Heme/Immune Flashcards
Factors Essential to Producing Healthy RBCs
Adequate amounts of iron
To form hemoglobin rings to carry the oxygen
Minute amounts of vitamin B12 and folic acid
To form a supporting structure that can survive being battered through blood vessels for 120 days
Essential amino acids and carbohydrates
To complete the hemoglobin rings, cell membrane, and basic structure
Epoetin Alfa (Epogen, Procrit)
Classification: Hematopoietic growth factor
Indications: Treats anemia associated with chronic renal failure, to reduce the need for allogenic blood transfusions in surgical patients, chemotherapy and other bone marrow suppression states
Actions: Natural glycoprotein that stimulates red blood cell production in the bone marrow
Route: Sub-Q or IV
***NOT to be used for patients: Iron deficiency anemia, folate deficiency, hemolysis, GI bleeding in HIV-positive patients with cancer.
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Epoetin Alfa (cont.d)
Contraindications
Uncontrolled hypertension
Hypersensitivity to albumin
Adverse Effects
Most common- hypertension & thrombotic events (in Chronic Kidney Disease), fever.
Seizures (if raising Hgb too quickly, i.e. 1g/dL in 2-week period)
Nursing Implications
Monitor blood pressure before erythropoietin therapy
Do not shake solution because it may denature the glycoprotein
Monitor hematocrit and serum iron
Monitor for seizures (rapid increase in Hct increases risks)
Epoetin Alfa Effectiveness
The first evidence that epoetin alfa is producing a positive response is an increase in the reticulocyte (immature RBC) count within 10 days. Then within 2-6 weeks an increase in the RBC count and Hgb levels are noted.
***It contains albumin
Neutropenia Protective Isolation Measures
Protective isolation measures: mask, minimizing visitors (especially when sick), washing hands, avoid fresh fruits and veggies (cooked) that need to be be peeled. Bananas, apples without peel are okay. No plants/flowers
Filgrastim (Neupogen)
Classification: recombinant Granulocyt, Colony-Stimulating Factors (G-CSF)
Indications: cancer patients receiving myelosuppressive chemotherapy, drug-induced neutropenia, AIDS neutropenia, or idiopathic neutropenia
Actions: stimulates and mobilizes progenitor cells for neutrophils into the peripheral blood WBC production
Contraindications: hypersensitivity to E. coli-derived proteins or any product components
Filgrastim (Neupogen) cont.d
Adverse Effects:
Medullary bone pain (long bones, hips, etc.)
Difficult to identify adverse effects due to effects of chemotherapy or symptoms of disease
Nursing Implications:
Avoid shaking, keep refrigerated
Do not decrease dose before expected neutrophil nadir*
Neutropenic precautions
Oprelvekin (interleukin-11)
Neumega (mega means grow)
Alters hematopoietic activity and stimulates the production of platelets
Pharmacotherapeutics
Used to prevent severe thrombocytopenia.
Contraindications and precautions
Hypersensitivity
Adverse effects
Nausea, vomiting, fluid retention, and weight gain*
*** Assess for CHF, pleural or pericardial effusion/Assess potassium intake. Can cause hypokalemia.
Oprelvekin: Planning & Interventions
Monitor the patient’s platelet count throughout oprelvekin therapy.
Therapy is effective if the platelet count rises to normal and severe bleeding is prevented.
Oprelvekin is safe to administer to children of any age?
False
The safety has not been established in children under the age of 12.
interferon alfa-2a
Produced by recombinant DNA technology using Escherichia coli bacteria.
Used for Hairy cell leukemia, Kaposi sarcoma and chronic hepatitis.
Inhibits the growth of tumor cells, prevents these cells from multiplying, and modulates the host immune response.
Adverse effects
Dizziness, confusion, lethargy, flu-like symptoms, anorexia, nausea, and changes in taste, hypotension, hypertension, edema, arrhythmias, mylosuppression, increased hepatic enzymes, rash, dry skin, partial alopecia, glucose intolerance
Monitor the patient’s labs before interferon-alfa 2a therapy and at least monthly during therapy.
Drugs That Are Cell Cycle–Specific: 5-fluorouracil (5-FU, Adrucil).
Adverse effects
Myelosuppression, evidenced by anemia, leukopenia, and thrombocytopenia
Patient and family education
Explain that 5-FU requires special precautions to prevent chemotherapy from coming into accidental contact with patients or others.
Explain side effects of medications.
Ongoing assessment and evaluation
Monitor the patient’s complete blood counts (CBCs) closely during each drug administration cycle.
