

also known as christmas disease

A

hemophilia B

88
Q

Hemophilia B is missing which clotting factor?

A

factor 9, IX

89
Q

Less common than Hemophilia A
Genetic
Caused by missing or defective IX (a clotting factor)

A

hemophilia B

90
Q

What medications are given for hemophilia?

A

Factor VIII and factor IX

91
Q

Excessive bleeding and easy bruising
Bleeding can happen in the joints
Injury causes prolonged bleeding
Internal bleeding can occur with “slight” injury

A

symptoms of hemophilia

92
Q

treatment for hemophilia?

A

Synthetically produced factors (or can be derived from human blood)

93
Q

put _____on the bleed, it can decrease bleeding

A

ice

94
Q

Observe and report signs of bleeding
From gums, skin, stool or emesis
Swelling of joints
Monitor I & O & color of urine
Assess for allergic reaction
Monitor BP, pulse, respirations

A

hemophilia assessment

95
Q

what labs do you need to monitor for hemophilia?

A

Hematocrit (Hct)
Direct Coombs test
Plasma factor VIII levels
Platelet count

96
Q

anytime you give a factor you want to assess for ______and monitor labs: _________

A

allergic reactions , Hct, direct coombs test, plasma factor level, platelet count

97
Q

Monitor BP, HR, RR
Obtain history of current trauma, estimate blood loss
Assess for renewed or increased bleeding q 15-30 minutes
Immobilize joint and apply ice
Obtain blood type and cross prior to administration
Apply pressure to all venipuncture sites for at least________, avoid injections when possible
Coagulation lab studies
aPTT, plasma fibrinogen, platelet count, PT, factor IX plasma concentrations

A

5 minutes

Assessment for giving factors

98
Q

go ahead and get _____ while youre doing the IV bc theyre more prone to bleeding

A

blood

99
Q

Reduce bleeding opportunities
Apply pressure to IM, IV sites- 5 min
Reduce IM and venipuncture
Avoid ASA and NSAIDs
Advise patients to consult health care professional prior to ______and to bring adequate supply to factor 8

A

travel

100
Q

Tell your doctor or dentist before any/all medical or dental care, emergency care, or surgery
Avoid products containing ASA or NSAIDs
Bleeding assessment & prevention Know this!

A

patient education for hemophilia and clotting factors.

101
Q

Emboli to brain- ______
Emboli to lung- ______
Emboli to vein in leg- _______
a clot is also known as a ______?

A

stroke
pulmonary embolism
Deep vein thrombosis
emboli

102
Q

What drugs are used to prevent or dissolve thrombi?

A

anticoagulants
antiplatelets
[thrombolytics which dissolve clots, but its not on the exam]

103
Q

drug class inhibits clotting factors?

A

anticoagulants

104
Q

______ inhibit clotting factors are used to prevent clots, not break them

A

anticoagulants

105
Q

What are the parenteral administration anticoagulants?

A

heparin
low molecular weight heparin: enoxaparin, dalteparin

106
Q

What are the oral anticoagulants?

A

warfarin

107
Q

heparin is given through ______
______ is a low molecular weight heparin –easy to give, not as dangerous as giving large amount of heparin IV

A

IV, Enoxaparin

108
Q

–works by inhibiting vitamin K synthesis, bacteria in GI are what make vitamin K, vitamin K helps clot formation

A

warfarin

109
Q

For quick anticoagulation needs (stroke, pulmonary embolism, massive DVT)
Prevent clots during specific surgeries/procedures
Prevent post-op venous thrombosis (mostly given subQ)
DOES NOT LYSE A CLOT
IV doses should be double checked with another nurse

A

heparin indications

110
Q

binds with antithrombin 3 which turns off the coagulation pathway

A

heparin

111
Q

Emergency anticoagulation therapy
Situations where clot formation is a risk
Slowed blood flow
Prevent AND/OR Treat DVT and PE
Anticoagulation “Bridge”

A

LMWH indications enoxaparin

112
Q

most of the time used for prevention or for someone who has a DVT after surgery

A

LMWH enoxaparin

113
Q

post surgery, slow blood flow, prevent or treat DVT, pulmonary embolism

A

indications for enoxaparin LMWH

114
Q

_______________: will stop oral warfarin and instead use lovenox during a certain period pre operatively

A

anticoagulation bridge

115
Q

Thrombocytopenia (low platelets)
Uncontrolled bleeding

A

contraindications for Heparin/LMWH

116
Q

Hemophilia
Peptic Ulcer
Decrease any punctures, procedures that cause bleeding

A

cautions for heparin/ LMWH

117
Q

Hemorrhage
Thrombocytopenia and HIT
Stop heparin if platelets less than 100,000/mm3
Hypersensitivity reactions (more likely with IV)
Small initial “test” dose
Chills, fever, urticaria
Neurological damage

A

Adverse effects of heparin and LMWH

118
Q

______ short half life (1-2 hours)
______ 4.5 hours (up to 7)

A

Heparin, LMWH

119
Q

What do you do if someone has an overdose to heparin or LMWH or toxicity to it?

A

administer 1 mg protamine sulfate … 1Mg of heparin overdose Slow IV injection: 20 mg/min or 50 mg in 10 min
replace blood loss

120
Q

protamine sulfate

A

reversal drug for heparin, give 1 mg protamine for every 1 mg of heparin overdose with slow injection rate

121
Q

______ subcutaneous or IV
______ subcutaneous, 2 in from umbilicus
Pinch skin, 90° angle, do not aspirate
Needle gauge consideration _______
Techniques to reduce bruising
Do I administer this air bubble?
Safety considerations

A

administration for heparin considerations.
Heparin, LWMH , use the smallest, yes administer air bubble

122
Q

tell them to avoid picking their nose

make sure you have the right concentration

A

considerations/education for heparin

123
Q

syringe comes prefilled with a bubble, do not take it out bc it helps to seal it
go in 90 degrees, do not Z track it, don’t rub site afterwards
two inches away from belly button in any direction

don’t give in legs ONLY GIVE in ABDOMEN

A

administration for enoxaparin

124
Q

Treats venous thrombosis
Prevention and treatment for patients with atrial-fibrillation and prosthetic heart valves
Prevention recurrent MI, TIA, PE, and DVT

A

uses for warfarin

125
Q

is oral and inhibits vitamin K synthesis

used to treat and prevent blood clots and a fib, heart valves, MI,

give vitamin K to reverse

A

warfarin

126
Q

May be started while the patient is still on heparin until PT/INR levels indicate adequate anticoagulation
Full therapeutic effect takes several days.
Monitor PT/INR regularly; keep follow-up appointments.

A

warfarin

127
Q

PO _______ is generally something they start before they go home

they have to go in for labs to have levels checked (time frame depends)
some people will be on the med for life

A

warfarin

128
Q

Pregnancy category X
Thrombocytopenia (low platelet count)
Uncontrolled bleeding
Specific surgeries
__________deficiency, liver disorders or alcoholism

A

contraindications for warfarin, Vitamin K

129
Q

Hemophilia
Severe HTN
Peptic ulcer
Dissecting aneurysm
Threatened abortion

A

caution for warfarin

130
Q

Bleeding… hemorrhage
Hepatitis
Lethargy
Muscle pain
Skin Necrosis
“Purple toes” syndrome

A

warfarin adverse side effects

131
Q

what is this condition and what is it caused by?

A

purple toes syndrome (skin necrosis), its an adverse effect of warfarin

132
Q

What do you do for a warfarin overdose?

A

Discontinue warfarin
Start Phytonadione (vitamin K)
PO preferred, IV available (dilute it)
2.5 mg PO, 0.5 to 1 mg IV
Clotting Factor Transfusion
Fresh frozen plasma
Whole blood transfusion

133
Q

first: stop med
get lab
get order for phytonadione which is vitamin K
PO is preferred if able

A

warfarin toxicity protocol

134
Q

what is the preferred method of admin for phytonadione?

A

PO is preferred

135
Q

t/f: warfarin has a lot of drug/drug interactions

A

Many but ntk Foods high in vitamin K

136
Q

if your patient eats a lot of _________ its alright, but they cant suddenly start eating it, they also don’t need to stop eating all of their ________

don’t take with salicylates

A

vitamin K, vitamin K foods
warfarin

137
Q

don’t take _________ along with warfarin

A

OTC herbs

138
Q

aPTT 45-70 seconds (heparins)
PT 18-24 seconds (warfarin)
INR 2-3 for MI, Afib, PE, venous thrombosis
INR 2.5-3.5 for mechanical heart valves, reoccurring systemic embolism
No more thrombi developing

A

warfarin treatment is effective when these occur

139
Q

aPTT time should be? (with heparins)

A

45-70 seconds

140
Q

PT time should be ? (warfarin)

A

18-24 seconds

141
Q

INR should be _________ for a MI, Afib, PE, venous thrombosis

A

2-3

142
Q

INR should be _____ for mechanical heart valves, reoccurring systemic embolism

A

2.5-3.5

143
Q

Obtain baseline ______________________
Continue to monitor through therapy with heparins

A

CBC, platelet count, HCT.

144
Q

get a ___ anytime youre wondering about their clotting ability

A

CBC

145
Q

Apply pressure to new venipuncture sites
Avoid unnecessary IM injections or IV routes, if possible

A

monitoring for heparin admin (also for people with blood disorders)

146
Q

Bleeding assessment
Guaiac fecal occult stool
Visual assessment

A

monitoring for heparin administration

147
Q

will have to apply extra extended pressure if they’re on an _________

don’t use a _____ razor, have them use an _____

A

anticoagulant , straight, electric razor

148
Q

Inhibit platelet aggregation

A

antiplatelets

149
Q

what is the antiplatelet we go over?

A

aspirin

150
Q

Prevent acute MI and re-occurance of MI
Prevent ischemic stroke or transient ischemic attacks (TIAs)
Other uses: analgesic, antiinflammatory, antipyretic (depends on the med)
Available in many combinations with other prescription and nonprescription drugs

A

indications for antiplatelet use

151
Q

Aspirin and ______
Used for antiplatelet purposes

A

dipyridamole

152
Q

Thrombocytopenia, bleeding disorders
Third trimester of pregnancy
Active bleeding-trauma, GI bleeding, Recent hemorrhagic stroke** (bleeding in brain)
Vitamin K deficiency
Cross allergy to other ______
“Flu-like symptoms in children or adolescents
Reyes Syndrome

A

contraindications for aspirin
NSAIDs

153
Q

Peptic ulcer disease
Severe kidney or hepatic disorders
Older adults

A

cautions for aspirin use

154
Q

is a rare, serious condition that causes swelling in the liver and brain. it most often affects children and teenagers recovering from a viral infection, commonly the flu or chickenpox.

A

Reye’s Syndrome

155
Q

GI effects
Nausea/Vomiting, dyspepsia
Hemorrhagic Stroke
Assess for weakness on one side of the body,
speech changes, headache
Prolonged bleeding time, gastric bleed
Thrombocytopenia
Tinnitus, hearing loss

A

side/adverse effects of aspirin

156
Q

81mg is called _____ aspirin

A

Children’s/Baby’s

157
Q

Discontinue 1 week prior to surgeries
Effects last this long too

A

aspirin education

158
Q

Good tissue perfusion
No abnormal bleeding
Absence of thrombi

A

aspirin is effective if these criteria have been met

159
Q

Inhibits platelet aggregation by preventing binding of ATP to platelet receptors

A

antiplatelet drugs

160
Q

contraindication/cautions are similar to aspirin except for?

A

clopidogrel is category B pregnancy risk, should not take when breastfeeding

161
Q

Side effects of antiplatelets are similar to aspirin with the exception of?

A

tinnitus

162
Q

What are the antiplatelet ATP inhibitors?

A

clopidogrel
ticlopidine

163
Q

Concurrent use of NSAIDS, anticoagulants, thrombolytics, antiplatelets

A

drug/drug interactions of ATP inhibitor antiplatelets

164
Q

Chest pain, edema
Abdominal pain, diarrhea, nausea
Thrombocytopenia
Flu-like symptoms
Bleeding issues:
Epistaxis
Prolonged bleeding time
Gastric bleeding

A

side effects of ATP inhibitor antiplatelets

165
Q

For unstable angina/MI
For thromboprevention
IV medication
Given in ICU

A

antiplatelet glypoprotein inhibitors,
eptifibatide,
tirofiban

166
Q

What are the antiplatelet arterial vasodilators?

A

Pentoxifylline
Dipyridamole
Cilostazol

Pharm (14 decks)

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