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HemaneticsRecordedPresentationHOMEWORKPLACE.pptx
Drugs for Deficiency Anemia
Hematinic Agents NSG 220
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Anemia (Overview)
Deficiency in the number of red blood cells or in the quality and amount of the hemoglobin. Low hemoglobin level decrease oxygen-carrying capacity to mee the physiologic needs of the body.
Causes:
Decreased number, size or hemoglobin RBCs.
Loss of blood (acute or chronic)
Hemolysis- destruction of RBC’s
Poor dietary intake of iron, Vit. B, folic acid
Chemotherapy
bone marrow dysfunction or deficiency of substances for RBC production or maturation.
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IRON DEFICIENCY ANEMIA
Most common type of anemia
Cause: Slow, chronic blood loss (GI bleeding, peptic ulcers, heavy menstrual bleeding, etc.), impaired absorption of iron, diet (lack of)
Drug Treatment
Ferrous Sulfate
IV Dextran
Ferrous fumarate
Ferrous succinate
Administered: IV, PO
Action: Used to treated the production of normal hemoglobin and the RBCs for transportation and utilization of oxygen
Iron Supplements
Adverse Effect- GI related- constipation*, nausea*, diarrhea, dark green to black stools, teeth staining (liquid preparations)
Can be toxic if given in large doses (accidental or intentional)
Patient Teaching:
Take with Vitamin C (ascorbic acid) to promote the absorption of iron*
Do not give with antiacids or tetracyclines*
Liquid preparations can stain teeth (dilute with a liquid, rinse mouth afterwards)
Encourage to eat food rich in iron- liver, eggs, meat, fish
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Vitamin B12 Deficiency
Cause
Impaired Absorption
Pernicious Anemia
Megaloblastic Anemia
Neurological Damage
GI disturbances
Severe B12 anemia
Mortality due to hypoxia to peripheral and cerebral hypoxiaHF and dysrhythmia
Drug Treatment
Vitamin B12 (Cyanocobalamin)
Hydroxocobalamin
Methylcobalamin
Administered: intranasal, subQ, or PO –never IV
Nursing Implications
Treatment duration is usually life long
Use with caution in patients who receive folic acid.
Hypokalemia can develop during early therapy.
Monitor serum potassium levels
Teach patient s/s of hypokalemia and instruct them to contact provider immediate.
Vitamin B12 is essential for the synthesis of DNA- required for the growth and division of cells.
Lack of Vit B12 causes anemia and injury to the nervous system.
Causes of B12 anemia is due to impaired absorption and rarely due to diet. Pernicious anemia (due to absence of intrinsic factors) is one you may remember in pathophysiology. Megaloblastic Anemia due to oversized erythroblasts (megaloblasts) and oversized erythrocytes (macrocytes) due to impaired DNA synthesis. I can also be cause by neurologic damage –when there is demyelination (damage) to the neurons of the spinal cord and brain. GI disturbances – autoimmune diseases such as Chron’s where uncontrolled inflammation if the terminal ileum can lead to this deficiency.
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Folic Acid Deficiency
Required for DNA synthesis. Identical to vitamin B12 deficiencies.
Cause
Poor diet*
Malabsorption
Sprue- intestinal disease which decreases folic acid uptake
ETOH use (acute or chronic)*
Indicated:
Prophylactic- pregnancy women
Severe deficiency – Megaloblastic anemia.
Treatment: Folic Acid
Administered: IV,PO, subQ and IM* (only for patients with impaired GI absorption only)
Identical to Vitamin B12 deficiencies. Megaloblastic anemia is the most common. However, the provider must determine which one is he cause- Vitamin B12 deficiency or Folic Acid deficiency.
"lack of folic acid may result in leukopenia, thrombocytopenia, and injury to the oral and GI mucosa. It can also case neural tube defects in early pregnancy which is many women are encouraged to take during pregnancy.
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Hematopoietic Agents
Hematopoiesis is the process by which our bodies make red blood cells, white blood cells, and platelets.
RBC production occurs in the bone marrow
The actual process “erythropoiesis occurs in the bone marrow”
Erythropoietin “hormone” is produced and secreted in the proximal tubules of the kidney (& liver). It stimulates RBC production
See process below
When there is anemia or hypoxia, levels of erythropoietin rise and trigger increase of erythrocytes synthesis (erythropoiesis= production of red blood cells)
Bone Marrow is the site of hematopoiesis- hemato means “blood” and poiesis means “to make”.
Erythropoietin is a hormone that is produced predominantly in the kidneys. Erythropoietin is made to protect RBCs from destruction. They also stimulate stem cell of the bone marrow to increase RBC production.
When there is sufficient oxygen in the blood circulation, the production of erythropoietin is reduced, but when oxygen levels go down, the production of erythropoietin goes up.
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Erythropoietin Alfa
MOA: Stimulate RBC production in bone marrow and erythropoietin in the kidneys
Indication:
Anemia due to chronic renal failure
chemotherapy
HIV patietns and takig zidovudine (Retrovir)
Treatment:
Erythropoietin alfa*
Darbepoetin alfa (Aranesp)
Long-acting
Administered: IV or subQ
Nursing implications:
Monitor H&H as well as iron levels
Monitor blood pressure before therapy
Due to increase hematocrit
Do not administer if hemoglobin >11 gm/dL (twice a week)
Do not agitate (shake) the vial
When there isn’t’ enough of red blood cells then medications are prescribed to increase the production of red blood cells. Remember red blood cells are produced in the marrow, the kidneys produce erythropoietin to protect the RBCs. When there isn’t enough RBC’
Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)
Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit
In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.
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High risk populations
Cancer Patients- accelerate tumor progression
Postoperative patients not given an anticoaugulant- increased risk of developing DVT’s
Dialysis patients- increased risk of cardiovascular events.
Monitor h & h – do not give for hemoglobin levels higher than 10 to 11 mg/dl
Filgrastim
MOA: Stimulate neutrophil production kidneys reduce neutropenia
Indication:
Chemotherapy – myelosuppressive reduce risk of infections
Patients undergoing bone marrow transplantation
Severe chronic neutropenia
Administered: IV or subQ
Can not be taken orally due
Adverse Effects
Bone pain
leukocytosis
Nursing implications:
“Filgrastim is given to reduce the risk of infection in patients undergoing cancer chemotherapy. Many anticancer drugs act on the bone marrow to suppress production of neutrophils, greatly increasing the risk of infection. By stimulating neutrophil production, filgrastim can decrease infection risk.
Increased risk of DVTs, CVA (strokes) or myocardial infarctions (MI)
Can cause HTN**Monitor blood pressure before therapy due to increase hematocrit
In order for erythropoietin to produce, there must be adequate store of iron, folic acid and vitamin B12 available.
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