Anemia Medications, Anticoagulants, and Hematopoietics

• This document provides an overview of anemia medications, anticoagulants, thrombolytics, and hematopoietic growth factors
• It also includes uses, side effects, nursing care, and patient teaching points for each medication

Anemia Meds ("RBC Boosters")

• These medications are typically Iron, Folic Acid, and Vitamin B12

Iron (Ferrous Sulfate)

• Use: Treats iron-deficiency anemia, which causes fatigue, pale skin, and dizziness
• Side Effects:
  • May cause teeth staining (liquid form), so use a straw when administering
  • Causes black stools as a normal side effect
  • Can be toxic to children, so store iron away properly
• Nursing Care:
  • Take with Vitamin C (e.g., orange juice) to boost absorption
  • Avoid dairy and antacids, as they block absorption
• Antidote: Deferoxamine (for iron overdose)

Folic Acid

• Use: Treats megaloblastic anemia (large RBCs), also important in pregnancy and for alcoholics
• Side Effects:
  • Can cause neon yellow pee
  • May hide B12 deficiency, so always check B12 levels first
• Foods: Found in citrus fruits, leafy greens, and meat
• Folic acid is fetus-friendly, helping to prevent birth defects

Vitamin B12 (Cyanocobalamin)

• Use: Treats pernicious anemia (no intrinsic factor, which means no B12 absorption)
• Side Effects:
  • Risk of neuropathy (tingling, numbness) if untreated
  • May lead to low potassium (hypokalemia), look out for muscle cramps
• Nursing Care:
  • Schilling test can be performed to check stomach absorption
  • Monthly B12 shots may be needed for life if a patient has pernicious anemia
• Foods: Eggs, dairy, and seafood

Anticoagulants ("Thin the Blood, Stop the Clots")

Heparin

• Use: Prevents DVT, PE, and stroke (fast-acting)
• Labs: Monitor aPTT (Normal: 30-40 seconds, Therapeutic: 60-80 seconds)
• Side Effects:
  • Bleeding (black stools, bruising, hematuria)
  • Low platelets (HIT - Heparin Induced Thrombocytopenia)
• Antidote: Protamine Sulfate
• Patient Teaching:
  • Use soft toothbrush, electric razor to avoid cuts
  • Avoid aspirin/NSAIDs due to risk of GI bleeds

Warfarin (Coumadin)

• Use: Long-term clot prevention for conditions like A-fib, DVT, and PE
• Labs: Monitor INR (Normal: 1, Therapeutic: 2-3)
• Side Effects:
  • Bleeding (black stools, bruising, gums)
• Antidote: Vitamin K (leafy greens = okay in moderation)
• Patient Teaching:
  • Wear a medic bracelet
  • Avoid alcohol due to liver damage increasing bleeding risk

Dabigatran

• Use: A-fib, DVT, PE (no monitoring needed)
• Side Effects:
  • Bleeding risk
• Antidote: Praxbind (idarucizumab)
• Patient Teaching:
  • Swallow whole, don’t crush
  • Avoid NSAIDs (bleeding risk)

Clopidogrel (Plavix)

• Use: Heart attack, stroke prevention, stents
• Side Effects:
  • GI bleeding (black stools, bruising)
• Patient Teaching:
  • Stop 5-7 days before surgery
  • Avoid NSAIDs & aspirin

Thrombolytics ("Clot Busters (ER Drugs!)")

Alteplase (tPA)

• Use: MI, stroke (ischemic only!), massive PE, DVT
• Must Give FAST:
  • MI: Within 2 hours
  • Stroke: Within 3-4.5 hours
• Never Give If:
  • Brain bleed (hemorrhagic stroke)
  • Recent surgery due to risk of major bleeding
• Antidote: Aminocaproic acid (prevents bleeding)
• Nursing Tip:Use 2 IV lines and limit pokes to minimize bleeding risk

Hematopoietic Growth Factors ("Boost Blood Cell Production")

Epoetin Alfa

• Use: CKD, chemo-induced anemia, pre-op blood donation
• Side Effects:
  • Thick blood which causes hypertension, stroke, and MI risk
• Monitor: Hgb < 12 g/dL (stop if higher)
• Patient Teaching:
  • Iron supplements are needed for RBC production
  • Monitor BP closely

Filgrastim

• Use: Chemo, neutropenia, bone marrow transplants
• Side Effects:
  • Bone pain (from rapid WBC growth)
  • High WBC count (leukocytosis > 10,000)
• Monitor: CBC w/ diff (stop if WBC > 10k)
• Patient Teaching:
  • Report LUQ pain (spleen rupture risk)

Oprelvekin

• Use: Thrombocytopenia (chemo patients)
• Side Effects:
  • Fluid retention leading to CHF risk, tachycardia, and A-fib
• Monitor: Baseline CBC & platelets
• Patient Teaching:
  • Watch for swelling & irregular HR

Key Exam Takeaways

• Anticoagulants prevent clots (Heparin, Warfarin, Dabigatran)
• Antiplatelets stop platelets from sticking (Clopidogrel, Aspirin)
• Thrombolytics break existing clots (Alteplase)
• Growth Factors boost blood cells (Epoetin, Filgrastim, Oprelvekin)

Overview of anemia medications like Iron, Folic Acid, and Vitamin B12, including their uses and side effects. Also describes anticoagulants, thrombolytics, and hematopoietic growth factors, detailing nursing care and patient teaching points.