Hematology meds

Question 0

Heparin

Answer 0

Anticoagulant

Treatment of venous thrombosis, pulmonary embolism, thromboembolic complications. Prevents formation of clot or worsening of present clot. Does not dissolve clots already present.

• Subq and IV administration.
• Most serious adverse effect is the risk for serious bleeding episodes. Also monitor for severe hypotension, injection site reactions, thrombocytopenia and anaphylaxis.
• Monitor aPTT (Activated Partial Thromboplastin Time). In general the Heparin dosage is adjusted to keep the aPTT between 1.5 and 2.5 times the normal control level.
• Antidote is Protamine Sulfate.

Question 1

Antiplatelets

Answer 1

Common examples: Aspirin, Clopidogrel, (Plavix), Ticlopidine (Ticlid), Tirofiban (Aggrastat), Abciximab (ReoPro), Anagrelide HCl (Agrylin), Eptifibatide (Integrilin), Dipyridamole (Persantine)

Uses: Decrease platelet aggregation, most effective against arterial thrombi.
Useful in the prevention of thrombotic stroke, TIAs, and post-MI thrombi.

• Most serious adverse effect is the risk for serious bleeding episodes. Other associated adverse effects include: GI complaints, tinnitus, dizziness, thrombocytopenia and agranulocytosis
• Should not be taken if patient has a bleeding peptic ulcer, or any active bleeding.
• Discontinue 7 days prior to surgery

Question 2

Lovenox

Answer 2

Anticoagulant

Low molecular weight heparin, for thromboembolism. Prevents and treats DVT and pulmonary embolism. Useful in the treatment and prevention of clot formation after certain types of surgeries including hip and knee replacements.

• • Subq administration.
• Adverse effects less likely than with Heparin, monitor for serious bleeding episodes.
• Monitor aPTT.

Question 3

Coumadin

Answer 3

Anticoagulant

Primarily oral anticoagulant. Treatment of DVT, pulmonary embolism, TIA, and prophylactic for cardiac valves. Prevents formation of clot or worsening of present clot. Does not dissolve clots already present.

• Most serious adverse effect is the risk for serious bleeding episodes, also monitor for hypersensitivity reactions, bronchospasms and anaphylaxis.
• Monitor PT (Prothrombin Time) and INR (International Normalized Ratio).
  In general, a therapeutic INR for a patient on Coumadin is 2 to 3.5 and a therapeutic PT is 1.5 to 2.5 times the control.
• Does not begin to work immediately in the body, may take several days. Patient may be started on Coumadin therapy while being weaned off Heparin or Lovenox.
  *Patients should avoid leafy green vegetables as these decrease the effectiveness of Coumadin.
• Antidote is Vitamin K.

Question 4

Thrombolytics

Answer 4

Common examples: Tenecteplase (TNKase), Reteplase (Retevase), Alteplase (tPA), Streptokinase, Urokinase

Clot busters! Work to dissolve clots following an acute MI, pulmonary embolism or acute ischemic stroke. Will dissolve any clot, including those that may serve a useful purpose.

• IV administration in controlled, monitored environment.
• Administer immediately after an event (MI, thrombotic stroke, massive pulmonary embolus, etc.) for better outcomes, generally within 4 hours.
• Most serious adverse effect is the risk for serious bleeding episodes, hemorrhage and anemia. Bleeding may last for 24- 48 hours after infusion. Also monitor for bronchospasms, anaphylaxis and reperfusion anemias.
• Antidote is Amicar.

Question 5

Plasminogen inactivator

Answer 5

Aminocaproic acid (Amicar)

Promotes clot formation. Useful in the prevention and treatment of excessive bleeding from hyperfibrinolysis.

• Adverse effects are uncommon and generally mild. Rare adverse effects include thrombophlebitis, HA, and orthostatic hypotension

Question 6

ferrous sulfate

Answer 6

Hematopoietic agent
Ferrous Sulfate: Ferosol, Slow FE
Ferrous Fumarate: Femiron
Ferrous Gluconate: Fergon

Indicated for the treatment if iron deficiency anemia

• Oral route for administration.
• Most common adverse effects include GI complaints: nausea, epigastric pain, constipation, tarry stools. Serious adverse effects include seizures and anaphylaxis
• Do not give with dairy products, antacids or tetracyclines due to decreased absorption.
• Administration with Vitamin C helps to promote absorption of iron
• Taking at bedtime helps to decrease GI effects
• Liquid preparations stain the teeth, dilute or administer with a straw.
• Therapy generally indicated for several months with follow-up lab at 4 weeks and 3 months.

Question 7

Iron dextran

Answer 7

Hematopoietic agent
Common examples: Imfed Dexferrum

Used when oral iron is not an option for the treatment of iron deficiency anemia

• IM/IV administration, IM/IV test dose required before administration. If no reaction in one hour after test dose, may give remainder of dose.
• IM route use Z-track technique to prevent brown skin discoloration at injection site.
• Contraindicated in patients with acute renal disease or active infections
• Serious adverse effects more commonly seen with IV administration include: anaphylaxis, coma, fatal cardiac arrhythmias and circulatory collapse. Monitor patient for HA, backache, fever, chills, difficulty breathing, N&V, pain at injection site and skin rash.

Question 8

Vitamin B12-cyanocobalamin

Answer 8

Hematopoietic agent
Anacobin, nascobal

Indicated for the treatment of megaloblastic anemia’s including vitamin B12 deficiency anemia, also known as pernicious anemia

• IM, SubQ, or nasal route of administration. Oral route generally ineffective
• Life-long treatment is required for Pernicious anemia.
• Generally non-toxic and large doses must be ingested to produce adverse effects, which include: fever, diarrhea, pruritis, flushing, and itching, rash or pain at injection site. More serious adverse effects include: Cardiac failure, thrombosis, optic nerve atrophy and pulmonary edema.
• Contraindicated with Leber’s disease and known allergies to cobalt.

Question 9

Folic acid, vitamin B9

Answer 9

Hematopoietic agent
Folate, folacin

Indicated for the treatment of megaloblastic anemias asoociated with folic acid deficiency. Also indicated during pregnancy to prevent neural tube defects in the fetus.

• May be given orally, IV, IM or Subq.
• Adverse effects are rare but include allergic bronchospasm, rash, pruritus, erythemas, general malaise and anaphylaxis.
• May cause urine to turn darker yellow

Question 10

Erythropoietin stimulating agents. ESAs

Answer 10

Epoetin Alfa/procrit, darbapoetin Alfa/aranesp

Indicated for anemias associated with chronic renal failure, HIV infection, chemotherapy, and to decrease the need for blood transfusions in surgical patients.

• May be given IV or Subq.
• Monitor hemoglobin. Target hemoglobin should never exceed 12g/dl
• Adverse effects rare but include: hypertension, HA, fever, muscle aches, flushing, seizures and bone pain
• Monitor BP.
• Only use one dose per vial
• Do not shake solution, it can cause the glycoprotein to denature.