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Pharmacology > Hematologic System > Flashcards

Hematologic System Flashcards

1
Q 
Medication Administration
IV Iron (ferrous sulfate)
A

Give test dose of 25 mg to determine sensitivity. Have epinephrine available in case of hypersensitivity. Follow with prescribed dose one hour later

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2
Q 
Medication Administration
Oral iron (ferrous sulfate)
A

Liquid: dilute with compatible liquid and give with a straw
Spread oral doses evenly over waking hours to maximize productions of RBCs
Give on an empty stomach for best absorption

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3
Q 
Client Education
ferrous sulfate (Anti-anemic)
A

Take on an empty stomach. If GI effects are too much, take with food
Stool may become dark green or black - harmless
Increase exercise and fiber intake if constipation occurs
Suck on hard candy or chew gum to relieve metallic taste

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4
Q 
Interactions
ferrous sulfate (anti-enemic)
A

Antacids reduce absorption
Vitamin C increases absorption, but also increases GI effects
Absorption of tetracyclines, fluoroquinolones, bisphosphates and penicillamine, will decrease administered with iron supplements
Concurrent use with ACE inhibitors may increase the risk of anaphylactic reaction with iron dextran

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5
Q 
Evaluation of Medication Effectiveness
ferrous sulfate (anti-anemic)
A

Increased reticulocyte count is expected within 4 to 7 days after beginning iron therapy
Increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy
Fatigue and pallor (skin, mucous membranes) should subside, and the client reports increased energy level

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6
Q

Adverse Effects

Vitamin B12

A

Erythema
Hypertension
Hypokalemia

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7
Q

Interactions

Vitamin B12

A

Folic acid can mask the symptoms of B12 deficiency; clients must take adequate doses of cyanocobalamin
Chloramphenicol (Chlormycetin) decreases effectiveness
Alcohol, cimetidine (Tagament), colchicine (Colcrys), and aminosalicyclic acid (Paser) reduce the absorption of oral form
Ascorbic acid (vitamin C) alters the stability of oral forms

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8
Q

Therapeutic Use

Vitamin B9 folate

A 
Megaloblastic (macrocytic) anemia
Folate deficiency (alcoholism)
Prevent neural tube defects in developing fetus
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9
Q

Adverse Effects

Vitamin B9 folate

A

Increased yellowing of urine
Masks B12 deficiency in high doses
Increased risk of developing colorectal or prostate cancer (long-term use)

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10
Q

Therapeutic Use

factor VIII and factor IX

A 
Hemophilia A (factor VIII)
Hemophilia B (factor IX)
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11
Q

Adverse Effects

factor VIII and factor IX

A

Allergic reaction

Creutzfeldt-Jakob disease (minimal risk, plasma-derived products only)

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12
Q 
Adverse Effects
Antidiuretic hormone (desmopressin)
A

Fluid retention, hyponatremia

Seizures, drowsiness, headache, nausea, and mild GI discomfort

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13
Q

Therapeutic Use

heparin, enoxaparin

A

Anticoagulation for evolving cerebrovascular accident, pulmonary embolism, massive deep-venous thrombosis
Adjunct therapy during angioplasty, open-heart surgery, hemodialysis, blood transfusion
Prophylaxis for postoperative venous thrombosis and pulmonary emboli
Acute myocardial infarction (with thrombolytic therapy)
Ischemic complications of unstable angina and some dysrhythmias
Disseminated intravascular coagulation

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14
Q

Adverse Effects

heparin, enoxaparin

A

Bleeding/hemorrhage
Thrombocytopenia (low platelet count)
Hypersensitivity reactions
Neurological injury (from hematoma formation during lumbar puncture, epidural anesthesia)

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15
Q

Nursing Interventions

heparin, enoxaparin

A

For heparin overdose, stop heparin and administer protamine, which binds to heparin to form a heparin-protamine complex that has no anticoagulant properties
Administer IV protamine no faster than 20mg/min or 50 mg in 10 minutes
Monitor vital signs, checking for hypotension and tachycardia
Monitor activated partial thromboembolism time (aPTT), making sure it is no higher than twice the baseline value
Monitor platelet count periodically throughout treatment, especially in the first month
Stop heparin for for platelet counts below 100,000/mm3 and administer a non-heparin anticoagulant, such as lepirudin
Administer a small test dose first
Monitor for itching and rash or hives
Monitor for spinal insertion site for signs of hematoma formation, such as bruising or swelling
Monitor sensation and movement of lower extremities

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16
Q

Herbal Interactions

heparin, enoxaparin

A

Ginger, ginko biloba, feverfew, and evening primrose oil increase bleeding risk

17
Q

Therapeutic Use

Vitamin K antagonist - warfarin

A

Prevention of venous thrombosis, PE during atrial fibrillation
Prevention of thromboembolism in clients who have prosthetic heart valves
Prevention or recurrent MI and TIA

18
Q

Adverse Effects

Vitamin K antagonist - warfarin

A 
Hemorrhage
Toxicity (overdose)
19
Q

Medication Administration

Vitamin K antagonist - warfarin

A

Administer orally
Measure baseline vital signs and prothrombin time (PT), reported as an international normalized ratio (INR)
Monitor INR; recommend reduced dosage for an INR above 2 to 3, depending on condition being treated, and an increased dosage for an INR below that range
Monitor PT/INR daily initially and eventually every 2 to 4 weeks
Expect anticoagulant effects to take 8 to 12 hr, with the full therapeutic effects in 3 to 5 days

20
Q

Nursing Interventions

Vitamin K antagonist - warfarin

A

For warfarin overdose, stop the drug an administer vitamin K parenterally, usually IV
Monitor vital signs, checking for hypotension and tachycardia
Check hematocrit and blood counts
Administer vitamin K to promote synthesis of of coagulation factors VII, IX, X, and prothrombin
Administer IV vitamin K slowly and in a diluted solution to prevent serious reactions
Administer small doses of vitamin K (2.5 mg by mouth, 0.5 to 1 mg IV) to prevent development resistance to warfarin
If vitamin K cannot control bleeding, administer fresh frozen plasma or whole blood

21
Q

Client Education

Vitamin K antagonist - warfarin

A

Stop taking the drug for signs of hemorrhage
Report bruising, petechiae, hematoma, or black tarry stool immediately
Wear medical identification indicating warfarin use
Avoid excessive alcohol ingestion
Tell clients to record the dosage, route, and time of warfarin administration on a daily basis
Make sure clients watch for and report signs of bleeding (bruising, gums bleeding, abdominal pain, nosebleeds, coffee-ground emesis, tarry stools)
Tell them not to take over the counter NSAIDs, especially aspirin, or drugs containing salicylates
Advise them to use an electric razor for shaving and a soft tooth brush
Avoid foods that contain vitamin K

22
Q

Interaction

Vitamin K antagonist - warfarin

A

Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins increase anticoagulation
Phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decrease anticoagulation
Excessive intake of foods high in vitamin K, such as dark green leafy vegetables including cabbage, broccoli, and Brussel sprouts, mayonnaise, canola, and soybean oils decrease anticoagulation
Warfarin interacts with many other prescription and over-the-counter drugs, foods, and herbals, so clients should check with their primary care provider and pharmacist to make sure no other interactions apply

23
Q

Medication Administration

aspirin

A

Make sure clients swallow enteric-coated or sustained release forms whole and do not crush or chew them
Discontinue 1 week before scheduled surgery
Monitor for initial and continued therapeutic effects

24
Q

Client Education

aspirin

A

Take with food or milk to minimize GI upset
Avoid alcohol
Report GI irritation or signs of bleeding
Report changes in urine output, weight gain, or S&S fluid retention such as edema or bloating
Report ringing or buzzing in the ears, sweating, headache, and dizziness (stop taking aspirin for these symptoms)
Do not give aspirin to children under 18

25
Q

Medication Administration

ADP Inhibitors - clopidogrel

A

Give daily dose orally, with or without food
Check platelet counts periodically
Discontinue 1 week before elective surgery

26
Q

Interactions

ADP Inhibitors - clopidogrel

A

Anticoagulants, NSAIDs, glucocorticoids, and alcohol increase bleeding risk
Proton pump inhibitors (PPI) reduce antiplatelet effects
Herbal supplements ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding risk

27
Q

Therapeutic Use

Thrombolytics - alteplase

A 
Acute myocardial infarction
Deep-vein thrombosis
Massive pulmonary emboli
Ischemic cerebrovascular accidents
Reestablishing patency of occluded central IV catheters
28
Q

Medication Administration

Thrombolytics - alteplase

A

Administer via IV infusion
Give thrombolytic agents within onset of symptoms (less than 2 hours for MI, 3-4.5 hours for CVA)
Obtain baseline vitals platelet counts, HgB, Hct, PTT, PT, INR, and fibrinogen levels, and monitor periodically
Obtain baseline vital signs and monitor continuously
Ensure adequate IV access for emergency drugs; have emergency equipment available (before treatment starts)
Following thrombolytic therapy, administer heparin or aspirin to reduce the risk of repeat thrombosis
Use a special form (Cathflo Activase) to open occluded IV catheters

29
Q

Nursing Interventions

Thrombolytics - alteplase

A

Limit venipuncture and injections
Apply pressure dressing to recent wounds
Monitor vital signs and signs of intracranial bleeding (level of consciousness, headache, unilateral weakness)
Monitor aPTT, PT, INR, bleeding time, HgB, and Hct
For severe bleeding, discontinue the drug and administer blood products. If bleeding continues, administer aminocaproic acid (Amicar)

30
Q

Therapeutic Use

Erythropoiesis Stimulating Agents - epoetin alfa

A

Supports production of erythrocytes in: chronic renal failure, preoperative anemia, chemotherapy, zidovudine (Retrovir) therapy for HIV

31
Q

Adverse Effects

Erythropoiesis Stimulating Agents - epoetin alfa

A

Hypertension
Seizures
Cardiovascular and CVA events (MI, HF, CVA, cardiac arrest)
Malignancy progression

32
Q

Nursing Interventions

Erythropoiesis Stimulating Agents - epoetin alfa

A

Monitor HgB and BP
For hypertension, recommend antihypertensive drugs; if still high, recommend a lower epoetin alfa dosage
Administer the lowest possible dose to support erythropoiesis
Do not give drug to cancer clients with Hgb above 10 g/dL
Monitor for tumor progression

33
Q

Adverse Effects

Leukopoietic Growth Factor - filgrastin

A

Leukocytosis
Bone pain and fever
Splenomegaly (long term use)

34
Q

Nursing Interventions

Leukopoietic Growth Factor - filgrastin

A

Monitor CBC twice a week during treatment
Give a lower dose or stop treatment with a WBC above 10,000/mm3
Monitor the degree of bone pain
Monitor temperature
Give acetaminophen or opioid analgesics
Monitor for spleen enlargement

35
Q

Therapeutic Use

Thrombopoietic Growth Factor - oprelvekin

A

Thrombocytopenia from myelosuppressive chemotherapy for nonmyeloid cancers

36
Q

Adverse Effects

Thrombopoietic Growth Factor - oprelvekin

A

Cardiac dysrhythmia (atrial fibrillation and flutter, tachycardia)
Fluid retention
Allergic reactions
Conjunctival injection, transient blurring of vision, papilledema

Pharmacology (9 decks)

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