Hematology: Anemia Drugs Flashcards
What is the primary function of bones? List the types of blood cells.
- Formation of new blood cells
~ Red blood cells (RBCs)
» Erythropoiesis
~ White blood cells (WBCs)
~ Platelets
Describe RBCs.
- Manufactured in bone marrow
- More than one third of a RBC is made of hemoglobin
Describe anemia.
- Excessive destruction of RBCs (hemolytic anemias)
- Underlying causes of anemia are red blood cell (RBC) maturation defects and factors secondary to excessive RBC destruction
List an example of an Erythropoiesis-Stimulating Agent (ESAs).
Epoetin alfa
Epoetin alfa drug profile?
- Biosynthetic form of the natural hormone erythropoietin
- Most patients receiving epoetin alfa need to also receive an oral or intravenous (IV) iron preparation
Epoetin alfa indication?
Therapeutic goal is to elevate RBCs which would decrease the need for blood transfusions
Epoetin alfa contraindication?
- patients w/ uncontrolled HTN
- hemoglobin levels above 10 g/dL for cancer patients
Epoetin alfa adverse effects?
CV: HTN
MSK: arthralgia
DERM: pruritus, transient rash
MISC: fever, headache, and injection site reaction
Epoetin alfa drug interactions?
May increase requirement for heparin during hemodialysis (for those w/ ESRD)
Epoetin alfa nursing considerations?
- Monitor BP before and during therapy; notify HCP if severe HTN is present or if BP starts to increase
- Monitor for symptoms of anemia
- Monitor CBC; may cause an increase in WBCs and platelets
- Monitor serum ferritin and iron levels to assess the need for concurrent therapy
- Implement seizure precautions if needed
- DO NOT shake the vial; inactivation of the medication may occur
Epoetin alfa patient education?
- Notify HCP immediately of cues of blood clots
- For women, discuss the possible return of menses
- For CKD patients, stress the importance of compliance w/ dietary restrictions (high iron and low potassium)
Describe iron.
- Oxygen carrier
- Stored in the liver, spleen, and bone marrow
- Iron deficiency results in anemia
- Dietary iron must be converted by gastric juices before it can be absorbed
How is iron adminstered?
Oral & Parenteral
List the types of Oral Iron.
- Oral iron preparations are available as ferrous salts
~ Ferrous fumarate
~ Ferrous sulfate
~ Ferrous gluconate
List the types of Parenteral Iron.
- Parenteral
~ Iron dextran
~ Iron sucrose
~ Ferric gluconate
Iron indication?
- Prevention and treatment of iron-deficiency syndromes
- Alleviates the symptoms of iron-deficiency anemia
Iron contraindications?
- Anemia not d/t iron deficiency
- Hemochromatosis
- Hypersensitivity to iron products
- Take cautiously in: alcoholism, severe renal impairment, severe hepatic impairment
Iron adverse effects?
- GI: black, tarry stools
- Liquid oral preparations may stain teeth
- Injectable forms cause pain upon injection
How to manage iron toxicity/overdose?
Antidote is deferoxamine
Ferrous Sulfate drug profile?
- Most frequently used oral iron
- 300 mg BID or TID for adults
- Each tablet contains 65 mg of elemental iron
Ferrous Fumarate drug profile?
- Contains largest amount of iron per gram of salt consumed
- Ferrous salts are contraindicated in clients with liver disease and GI disorders
Iron dextran drug profile?
- May cause anaphylactic reactions, including major orthostatic hypotension
- A test dose of 25 mg is administered before injecting full dose, then remainder is given after 1 hour
Ferric gluconate drug profile?
- Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis
- Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required
- Doses higher than 125 mg are associated with increased adverse events
Iron Sucrose drug profile?
- Adverse effects: hypotension (r/t infusion rates)
- Infuse over 2.5 to 3.5 hours
Folic acid drug profile?
- Should not be used until actual cause of anemia is determined
- Goal is to restore and maintain normal hematopoiesis
- Antacids should be given 2 hours after folic acid
Folic acid indication?
- Prevention and treatment of megaloblastic anemia, and macrocytic anemias
- Given during pregnancy to promote fetal development
Folic acid contraindication?
Hypersensitivity and uncorrected anemias (neurological damage)
Describe Cyanocobalamin (Vitamin B12).
- Used to treat megaloblastic anemias
- Administered orally or intranasally to treat vitamin B12 deficiency
- Usually administered by deep intramuscular injection
Folic acid drug interactions?
- oral contraceptives
- corticosteroids
- sulfonamides
can cause folic acid deficiency
Folic acid PO pills nursing considerations and patient educations?
- Administer oral folic acid with food
- Keep away from children because oral forms may look like candy
Iron PO Liquids nursing considerations?
- Take through a straw to avoid staining tooth enamel
- Give w/ ascorbic acid (OJ) to increase absorption
- Remain upright for 15 to 30 minutes after oral iron doses
- Eat foods high in iron and folic acid
Iron Parenteral and IM nursing considerations?
- For IM, administer deep into a large muscle mass using the Z-track method
~ Give in vastus lateralis
