Anemia Drugs Overview and ESAs
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Questions and Answers

What is the primary mechanism of action for ferrous/iron preparations?

  • To replace the body’s deficiency of iron. (correct)
  • To inhibit the production of hemoglobin.
  • To prevent the absorption of iron in the intestines.
  • To decrease the body’s iron storage capacity.

    • A patient with iron deficiency anemia is prescribed ferrous sulfate. What crucial role does iron play in alleviating the symptoms of this condition?

  • Increasing the production of white blood cells for immune response.
  • Enhancing the absorption of vitamin B12 in the stomach.
  • Assisting in the production of hemoglobin for oxygen transport. (correct)
  • Facilitating the transport of carbon dioxide from the tissues.

    • Which of the following routes of administration is available for ferrous gluconate?

  • Subcutaneous injection
  • Oral (correct)
  • Intrathecal
  • Intramuscular injection

    • A patient is prescribed ferrous fumarate 300mg twice daily. According to the information, approximately how much elemental iron is the patient receiving per day?

    <p>$200$ mg. (D)</p> Signup and view all the answers

    In which condition is the administration of ferrous/iron preparations contraindicated?

    <p>Hemochromatosis. (D)</p> Signup and view all the answers

    A patient taking oral iron supplements complains of constipation and dark stools. Which of the following actions is most appropriate?

    <p>Reassure the patient that these are common side effects. (C)</p> Signup and view all the answers

    Erythropoiesis-stimulating agents (ESAs) increase red blood cell production by which mechanism?

    <p>Stimulating the bone marrow with a recombinant form of erythropoietin. (B)</p> Signup and view all the answers

    What is a crucial assessment to make prior to administering epoetin alfa?

    <p>Patient's current hemoglobin level. (B)</p> Signup and view all the answers

    Which of the following is a potential adverse effect specific to parenteral (injectable) iron administration?

    <p>Injection site pain. (C)</p> Signup and view all the answers

    What serum iron level is indicative of iron toxicity/overdose?

    <p>Greater than $54$ micromol/L. (A)</p> Signup and view all the answers

    A patient receiving epoetin alfa reports experiencing joint pain. Which action should the nurse take first?

    <p>Document the complaint and monitor. (A)</p> Signup and view all the answers

    Why is subcutaneous (SC) injection the preferred route of administration for epoetin alfa?

    <p>SC injections facilitate slower absorption, which leads to needing lower doses. (D)</p> Signup and view all the answers

    Which of the following conditions is a contraindication for erythropoiesis-stimulating agents (ESAs)?

    <p>Uncontrolled hypertension (A)</p> Signup and view all the answers

    What information should be included in patient teaching regarding epoetin alfa?

    <p>The medication may take several weeks to show noticeable effects. (B)</p> Signup and view all the answers

    An athlete is caught using epoetin alfa. What is the primary reason this drug is prohibited in sports?

    <p>It increases oxygen-carrying capacity, providing an unfair advantage and increasing the risk of stroke or MI. (B)</p> Signup and view all the answers

    What is the rationale for most patients receiving epoetin alfa also needing to receive an oral iron preparation?

    <p>Iron is essential for hemoglobin synthesis and red blood cell production. (A)</p> Signup and view all the answers

    Which of the following is a common manifestation of iron toxicity or overdose in children?

    <p>Hematemesis (B)</p> Signup and view all the answers

    Which of the following interventions is a priority in the treatment of severe iron toxicity?

    <p>GI tract decontamination like bowel irrigation (A)</p> Signup and view all the answers

    A patient is prescribed an oral iron supplement. Which of the following substances, if taken concurrently, would decrease the absorption of iron?

    <p>Antacids (C)</p> Signup and view all the answers

    What is important to educate patients about regarding their stool, when they are taking iron supplements?

    <p>Stool will change color (D)</p> Signup and view all the answers

    When administering IM iron, which technique is recommended to prevent staining of the skin?

    <p>Using the Z-track technique (D)</p> Signup and view all the answers

    A patient with pernicious anemia is prescribed cyanocobalamin (Vitamin B12). What is the primary mechanism of action of this medication in this patient?

    <p>To replace the body’s deficiency of Vitamin B12 due to impaired absorption (D)</p> Signup and view all the answers

    A patient is prescribed oral cyanocobalamin. Which of the following factors is essential for the absorption of oral Vitamin B12?

    <p>Presence of intrinsic factor (A)</p> Signup and view all the answers

    Which of the following is a contraindication for cyanocobalamin (Vitamin B12) administration?

    <p>Hereditary optic nerve atrophy (Leber’s disease) (C)</p> Signup and view all the answers

    A patient taking cyanocobalamin should be cautioned that the absorption of oral B12 can be decreased by which of the following medications?

    <p>Anticonvulsants (B)</p> Signup and view all the answers

    When educating a patient about anemia and diet, which of the following instructions is most appropriate?

    <p>Dietary suggestions depend on the type of anemia (B)</p> Signup and view all the answers

    Flashcards

    Types of Anemia Drugs

    Drugs used to treat anemia vary by type, influencing treatment choices.

    Erythropoiesis Stimulating Agents (ESAs)

    Drugs that stimulate bone marrow to produce more red blood cells.

    Epoetin Alfa

    A type of ESA that is a human recombinant erythropoietin.

    Mechanism of Action of ESAs

    Stimulates the bone marrow to increase RBC production and maturation.

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    Indications for ESAs

    Used for anemia associated with end-stage renal disease and chemotherapy.

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    Common Adverse Effects of ESAs

    Hypertension, fever, headache, rash, nausea, and injection reactions.

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    Safety Note for ESAs

    Target hemoglobin levels should be between 100-120 g/L to avoid risks.

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    Patient Teaching for ESAs

    Teach that improvement takes 2-6 weeks and not to shake the vial.

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    WBC Count

    A measure of white blood cells in the blood, indicating immune function.

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    Hemoglobin Level

    The amount of hemoglobin in the blood, essential for oxygen transport.

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    Urine Specific Gravity

    A measure of urine concentration, indicating hydration status.

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    Mechanism of Action of Iron Preparations

    Replaces the body's iron deficiency, essential for hemoglobin production.

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    Indication for Iron Preparations

    Used for preventing/treating iron deficiency anemia and supporting erythropoietin therapy.

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    Contraindications of Iron Preparations

    Conditions where iron use is not recommended, like allergies and hemochromatosis.

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    Adverse Effects of Iron Preparations

    Common side effects from iron include nausea, constipation, and dark stools.

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    Iron Toxicity/Overdose

    Excess iron accumulation characterized by serum iron levels exceeding 54 micromol/L.

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    Iron Toxicity Symptoms

    Common symptoms include nausea, diarrhea, and shock.

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    Iron Toxicity Treatment

    Treatment includes supportive measures and GI tract decontamination.

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    Iron Chelation Therapy

    Use IV deferoxamine in severe cases of iron toxicity.

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    Vitamin C and Iron Absorption

    Ascorbic acid enhances iron absorption in the GI tract.

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    Iron Absorption Inhibitors

    Antacids and calcium decrease iron absorption in the GI tract.

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    Cyanocobalamin Role

    Replaces the body's deficiency of Vitamin B12, aiding blood cell production.

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    Cyanocobalamin Administration Forms

    Available in PO, sublingual, and IM injections for vitamin B12.

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    Vitamin B12 Contraindications

    Allergies and hereditary optic nerve atrophy prevent B12 use.

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    Adverse Effects of B12

    Large doses may cause itching, diarrhea, and fever.

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    Patient Education for Anemia Drugs

    Educate about signs of anemia or iron toxicity and dietary advice.

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    Study Notes

    Anemia Drugs

    • Several types of anemia exist, and the type influences treatment approach.
    • Common anemia drugs include Erythropoiesis Stimulating Agents (ESAs), Ferrous/Iron preparations, and Cyanocobalamin (B12).
    • Effectiveness is monitored through improvements in symptoms and lab results.

    Erythropoiesis Stimulating Agents (ESAs)

    • Examples include Epoetin Alfa (Eprex®) and Darbepoetin Alfa (Aransep®).
    • Mechanism: Human recombinant form of erythropoietin, stimulates bone marrow to produce more red blood cells (RBCs) and speeds up maturation.
    • Ineffective without adequate body iron stores and bone marrow function.
    • Indications: ESRD-associated anemia and chemotherapy-induced anemia.
    • Administration: Typically injected subcutaneously, sometimes intravenously; often requires an oral iron preparation for optimal efficacy.
    • Dosing range: 2000-40,000 units given 1-3 times per week. Dosing adjusts based on weight and disease severity.
    • Contraindications: Allergy, uncontrolled high blood pressure (HTN), drug-associated pure red cell aplasia, certain cancers with high thrombosis risk.
    • Adverse effects: Hypertension, fever, headache, pruritus (itching), rash, nausea, vomiting, joint pain, and injection site reactions.
    • Safety note: Target hemoglobin (Hgb) level 100-120 g/L. Do not administer if Hgb > 130 g/L in renal disease; or >100g/L in cancer due to risk of heart attack (MI), stroke, death. Head and neck cancers may trigger thrombosis. Elite athletes may abuse ESAs for performance enhancement. Use is banned in some sports.
    • Patient teaching: Improvement takes time (2-6 weeks); do not shake the vial or mix with other drugs.
    • Critical thinking: Before administering epoetin alfa to a patient with kidney failure, assess their hemoglobin level.

    Ferrous/Iron Preparations

    • Mechanism: Replaces iron deficiency, iron is vital for body function, needed to produce hemoglobin for oxygen transport. Iron stored in liver, spleen, bone marrow.
    • Indications: Prevent/treat iron deficiency anemia; often used concurrently with erythropoietin therapy. Underlying causes need correcting.
    • Administration: Oral (gluconate, sulfate, fumarate) or parenteral (dextran, sucrose, ferric gluconate).
    • Oral dosing: varies.
    • Typical Dosing Range: Oral dosing varies (e.g., 3-4 300 mg tabs daily; 3-4 324 mg tabs daily). Consult specific drug information.
    • Contraindications: Allergy, hemochromatosis (iron overload), other anemia types (hemolytic anemia).
    • Adverse effects: Nausea, vomiting, constipation, diarrhea, dark stools, stomach cramps, discoloration of teeth.
    • Adverse events during parenteral administration: injection site pain and anaphylaxis (iron dextran).
    • Iron Toxicity/Overdose: Serum iron level exceeding 54 micromoles/L. Accidental ingestion, especially in children, is a concern. Symptoms include nausea, diarrhea, hematemesis (vomiting of blood), pallor, cyanosis, shock, and coma.
    • Treatment for iron toxicity/overdose: Supportive measures, correcting acid-base imbalance via IV fluids, blood transfusions, Gl decontamination. Iron chelation therapy (IV deferoxamine).
    • Nursing considerations: Patients may experience difficulty with certain oral formulations (slow-release). Older adults respond well to lower doses. Use parenteral iron if oral iron is not effective (or if patient has kidney disease). Vitamin C enhances absorption of iron, antacids and calcium reduce iron absorption. Several antibiotics decrease absorption of iron.
    • Patient education: Dark stools are common and harmless. Manage constipation/diarrhea. Dilute iron syrups. Do not chew or crush tablets. Take with lots of fluid. Sit up for 30 min after taking. Store iron out of children's reach. Could take with food to prevent GI upset.
    • Nursing considerations for administration: Avoid substitution. IM administration uses the Z-track method. Monitor for anaphylaxis (IM/IV) and hypotension (IV). Monitor patient for iron toxicity.

    Cyanocobalamin (Vitamin B12)

    • Mechanism: Water-soluble B vitamin, crucial coenzyme for metabolic reactions, including blood cell production.
    • Indications: Pernicious anemia (inability to absorb B12), megaloblastic anemia (abnormal RBC development).
    • Administration: Oral, chewable, sublingual, or IM (deep injection). High-dose monthly IM injections are common for maintenance of steady levels. Oral forms need intrinsic factor for absorption.
    • Contraindications: Allergy and hereditary optic nerve atrophy (Leber's disease).
    • Adverse effects: High doses can cause itching, transient diarrhea, and flushing/fever.
    • Adverse events: Rare instances of allergic reactions.
    • Cautions: PO absorption reduced by anticonvulsants, aminoglycoside antibiotics, and long-acting potassium supplements.

    Anemia Drug - General Considerations

    • Patient Education: Report worsening anemia/iron toxicity symptoms. Include dietary suggestions based on the specific anemia. B12 is better absorbed with food.
    • Nursing Considerations: Assess for anemia symptoms (shortness of breath (SOB), fatigue), address treatment response. Assess patient's diet and provide dietary recommendations. Be aware of potential drug interactions. Monitor blood tests (hemoglobin (Hgb), hematocrit (Hct), and specific tests).

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    Anemia Drugs PDF 2024-2025

    Description

    This quiz explores various types of anemia and their respective treatment approaches with a focus on Erythropoiesis Stimulating Agents (ESAs). You'll learn about common anemia medications, their mechanisms, indications, and administration details. Test your knowledge on the effectiveness and monitoring of anemia treatment.

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