vivian lecture Flashcards
what is the immediate action when there is low ion?
IV iron (by passes the need for absorption and less GI effects)
how long does iv iron takes to work?
takes 1 week to improve Hb by 1 unit ,
requires time for iron abroption and incorporation into RBC
what is faster than administering iron?
blood transfusion can be done to quickly increase haemoglobin level
what is a long term action to solve low ironlevel ?
PO iron
what are the advantages of using PO iron?
it avoid the need for IV access and monitoring
what are the disadvantages of PO iron?
needs compliencce for 3-6 months
some med need compliance to take 30 min beofre eating
GI side effect may not be tolerable for some
TAKES 2 weeks to improve HB by 1 unit
how to solve heavy mensural bleeding?
- hormonal therapy by regulating mensural cycle (estrogen progestin therapy)
- helps to make bleeding more regular, lighter - anti fibrinolytic to reduce fibrinolysis (cause growth of clots)
- tranexamic acid
what are the oral iron meds?
ferrous sulphate
polymaltose
gluconate
what are the adverse effects of oral iron?
metallic taste nausea flatulence black urine constipation black and dry stools
what are some special note on polymaltose ?
lesser GI side effect than sulphate
taken with food
when are ferous sulpahte and gluconate taken?
30 min before food as it requires an acidic medium to be absorbed
what to do for sulphate and polymaltose if side effect is very bad?
can lower dose or take every other day to improve tolerance and absorption
can take after food if tolerance is an issue
what is one special thing about gluconate?
contains maganase copper folic acid vit C (helps with iron absorption) sorbitol (laxative)
what are the other medication for iron?
ferrous carboxymalose
dextran
sucrose
which medication is admistered through IV?
carboxy , dextran and sucrose
which medication can be both IM or IV ?
dextram
which medication have highest rate of anaphylaxis ?
destran
what to do after administering the iron through IV or IM ?
observe patient for at least 30 mins
what is the disadvantage of IM route of iron?
IM route is painful and it stains the buttock
has varibale absorption
where is iron absorbed at ?
DUODENUM (gastric acid lower the ph here)
how much is PO vs IV is being absorbed?
14-18%
vs
100%
what to take note when administering parenternal iron ?
most of the time administer a test dose as ordered
ensure patent IV access
carefully monitor the infusion rate
observe for allergic reaction
which IV dont need test dose?
carboxy and sucrose
what to take note when administering IM?
Z track technique to prevent skin discoloration, scarring and irritating iron deposits in the skin
what are the grades of hypersensitivity (allergic)
- mild (skin and s/c tissue only) , erythemia and edema
- moderate (respri, cvs and GI) , wheezing nausea and vomitting , dizziness
- severe (hypoxia, hypotention or neurological ), cyanosis or spo2 lower than 92
how long to wait for dextran after administering a test dose?
observe for at least 1hour for hypersensitivity reaction
altho reaction usually happen within few minutes
what are the drug drug interations?
- vit c and iron
- milk / calcium and iron
- levothyroxine and iron
- ciprofloxacin and iron (antibiotic)
how does vit c affect iron?
acidity improves the absorption of iron
useful for those on gastric acid suppressing drugs
usually can take iron 30 min before food to improvev absorption
if not can take with vit C
how does milk affect iron?
calcium inhibits absorption of iron
how to solve the problem if patient want to take milk and iron at same time ?
seprate then by 2 hours
how does levothyroxine affect iron?
they will combine to form insoluble compound (ferric levothyroxine)
lead to poorer absorption
how to solve if levothyroxine and iron need to be used?
take them 2 hours apart (or 4)
what is the reaction between ciprofloxacin and iron?
form insoluble compound too?
who are parenteral iron not rerccomended for?
if patient has active systemic infection and on dialysis
what are some signs of excressive oral iron?
injestion of more than 60mg / kg
diarrhea (injury to GI mucosa) fever severe stomach pain nausea vomitting
what to do when there is overload of iron?
notify the practitioner
include chelation therapy vigorous IV fluid replacement gastric lavage whole bowel irrigation supplemental oxygen
