Lecture Hematopoesis Flashcards
Epoetin alfa (epogen, Procrit) is synthetic ___.
erythropoietin which increases Hct and Hgb.
Epoetin alfa (procrit) is used to treat __.
anemia associated with chronic renal failure & Chemotherapy.
Epoetin alfa is contraindicated when Hgb is ___.
11 d/t increased risk of adverse effects.
Hgb should not be increased more than 1g/dL in two weeks time (i.e. SLOWLY)
AE of epoetin alfa include:
HTN, TIA, MI, thrombolic events
HTN must be controlled before epoetin is given!
So before administration of epoetin alfa (Procrit) the nurse should:
Check for HTN ctrl
Check transferrin ≥ 20%
Check ferritin ≥ 100
(iron stores)
monitor for thrombosis!
This medication will increase neutrophil production in the bone marrow.
Filgrastim (Neupogen)
Usually given SubQ, but can be given IV
Usually given 24 hours after a chemotherapy session because the antineoplastic drugs produce opposite effects
Filgrastim (Neupogen) is usually discontinued when __.
ANC count is 10,000 or greater
it shortens the length of time of neutropenia
Nursing 101 for Filgrastim
Adverse Effects:
N/V, bone pain (tx with analgesics), watch out for leukocytosis
Nursing 101
Notify if history of hypersensitivity to proteins derived from E. coli
Baseline laboratory tests, including
1. CBC with differential and
2. platelet count
Monitor patients with preexisting cardiac conditions
Monitor temperature every 4 hours
Assess the degree of bone pain
Do not shake the medication vial or syringe
platelet enhancer that works by stimulating the synthesis and maturation of megakaryocytes into platelets
Oprelvekin (Neumega)
Dosing started 6-24 hours after chemo and daily until platelet count is > than 50,000..plts will remain elevated 7 days after the last dose.
Using this drug decreases the need for a platelet transfusion
Nursing 101 for Oprelvekin (Neumega)
AE:
N/V, fluid retention, anaphylaxis, caution in patients with heart failure, papilledema (swelling of optic nerve…lead to blindness)
Nursing 101
Watch for HTN d/t fluid retention
Frequent eye exams may be needed r/t papilledema
Iron deficient anemia can be caused by __.
Blood loss
Hemolysis
Bone marrow dysfunction - Deficiency of substances essential for RBC formation and maturation
anemia is a decrease in the number, size, or hemoglobin content of RBCs
Choice of therapy for iron deficiency anemia depends on:
etiology and severity.
Mild anemia - Increase iron-rich foods
Moderate anemia - Oral iron supplements
s/s: pallor, fatigue
Severe anemia - Parenteral iron therapy
s/s: tachycardia, dyspnea, angina
Administration of iron salts can rapidly reverse symptoms of iron deficiency anemia.
Ferrous sulfate
iron supplement
After absorption, most iron is used by the body to make hemoglobin
Give with Vit C to enhance absorption (OJ)
Interacts with
Antacids, proton pump inhibitors, or calcium supplements
also Tetracyclines, fluoroquinolones
Adverse effects of Ferrous sulfate include:
Nausea and vomiting
Brown stains on teeth from liquid
Darkened stools
Constipation - Add fluid and fiber to diet to counteract this
Instructions for administration of Ferrous sulfate
Give on an empty stomach, if possible. This is a hard medicine to take w/o food.
Better to lower dose than take with food!!
Monitor bowel movements. Monitor the older adult for constipation. Increase the amount of fluids and soluble fiber in the diet if occurs.
Keep iron preparations in a secured location if there are young children in the household
Watch for Toxicity
Dark green or black stools are a harmless side effect
Ferrous sulfate toxicity
Deferoxamine (Desferal)
s/s: N/V/D, shock, acidosis, pulmonary edema, vasomotor death
Ferrous sulfate cousin drugs:
Oral iron salts
Enteric coating so they dissolve in the intestine leading to less gastric irritation, but they may dissolved after the drug has passed the duodenum (site of iron absorption)
Parenteral iron salts
Malabsorption disorder
Intolerance to oral iron, CKD on chronic hemodialysis
Includes Iron Dextran [INFeD, DexFerrum], Sodium Ferric Gluconate Complex, iron sucrose, ferumoxytol
Pernicious anemia
Megaloblastic anemia
Usually malabsorption of B12 with alcoholism or Crohn’s disease
Occurs when hematopoietic stem cells produce abnormally large erythrocytes that do not mature
Symptoms develop slowly and involve the nervous system.
Early s/s: paresthesia, decrease deep tendon reflexes
Later s/s: memory loss, mood changes, psychoses
Treated with vitamin B12 (Cyanocobalamin)
Folic acid (folate)
essential for normal DNA and RNA synthesis.
Does not require intrinsic factor for intestinal absorption
Most common cause of deficiency is insufficient dietary intake usually d/t alcoholism
Cyanocobalamin (Nascobal)
a vitamin supplement used to treat B12 deficiency anemia
AE include:
hypokalemia - so monitor Potassium level
Sodium retention - may worsen heart failure
Monitor for edema or s/s of HF
It is important to ask about ___ before administration of Cyanocobalamin.
cobalt allergy and alcohol use
test dose for cobalt reaction
ETOH decreases absorption. Often decides form of administration/route: 1. Oral – not for alcohol or Crohn’s 2. Sublingual 3. Intranasal 4. Injection
