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Pharmacology Spring 2021: Set 2 > Hematological Medications: Anemia Treatments > Flashcards

Hematological Medications: Anemia Treatments Flashcards

1
Q

What are the main components of the hematologic system?

A
  1. Plasma

2. Blood cells

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2
Q

What is plasma?

A

The liquid component of blood

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3
Q

What type of blood cells are there?

A
  1. RBCs
  2. WBS
  3. Platelets
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4
Q

What function do Hematinic drugs serve?

A

Provide essential components for RBC

production by increasing HGB

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5
Q

What is the function of HGB?

A

Necessary element for oxygen transportation

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6
Q

What are the different types of Hematinic drugs?

A
  1. Iron
  2. Vitamin B12
  3. Folic Acid
  4. Epoetin alfa
  5. Darbepoetin alfa, which may be used to treat some
    normocytic anemias.
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7
Q

What is Iron, vitamin B12 and folic acid used to treat?

A

Microcytic and macrocytic anemia

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8
Q

What is used Epoetin alfa to treat?

A

Some normocytic anemias

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9
Q

What form of anemia is iron used to treat?

A

iron deficiency anemia

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10
Q

What form of anemia is Vitamin B12 used to treat?

A

megaloblastic anemia caused by folic acid

deficiency

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11
Q

What form of anemia is Folic Acid used to treat?

A

pernicious anemia

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12
Q

What are some types of iron preparations used to treat anemia called?

A
  1. ferrous fumarate
  2. ferrous gluconate
  3. ferrous sulfate
  4. iron dextran
  5. iron sucrose
  6. sodium ferric gluconate complex
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13
Q

What are some types of Vitamin B12preparations used to treat anemia called?

A
  1. cyanocobalamin

2. hydroxocobalamin

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14
Q

What are some types of Folic Acid preparations used to treat anemia called?

A

It is just called folic acid

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15
Q

In what population is Megaloblastic anemia most common?

A
  1. Infants
  2. Adolescents
  3. Pregnant/lactating women
  4. Elderly persons
  5. Alcoholics
  6. Intestinal diseases
  7. Malignant diseases
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16
Q

Other than anemia, what is folic acid used for?

A

as a nutritional supplement.

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17
Q

Where is iron absorbed?

A
  1. Duodenum

2. Upper JJ

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18
Q

How are the pharmacokinetics of the different iron preparations similar?

A

Rate of absorption

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19
Q

How are the pharmacokinetics of the different iron preparations different?

A

Amount of elemental iron supplied

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20
Q

What forms of Vitamin B12 are available?

A
  1. Parenteral
  2. Oral
  3. Intranasal forms
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21
Q

At what rate is Folic Acid absorbed?

A

Rapidly

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22
Q

Where is Folic Acid absorbed?

A

First third of the small intestine

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23
Q

Where is Folic Acid distributed?

A

Into all body tissues

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24
Q

Where is Folic Acid metabolized?

A

In the liver

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25
Q

In what form is Folic Acid excreted?

A

Unchanged

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26
Q

How is Folic Acid excreted?

A
  1. Mostly urine

2. A little in feces

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27
Q

If a patient has a malabsorption syndrome will they absorb folic acid?

A

Yes

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28
Q

Is folic acid excreted in breast milk?

A

Yes

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29
Q

Iron: Iron: What’s in store?

A

The amount of iron absorbed depends partially on the body’s stores of
iron. When body stores are low or RBC production is accelerated,
iron absorption may increase by 20% to 30%. On the other hand,
when total iron stores are large, only about 5% to 10% of iron is
absorbed.

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30
Q

Iron: Form and function

A

Enteric coated preparations decrease iron absorption because, in that
form, iron isn’t released until after it leaves the duodenum. The
lymphatic system absorbs the parenteral form after IM injections.
Iron is transported by the blood and bound to transferrin, its carrier
plasma protein. About 30% of the iron is stored primarily as
hemosiderin or ferritin in the reticuloendothelial cells of the liver,
spleen, and bone marrow. About 66% of the total body iron is
contained in hemoglobin. Excess iron is excreted in urine, stool, and
sweat and through intestinal cell sloughing. Excess iron is also
secreted in breast milk.

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31
Q

Iron: Pharmacodynamics (how drugs act)

A

Although iron has other roles, its most important role is the
production of hemoglobin. About 80% of the iron in the plasma goes
to the bone marrow, where it’s used for erythropoiesis (production of
RBCs).

32
Q

Iron: Pharmacotherapeutics (how drugs are used)

A

Oral iron therapy is used to prevent or treat iron deficiency anemia.
It’s also used to prevent anemia in children ages 6 months to 2 years
because this is a period of rapid growth and development.

33
Q

Iron: Baby makes two

A

A pregnant woman may need iron supplements to replace the iron
used by the developing fetus. She should take oral iron therapy in the
form of prenatal vitamins unless she’s unable to take iron.

34
Q

Iron: An alternate route

A

Parenteral iron therapy is used for patients who can’t absorb oral
preparations, aren’t compliant with oral therapy, or have boweldisorders (such as ulcerative colitis or Crohn’s disease). Patients with
end-stage renal disease who receive hemodialysis may also receive
parenteral iron therapy at the end of their dialysis session. Parenteral
iron therapy corrects the iron store deficiency quickly; however, the
anemia isn’t corrected any faster than it would be with oral
preparations.

35
Q

Iron: Two of a kind

A

There are two parenteral iron products available. Iron dextran is given
by either IM injection or slow continuous IV infusion. Iron sucrose,
indicated for use in the hemodialysis patient, is administered by IV
infusion.

36
Q

Iron: Drug interactions

A

Iron absorption is reduced by antacids as well as by such foods as
spinach, whole-grain breads and cereals, coffee, tea, eggs, and milk
products. Other drug interactions involving iron include the
following:

Tetracycline, demeclocycline, minocycline, oxytetracycline,
doxycycline, methyldopa, quinolones, levofloxacin, norfloxacin,
ofloxacin, gatifloxacin, lomefloxacin, moxifloxacin, sparfloxacin,
ciprofloxacin, levothyroxine, and penicillamine absorption may be
reduced when taken with oral iron preparations.

Cholestyramine, cimetidine, magnesium trisilicate, and colestipol may reduce iron absorption in the GI tract.

Cimetidine and other histamine-2

37
Q

Iron: Adverse reactions

A

The most common adverse reaction to iron therapy is gastric irritation
and constipation. Iron preparations also darken the stool. The liquid
form can stain the teeth. Parenteral iron has been associated with an
anaphylactoid reaction.

38
Q

Iron: Parenteral iron

A

Before administering parenteral iron, be aware that it has been associated
with an anaphylactoid reaction. Administer initial test doses before a fulldose infusion to evaluate for potential reactions. Continue to monitor the
patient closely because delayed reactions can occur 1 to 2 days later.

39
Q

Iron: Signs and symptoms of an anaphylactoid reaction to parenteral iron
include:

A 
arthralgia
• backache
• chest pain
• chills
• dizziness
• headache
• malaise
• fever
• myalgia
• nausea
• vomiting
• hypotension
• respiratory distress.
40
Q

Iron: Assessment/Monitoring

A

Assess the patient’s iron deficiency before starting therapy.
• Monitor the iron’s effectiveness by evaluating the patient’shemoglobin level, hematocrit, and reticulocyte count.
• Monitor the patient’s health status.
• Assess for adverse reactions and drug interactions.
• Observe the patient for delayed reactions from therapy.
• Assess the patient’s and family’s knowledge of drug therapy.

41
Q

Iron: Implementation

A

Don’t give iron dextran with oral iron preparations.

42
Q

Iron: Testing, testing

A

If IM or IV injections of iron are recommended, a test dose may be
required in the facility

If administering iron IM, use a 19G or 20G needle that’s 2″ to 3″
long. Inject into the upper outer quadrant of the buttock. Use the
Z-track method to avoid leakage into subcutaneous tissue and
staining of the skin.

Minimize skin staining with IM injections of iron by using a
separate needle to withdraw the drug from its container.

IV iron is the preferred method of parenteral administration
because it results in fewer anaphylactoid reactions as well as other
adverse effects. It is also used if the patient has insufficient muscle
mass for deep IM injection, impaired absorption from muscle as a
result of stasis or edema, the potential for uncontrolled IM
bleeding from trauma (as in patients with hemophilia), or the need
for massive and prolonged parenteral therapy (as in patients with
chronic substantial blood loss).

Promote a varied diet that’s adequate in protein, calories, minerals,and electrolytes.

Encourage foods high in iron as applicable to help delay the onset
of iron deficiency anemia.

Administer IV fluids and electrolytes as necessary to provide
nutrients. Oral food intake or tube feedings are preferable to IV
therapy.

Correct underlying disorders that contribute to mineral and
electrolyte deficiency or excess.

Promote measures to relieve anorexia, nausea, vomiting, diarrhea,
pain, and other signs and symptoms

Arrange for a nutritional consult as needed.

43
Q

Iron: Evaluation

A

Patient’s hemoglobin level, hematocrit, and reticulocyte counts are
normal.

Patient doesn’t experience anaphylaxis.

Patient and his family demonstrate an understanding of drug
therapy. (See Teaching about hematinic drugs.)

44
Q

Iron: A pernicious problem

A

A substance called intrinsic factor, secreted by the gastric mucosa, is
needed for vitamin B12 absorption. People who have a deficiency of
intrinsic factor develop a special type of anemia known as vitamin
B12
-deficiency pernicious anemia. It has been the common thought
that those with pernicious anemia cannot take vitamin B12 orally
because they cannot absorb it; however, that is not the case. What is
true is that those with vitamin B12
-deficiency pernicious anemia haveseverely impaired vitamin B12 absorption; they can be treated with
oral doses of vitamin B12 but at much higher doses.

45
Q

Vitamin B12: Final destination: Liver

A

When cyanocobalamin is injected by the IM or subcutaneous route,
it’s absorbed and binds to transcobalamin II for transport to the
tissues. It’s then transported in the bloodstream to the liver, where
90% of the body’s vitamin B12 supply is stored. Although
hydroxocobalamin is absorbed more slowly from the injection site, its
uptake in the liver may be greater than that of cyanocobalamin.

46
Q

Vitamin B12: Slow release

A

With either drug, the liver slowly releases vitamin B12 as needed. It’s
secreted in breast milk during lactation. About 3 to 8 mcg of vitamin
B12 are excreted in bile each day and then reabsorbed in the ileum.
Within 48 hours after a vitamin B12
injection, 50% to 95% of the dose
is excreted unchanged in urine.

47
Q

Vitamin B12: Pharmacodynamics

A

When vitamin B12
is administered, it replaces vitamin B12
that the
body normally would absorb from the diet.

48
Q

Vitamin B12: A must for myelin maintenance

A

This vitamin is essential for cell growth and replication and for the
maintenance of myelin (nerve coverings) throughout the nervous
system. Vitamin B12 also may be involved in lipid and carbohydrate
metabolism.

49
Q

Vitamin B12: Pharmacotherapeutics

A

Cyanocobalamin and hydroxocobalamin are used to treat pernicious
anemia, a megaloblastic anemia characterized by decreased gastric
production of hydrochloric acid and the deficiency of intrinsic factor,
a substance normally secreted by the parietal cells of the gastric
mucosa that’s essential for vitamin B12 absorption.

50
Q

Vitamin B12: Common ground

A

Intrinsic factor deficiencies are common in patients who have
undergone total or partial gastrectomies or total ileal resection. Oral
vitamin B12 preparations are used to supplement nutritional
deficiencies of the vitamin.

51
Q

Vitamin B12: Drug interactions

A

Alcohol, aspirin, aminosalicylic acid, neomycin, chloramphenicol,
and colchicine may decrease the absorption of oral cyanocobalamin.

52
Q

Vitamin B12: Adverse reactions

A

No dose-related adverse reactions occur with vitamin B12
therapy.
However, some rare reactions may occur when vitamin B12
is
administered parenterally

53
Q

Vitamin B12: Don’t be so (hyper)sensitive

A

Adverse reactions to parenteral administration can include
hypersensitivity reactions that could result in mild diarrhea, itching,
transient rash, hives, hypokalemia, polycythemia vera, peripheral
vascular thrombosis, heart failure, pulmonary edema, anaphylaxis, or
even death.

54
Q

Vitamin B12: Assessment and Monitoring

A

Assess the patient’s vitamin B12 deficiency before therapy.
• Monitor the drug’s effectiveness by evaluating the patient’s
hemoglobin level, hematocrit, and reticulocyte count.
• Monitor the patient’s health status.
• Assess for adverse reactions and drug interactions.
• Observe the patient for delayed reactions to therapy.
• Assess the patient’s and family’s knowledge of drug therapy.

55
Q

Vitamin B12: Implementation

A

Promote a varied diet that’s adequate in protein, calories, minerals,
and electrolytes.
• Encourage foods high in iron as applicable to help delay the onset
of iron deficiency anemia.
• Administer IV fluids and electrolytes as necessary to provide
nutrients. Oral food intake or tube feedings are preferable to IV
therapy.
• Correct underlying disorders that contribute to mineral and
electrolyte deficiency or excess.
• Promote measures to relieve anorexia, nausea, vomiting, diarrhea,
pain, and other signs and symptoms.

56
Q

Vitamin B12: Evaluation

A

Patient’s hemoglobin level, hematocrit, and reticulocyte counts are
normal.
• Patient’s underlying condition and neurologic signs and symptoms
improve.
• Patient and his family demonstrate an understanding of drug
therapy.

57
Q

Folic Acid: Pharmacodynamics

A

Folic acid is an essential component for normal RBC production and
growth. A deficiency in folic acid results in megaloblastic anemia and
low serum and RBC folate levels.

58
Q

Folic Acid: Pharmacotherapeutics

A

Folic acid is used to treat folic acid deficiency. Patients who are
pregnant or undergoing treatment for liver disease, hemolytic anemia,
alcohol abuse, skin disorders, or renal disorders typically need folic
acid supplementation. Folic acid supplementation also reduces the
risk of neural tube defects during pregnancy and colon cancer. Serum
folic acid levels less than 5 mg indicate folic acid deficiency.

59
Q

Folic Acid: Drug interactions

A

These drug interactions may occur with folic acid:

60
Q

Folic Acid: The anti-anticonvulsant

A

Methotrexate, sulfasalazine, hormonal contraceptives, aspirin,
triamterene, pentamidine, and trimethoprim reduce the
effectiveness of folic acid.

61
Q

Folic Acid: Adverse reactions

A 
Adverse reactions to folic acid include:• erythema
• itching
• rash
• anorexia
• nausea
• altered sleep patterns
• difficulty concentrating
• irritability
• overactivity.
62
Q

Folic Acid: Assessment

A

Assess the patient’s folic acid deficiency before therapy.
• Monitor the therapy’s effectiveness by evaluating the patient’s
hemoglobin level, hematocrit, and reticulocyte count.
• Monitor the patient’s health status.
• Assess for adverse reactions and drug interactions.
• Observe the patient for delayed reactions to therapy.
• Assess the patient’s and family’s knowledge of drug therapy.

63
Q

Folic Acid: Implementation

A

Promote a varied diet that’s adequate in protein, calories, minerals,
and electrolytes.
• Administer IV fluids and electrolytes as necessary to provide
nutrients. Oral food intake or tube feedings are preferable to IV
therapy.
• Correct underlying disorders that contribute to mineral and
electrolyte deficiency or excess.
• Promote measures to relieve anorexia, nausea, vomiting, diarrhea,
pain, and other signs and symptoms.
• If using the IM route, don’t mix folic acid and other drugs in the
same syringe.

64
Q

Folic Acid: Evaluation

A

Patient’s hemoglobin level, hematocrit, and reticulocyte counts arenormal.
• Patient’s underlying condition improves.
• Patient and his family demonstrate an understanding of drug
therapy.

65
Q

Epoetin alfa and darbepoetin alfa General Information

A

Erythropoietin is a substance that forms in the kidneys in response to
hypoxia (reduced oxygen) and anemia. It stimulates RBC production
(erythropoiesis) in the bone marrow. For the patient experiencing
decreased erythropoietin production, epoetin alfa and darbepoetin alfa
are glycoproteins that are used to stimulate RBC production.

66
Q

Pharmacokinetics

A

Epoetin alfa and darbepoetin alfa may be given subcutaneously or IV.

67
Q

Reaching the peak

A

After subcutaneous administration, peak serum levels of epoetin alfa
occur in 5 to 24 hours. The peak level of darbepoetin alfa occurs
within 24 to 72 hours. The circulating half-life is 4 to 13 hours for
epoetin alfa and 49 hours for darbepoetin alfa. The therapeutic effect
of these drugs lasts for several days after administration. They’re
eliminated through the kidneys.

68
Q

Pharmacodynamics

A

Patients with conditions that decrease erythropoietin production (such
as chronic renal failure) typically develop normocytic anemia.
Epoetin alfa and darbepoetin alfa are structurally similar to
erythropoietin. Therapy with these drugs corrects normocytic anemia
within 5 to 6 weeks.

69
Q

Pharmacotherapeutics

A

Epoetin alfa is used to:
• treat patients with anemia associated with chronic renal failure
• treat anemia associated with zidovudine therapy in patients with
human immunodeficiency virus infection
• reduce the need for allogenic blood transfusions in patients
undergoing surgery.
Darbepoetin alfa is indicated for anemia associated with chronic
renal failure.

70
Q

Drug interactions

A

No known drug interactions exist.

71
Q

Adverse reactions

A 
Hypertension is the most common adverse reaction to epoetin alfa and
darbepoetin alfa. Other common adverse reactions may include:
• headache
• joint pain
• nausea and vomiting
• edema
• fatigue• diarrhea
• seizures
• chest pain
• skin reactions at the injection site
• stroke
• dizziness
• deep vein thrombosis (DVT)
• transient ischemic attack.
72
Q

Stop the presses!

A

Both epoetin alfa and darbepoetin alfa increase the risk of pure redcell aplasia, myocardial infarction (MI), heart failure, stroke, cardiac
arrest, and other cardiovascular events. In addition, both drugs can
accelerate tumor growth and shorten lifespan in some oncology
patients.

73
Q

Assessment

A

Assess the patient’s iron deficiency before starting therapy.
• Monitor the drug’s effectiveness by evaluating the patient’s
hemoglobin level, hematocrit, and reticulocyte count.
• Monitor the patient’s health status.
• Assess vital signs, especially blood pressure.
• Assess for adverse reactions and drug interactions.
• Observe the patient for delayed reactions to therapy.
• Assess the patient’s and family’s knowledge of drug therapy.

74
Q

Implementation

A

Give the IV form of the drug by direct injection.
• Additional heparin may be needed to prevent blood clotting if the
patient is on dialysis.
• Promote a varied diet that’s adequate in protein, calories, minerals,
and electrolytes.

75
Q

Delaying tactics

A

Encourage foods high in iron as applicable to help delay the onsetof iron deficiency anemia.
• Administer IV fluids and electrolytes as necessary to provide
nutrients. Oral food intake or tube feedings are preferable to IV
therapy.
• Correct underlying disorders that contribute to mineral and
electrolyte deficiency or excess.
• Promote measures to relieve anorexia, nausea, vomiting, diarrhea,
pain, and other signs and symptoms.
• Administer supplementation as necessary.

76
Q

All Hematinic drugs: Teaching about hematinic drugs

A

If hematinic drugs are prescribed, review these points with the patient and
his caregivers:
• The best source of minerals and electrolytes is a well-balanced diet that
includes a variety of foods.
• Don’t take over-the-counter preparations, other drugs, or herbal
remedies without first talking to the prescriber or a pharmacist. Adverse
interactions can occur with hematinic drugs. For example, herbal
preparations of chamomile, feverfew, and St. John’s wort may inhibit ironabsorption.
• Keep all mineral and electrolyte substances out of the reach of children;
accidental overdose can occur.
• Keep follow-up appointments for periodic blood tests and procedures to
make sure treatment is appropriate.
• Take the drug as prescribed. Iron supplements should be taken with or
after meals with 8 oz (237 mL) of fluid.
• Don’t crush or chew slow-release tablets or capsules. Liquid
preparations can be diluted with water and sipped through a straw.
• Rinse the mouth after taking liquid preparations to prevent staining of
the teeth.
• Iron preparations may cause dark green or black stools.
• Get plenty of rest and rise slowly to avoid dizziness. Take rest periods
during the day to conserve energy.

Pharmacology Spring 2021: Set 2 (14 decks)

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