Module 10A Agents to Treat Anemia Flashcards
Blood Components
Plasma
◦ The liquid part of blood; contains proteins
essential for the immune response and blood
clotting
Formed Elements of the Blood
◦ Leukocytes (WBCs): Part of the immune system
◦ Erythrocytes (RBCs): Carry oxygen to the tissues
and remove carbon dioxide
◦ Platelets: Part of clotting system
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
Types of Anemia
Iron Deficiency Anemia
◦ A negative iron balance occurs Megaloblastic Anemia ◦ Folic acid deficiency ◦ Vitamin B12 deficiency ◦ Pernicious Anemia Sickle Cell Anemia ◦ Chronic hemolytic anemia that occurs almost exclusively in African Americans
Persons at Risk for Iron
Deficiency Anemia
Menstruating women who lose RBCs monthly
Pregnant and nursing women who have increased demands for iron
Rapidly growing adolescents, especially those who do not have a nutritious diet
Persons with GI bleeding
Use of Drugs Used to Treat
Anemias Across the Lifespan
Children
adult and Older adults
◦ Ensure proper nutrition
◦ Safety and efficacy not established for epoetin alfa
Children
◦ Dosage based on age and weight
◦ Drink iron through straw
◦ Monitor for iron toxicity
Adults
◦ Use appropriate measures to prevent constipation
for iron replacement
◦ Increased demand during pregnancy/lactation;
may need supplementation
◦ Epoetin alfa/darbepoetin not recommended
during pregnancy/lactation
Older Adults
◦ Nutritional problems related to aging increase
risk of deficiencies
◦ Bowel program for constipation
Erythropoiesis-Stimulating
Agents
Stimulate the bone marrow to make more RBC’s
◦ Epoetin Alfa
◦ Treats anemia associated with renal failure and AIDS, decreases need for blood transfusions in patients undergoing surgery
◦ Darbopoetin Alfa
◦ Treats anemia associated with chronic renal failure, including patients on dialysi
Erythropoiesis-Stimulating
Agents
Actions
indication
action
◦ Acts like the natural glycoprotein erythropoietin to stimulate the production of RBC’s in the bone
marrow
Indications
◦ Treats anemia associated with chronic renal failure to reduce the need for allogenic blood transfusions
in surgical patients
Erythropoiesis-Stimulating
Agents
Contraindications
◦ Uncontrolled hypertension ◦ Allergy to mammalian cell-derived ◦ Allergy to human albumin Cautions ◦ Normal renal function ◦ Renal dysfunction ◦ Pregnancy and lactation
Erythropoiesis-Stimulating Agents Adverse Effects ◦ Drug-Drug Interaction
◦ CNS – Headache, fatigue, asthenia, dizziness, and seizure
◦ Nausea, vomiting, and diarrhea
◦ CV – Hypertension, edema, possible chest pain
Drug-Drug Interactions
◦ Should not be mixed in solution with other drugs
Nursing Considerations for
Erythropoiesis-Stimulating
Agents
Assessment
◦ History and physical exam and known allergies
◦ Severe hypertension, pregnancy, anemia and abnormal renal function
◦ Patients with cancer receiving the drugs to increase hematocrit after antineoplastic chemotherapy
◦ Neurological and CV status, respirations
◦ Appropriate lab values
Nursing Diagnoses
◦ Nausea related to adverse GI effects
◦ Diarrhea related to GI effects
◦ Risk for injury related to CNS effects
◦ Risk for imbalanced fluid volume related to CV effects
◦ Deficient knowledge regarding drug therapy
Implementation
◦ Confirm the chronic, renal nature of the patient’s anemia before administering the drug
◦ Give epoetin alfa three times per week, either IV or subcutaneously
◦ Provide the patient with a calendar of marked days
◦ Do not mix with any other drug solution
◦ Monitor lines for clotting
◦ Ensure that prescribed laboratory testing, such as hematocrit levels, is completed before drug
administration
◦ Evaluate iron stores before and periodically during therapy
◦ Monitor blood pressure due to risk for hypertension
◦ Maintain seizure precautions on standby
◦ Provide thorough patient teaching
Common Agents Used for
Iron Deficiency Anemia
Ferrous Asparate Ferrous Fumarate Ferrous Gluconate Ferrous Sulfate Iron Dextran Iron Sucrose
Agents Used for
Iron Deficiency Anemia
Actions- and indication
Elevate the serum iron concentration
Indications-
◦ Treatment of iron deficiency anemias and may also be used as adjunctive therapy in patients receiving
Epoetin Alfa
Agents Used for
Iron Deficiency Anemia
Contraindications
◦ Allergy ◦ Hemochromatosis ◦ Hemolytic anemia ◦ Normal iron balance ◦ Peptic ulcer, colitis, or regional enteritis
Agents Used for
Iron Deficiency Anemia
Adverse Effects
Drug-Drug Interactions
Food Interactions
◦ Oral - GI irritation and CNS toxicity ◦ Parental iron is associated with severe anaphylactic reactions, local irritation, staining of the tissues, and phlebitis Drug-Drug Interactions ◦ Antacids, tetracycline, cimetidine ◦ Ciprofloxacin, norfloxacin, or ofloxacin ◦ Chloramphenicol Food Interactions ◦ Eggs, milk, coffee, tea ◦ Acidic liquids
Nursing Considerations for Iron
Preparations
Assessment
◦ History and physical exam
◦ Allergy; colitis, enteritis, or peptic ulcer, hemolytic anemias
◦ Skin, neurological status, VS and CV function and BS
◦ Appropriate lab values
Nursing Diagnoses
◦ Acute pain related to CNS or GI effects or parenteral administration
◦ Nausea related to adverse GI effects
◦ Constipation related to adverse GI effects
◦ Disturbed body image related to drug staining of the skin from parenteral injection
◦ Risk for injury related to CNS effects
◦ Deficient knowledge regarding drug therapy
implementation
◦ Ensure that iron deficiency anemia is confirmed before administering drugs
◦ Consult with the physician to arrange for the treatment of the underlying cause of anemia if possible
◦ Administer the oral form with meals that do not include eggs, milk, coffee, and tea
◦ Caution the patient that stools may be dark or green
◦ Take measures to help alleviate constipation
◦ Administer IM only by the Z-track technique
◦ Arrange for hematocrit and hemoglobin measurements before administration and periodically during
therapy
◦ Provide thorough patient teaching
