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Classification:
A. Erythropoietin
1. Darbopoeitin alfa
2. Epoetin alfa (Epogen, Procrit)
B. Iron Preparations
1. Ferrous fumarate
2. Ferrous gluconate
3. Ferrous sulfate
4. Ferrous sulfate exsiccated
5. Iron dextran
6. Iron sucrose
7. Sodium ferric gluconate complex
D. Vitamin B12
1. Cyanocobalamin
2. Hydroxocobalamin
I. A. Blood Components
Blood
contains oxygen & nutrients essential for cell survival delivers these to cells &
removes waste products from the tissues.
Blood- composed of :
a. Plasma mostly water
• Also contain glucose, electrolytes & proteins for immune response & for blood
clotting.
b. Formed elements
• Leukocytes (WBC) – impt part of immune system.
• Erythrocytes (RBC) – carry O2 to tissues & remove CO2 for delivery to lungs.
• Platelets – impt. part of coagulation, blood clotting.
B. Erythropoiesis
• Process of RBC production.
• Produced in myeloid tissue of the bone marrow.
• Controlled by Erythropoeitin.
• Is a constant process 1% of body’s RBC are destroyed & replaced each day.
Erythropoeitin
Released from kidneys in response to decreased blood flow in the kidneys.
Insert fig 49-1 p668
II. Anemia
Decrease in number of RBCs
• when erythropoeitin are low .
• or lack of components needed to produce RBCs .
To produce healthy RBCs, the bone marrow must have the FF :
1. iron used in forming hemoglobin rings to carry O2.
2. Vit B12 & Folic Acid form supporting structure
3. Essential amino acids & carbohydrates.
Normally, diet supplies adequate amount but if inadequate deficiency anemia.
B. Megaloblastic Anemia
Lack of Vit B12 or Folic Acid needed to produce strong structure in RBC to
survive 120 days in vascular system.
Cause slowing of nuclear DNA synthesis of human cells.
Produce large & immature RBCs with short lifespan.
Seen in rapidly dividing cells (BM & GIT)
I. ERYTHROPOEITINS
1. Epoeitin Alfa
a. Epogen
b. Procrit
2. Darbopoeitin Alfa
a. Epogen
1. Tx of anemia associated with renal failure.
2. Reduction in need for blood transfusions in surgical pxs.
3. Tx of anemia associated with AIDS therapy.
• Halflife- 3-4 hrs Given 3x a week by IV or SC.
b. Procrit
1. Tx of anemia associated with cancer chemotherapy.
• Half-life-3-4 hrs Given 3x a week by SC.
2. Darbopoeitin Alfa
• Erythropoeitin-like protein stimulate RBC production.
• Produced in Chinese hamster ovary cells
• Half-life- 4-13hrs Given once a week by IV or SC.
• Cross into breastmilk
Tx of anemia associated with Chronic renal failure & dialysis pxs.
Nursing Considerations:
A. Before administration
1. Confirm the chronic, renal nature of px’s anemia to ensure proper use of drug.
2. Arrange for hematocrit reading to determine correct dosage.
If no response within 8 wks, re-evaluate cause of anemia.
3. Know contraindications:
Uncontrolled hypertension worsen HPN with increase RBC.
Allergy to mammalian cell-derived products or to human albumin.
Lactation potential allergic reaction in neonate.
B. During
. 1. Give Epoeitin Alfa 3x a wk, Darbopoeitin Alfa once a week.
Give calendar marked days to increase compliance.
2. Donot give with other drug solution avoid interaction.
3. Maintain seizure precautions on standby.
C. After
1. Monitor for adverse effects.
CNS – headache, fatigue, asthenia,dizziness, serious seizures
GIT – n & v, diarrhea
CVS- hypertension, edema, chest pain
• Increase serum iron concentration either converted to Hgb or stored in RES for eventual
use.
• Primarily absorbed from small intestine by active transport system
transported in blood bound to transferring.
• Small amounts of iron lost daily in :
sweat, urine, sloughing of skin & mucosal cells, sloughing of intestinal cells,
menstrual flow in women.
1. Ferrous fumarate
2. Ferrous gluconate
3. Ferrous sulfate
4. Ferrous sulfate exsiccated
Tx of Iron deficiency anemia (IDA)
• Oral preparation
• Mostly lost in feces but some absorbed in intestine transported in bone marrow.
• Takes 2-3 wks upto 6-10 months to return to stable iron level.
5. Iron dextran
Tx of IDA
• Parenteral form used when oral form cant be tolerated.
• If given IM use Z-track method stain tissues brown & can be very painful.
• Cause severe hypersensitivity reaction.
6. Iron sucrose
7. Sodium ferric gluconate complex
Tx of IDA in px’s on chronic hemodialysis & who are receiving supplemental
erythropoeitin therapy.
• Given IV
Nursing Considerations:
A. Before administering
1. Assess for contraindications.
Hemochromatosis
Hemolytic anemia may increase serum Fe cuase toxicity
Normal Iron balance drug wont be absorbed & will just pass thru body
Peptic Ulcer, Colitis or regional enteritis directly irritate tissues
2. Confirm IDA before administering drugs to ensure proper use.
3. Arrange Hct & Hgb count to monitor drug effectiveness.
4. Caution that stool may be dark or green.
B. During
1. Administer with meals to relieve GI irritation. ( Avoid eggs, milk, coffee & tea.)
2. Have px drink solutions thru straw to prevent staining of teeth.
3. Dissolve ferrous salts in orange juice to improve taste.
4. Place iron drops on the back of the tongue to prevent staining teeth.
5. Administer IM by Z-track method only to avoid staining of tissues.
C. After
1. Monitor for adverse effects & toxicity:
GIT- direct GI irritation anorexia, n & v, diarrhea, dark stools & constipation
CNS –directly toxic coma , death
Parenteral iron Severe anaphylactic reactions, local irritation, staining of
tissues & phlebitis
2. Counteract Fe toxicity by giving chelating agent..
Chelating agents
Counteract metal toxicity (Fe, lead, arsenic, mercury, copper, gold)
Grasp & hold toxic metal carried out of the body prevents further
damge to cells.
Excreted by kidneys.
a. Deferoxamine mesylate
Counteract Fe toxicity.
• given IM, SC or IV
• rash & vision changes are common.
c. Dimercaprol
for Arsenic, Gold, & mercury toxicity
• given IM only for 7-10 days.
• Cardiovascular toxicity may occur.
• Push fluids & alkalinize urine to increase excretion.
1. Folic Acid
• Given oral, IM, SC, IV
• Parenteral form preferred for pxs with absorption problems.
Use as replacement therapy & Tx of Megaloblastic Anemia.
2. Leucovorin
• Reduced form of folic acid.
• Given oral, IM , IV
Use as replacement therapy & tx of Megaloblastic Anemia
Use as rescue after high dose chemotherapy allow noncancerous cells to survive
• Methotrexate for osteocarcinoma
• Fluorouracil for colorectal cancer
3. Hydroxocobalamin
• Given IM everyday for 5-10 days, then once a month for life.
• Cant be taken orally.
• Highly protein bound slowly released for use.
Traditional Tx of Pernicious Anemia & Vit B12 deficiency.
Use as replacement therapy in states of increased demands or inadequate diet.
4. Cyanocobalamin
• Given IM or SC, intranasal gel, intranasal spray
• Not as tightly bound to proteins does not last long in body.
• Intranasal spray given once a week in 1 nostril.
Use as replacement therapy.
Tx of Megaloblastic Anemia.
Nursing Considerations:
A. Before administration.
1. Confirm the nature of megaloblastic anemia to ensure proper drug regimen.
2. Assess for contraindication:
Allergies to drug
Use with caution in pregnant & lactating mothers.
Use with caution nasal form in pxs with nasal erosion or ulcers.
3. Screen baseline status: VS, Hct., Fe levels etc.
B. During
1. Give both types of drugs in cases of pernicious anemia to ensure therapeutic effectiveness.
2. Parenteral Vit B must be given IM each day for 5-10 days, then once a month for life, if used
to tx Pernicious anemia
C. After
1. Monitor for adverse effects.
Pain & discomfort at injection sites.
Nasal irritation.
Hypersensitivity reactions.