Lewis 34 - Hematologic Disorders

Question 1

MOA/Class

deferoxamine, deferasirox, deferiprone

Answer 1

Binds to the iron for excretion by the kidneys

Chelating agent / heavy metal antagonist

Tucker 49

Question 2

Side Effects

deferoxamine, deferasirox, deferiprone

Answer 2

red urine, abdominal pain, ototoxicity, oculotoxicity

Tucker 49

Question 3

Nursing Considerations

deferoxamine, deferasirox, deferiprone

Answer 3

Monitor urine output

Tucker 49

Question 4

Indications

deferoxamine, deferasirox, deferiprone

Answer 4

Iron overload

Tucker 49

Question 5

MOA/Class

hydroxyurea

Answer 5

Myelosuppression. (Inhibits reticulocyte production.)

Question 6

Side Effects

hydroxyurea

Answer 6

Bone marrow suppression.

Question 7

Nursing Considerations

hydroxyurea

Answer 7

Risk for infection, bleeding, low SpO2/fatigue.

Question 8

Indications

hydroxyurea

Answer 8

Polycythemia, sickle cell anemia, hematologic cancers

Question 9

MOA/Class

Aspirin (ASA)

Answer 9

Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.

Salicylate

Tucker 16

Question 10

Side Effects

Aspirin (ASA)

Answer 10

GI upset, bleeding, salicylism

Tucker 16

Question 11

Nursing Considerations

Aspirin (ASA)

Answer 11

Risk for Reye’s syndrome when given to children or with concurrent chicken pox or influenza.
Salicylism manifestations - tinnitus, sweating, headache, dizziness, acidosis. Give activated charcoal and/or bicarbonate.
Dose of 81 mg is typically for antiplatelet activity. May give larger dose for antiplatelet effect in acute situations (i.e., active MI).
Risk for hypersensitivity in patients with asthma and/or nasal polyps.

Tucker 16

Question 12

Indications

Aspirin (ASA)

Answer 12

Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention

Tucker 16

Question 13

MOA/Class

allopurinol

Answer 13

Inhibits the production of uric acid by inhibiting xanthine oxidase.

Xanthine oxidase inhibitor

Tucker 16

Question 14

Side Effects

allopurinol

Answer 14

Rash - discontinue use immediately if rash develops.

Tucker 16

Question 15

Nursing Considerations

allopurinol

Answer 15

Increased risk of bleeding when given with warfarin.
Maintain hydration to avoid renal calculi.

Tucker 16

Question 16

Indications

allopurinol

Answer 16

Hyperuricemia
(Gout, high levels of cell destruction [i.e., cancer treatment])

Tucker 16

Question 17

MOA/Class

Prednisone, methylprednisolone

Answer 17

Steroids stabilize leukocytes (WBCs) preventing the release of intracellular chemical/inflammatory mediators

Systemic glucocorticoid/corticosteroid

Tucker 36

Question 18

Side Effects

Prednisone, methylprednisolone

Answer 18

Growth suppression, elevated blood glucose, weight gain
GI upset (tolerated best in AM with food/milk)
Osteoporosis (long-term use)

Tucker 36

Question 19

Nursing Considerations

Prednisone, methylprednisolone

Answer 19

Taper dose when stopping to prevent adrenal insufficiency

Tucker 36

Question 20

Indications

Prednisone, methylprednisolone

Answer 20

Used to decrease inflammation/immune responses.

Tucker 36

Question 21

MOA/Class

azathioprine, cyclosporine, tacrolimus

Answer 21

Suppresses cell-mediated immunity

Immunosuppressant

Tucker 17

Question 22

Side Effects

azathioprine, cyclosporine, tacrolimus

Answer 22

Bone marrow suppression. Hepatotoxicity.

Tucker 17

Question 23

Nursing Considerations

azathioprine, cyclosporine, tacrolimus

Answer 23

Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice.

Tucker 17

Question 24

Indications

azathioprine, cyclosporine, tacrolimus

Answer 24

Crohn’s disease/UC, transplant rejection, RA

Tucker 17

Question 25

# MOA/Class alendronate, zolendronate acid

Answer 25

Slows bone resorption (degeneration) ## Footnote Tucker 37

Question 26

# Side Effects alendronate, zolendronate acid

Answer 26

GI and musculoskeletal pain, constipation, esophageal burns ## Footnote Tucker 37

Question 27

# Nursing Considerations alendronate, zolendronate acid

Answer 27

Take on an empty stomach 30-60 minutes before food. Adminsitered with a full glass of water. Remain upright 30 minutes after administration. Ensure adequate calcium intake during therapy. ## Footnote Tucker 37

Question 28

# Indications alendronate, zolendronate acid

Answer 28

osteoporosis, Paget's disease, multiple myeloma, hypercalcemia ## Footnote Tucker 37

Question 29

# MOA/Class filgrastim

Answer 29

Increases the production of neutrophils in the bone marrow. | Colony stimulating factor ## Footnote Tucker 17

Question 30

# Side Effects filgrastim

Answer 30

N/V, generalized pain, bone pain ## Footnote Tucker 17

Question 31

# Nursing Considerations filgrastim

Answer 31

Teach and implement good infection control mechanisms. Monitor absolute nuetrophil count (ANC). Implement neutropenic precautions for ANC <1. Most effective when given at least 24 hours after myelosuppressive therapies. ## Footnote Tucker 17

Question 32

# Indications filgrastim

Answer 32

Neutropenia associated with bone marrow transplants, chemo, and blood-related cancers. ## Footnote Tucker 17