Anemia Drugs PDF 2024-2025

ANEMIA DRUGS NURS1059 – 2024-2025 Drugs Used to Treat Anemia  There are several types of anemia… The type of anemia will influence the approach used  Common drugs: 1. Erythropoiesis stimulating agents (ESAs) 2. Ferrous/Iron preparations 3. Cyanocobalamin (B12)  Effect...

ANEMIA DRUGS NURS1059 – 2024-2025 Drugs Used to Treat Anemia  There are several types of anemia… The type of anemia will influence the approach used  Common drugs: 1. Erythropoiesis stimulating agents (ESAs) 2. Ferrous/Iron preparations 3. Cyanocobalamin (B12)  Effectiveness is monitored by improvements in manifestations and lab results (examples?) Erythropoiesis Stimulating Agents (ESAs) Epoetin Alfa (Eprex®) Darbepoetin Alfa (Aransep®) Mechanism of Action  Human recombinant (analogue) form of erythropoietin  Stimulates bone marrow to produce more RBCs and speed up maturation  Medication is ineffective without adequate body iron stores and bone marrow function Indications for Use  ESRD associated anemia  Chemotherapy-induced anemia Erythropoiesis Stimulating Agents (ESAs) Epoetin Alfa (Eprex®) Darbepoetin Alfa (Aransep®) Administration  Injection only (usually Subcutaneous, also available IV)  Most patients receiving epoetin alfa need to also receive an oral iron preparation.  Darbepoetin is a longer-acting form a and requires fewer injections  SC- slower absorption, lower doses needed  Dose depends on weight, indication (i.e. severity of disease) Common dosing range  Dose: 2000-40000 units given 1-3x/wk Erythropoiesis Stimulating Agents (ESAs) Contraindications  Allergy  Uncontrolled HTN  Drug-associated pure red cell aplasia  Certain cancers with increased risk of thrombosis Adverse Effects  Hypertension  Fever  Headache  Pruritus  Rash  Nausea and vomiting  Joint pain  Injection site reaction Erythropoiesis Stimulating Agents (ESAs) Safety Note Target Hgb level 100-120 g/L  Do not administer if Hgb > 130g/L in renal disease or Hgb>100 g/L in cancer due to increased risk of MI, stroke, death  Certain head and neck cancers may have thrombosis and may also increase risk of tumor growth  Be alert to potential abuse by elite athletes  Elite athletes use as performance enhance to increase oxygen carrying capacity but increases risk of stroke, MI  Banned in sports Erythropoiesis Stimulating Agents (ESAs) PATIENT TEACHING Takes time for improvement (ESA take 2-6 weeks) Do not shake the vial or administer with another drug Critical thinking… Before administering epoetin alfa to a patient in kidney failure, it is most important for the nurse to assess which laboratory result? A. Blood urea nitrogen B. WBC count C. Hemoglobin level D. Urine specific gravity Think about it… Answer: C. Hemoglobin level Ferrous/Iron Preparations Mechanism of Action  Replacing Body’s Deficiency of Iron  Iron is required for proper functioning of body  Iron has a key role in making hemoglobin and carrying oxygen  Stored in sites such as liver, spleen, bone marrow Indication for Use  Prevention/treatment of iron deficiency anemia (Diet often deficient)  Also used in combination with erythropoietin therapy  Iron deficiency may be due to underlying medical issue  Administration of iron alleviates the symptoms of iron deficiency anemia, but the underlying cause of the anemia should be corrected Ferrous/Iron Preparations Administration Oral  Ferrous gluconate  Ferrous sulphate  Ferrous fumarate Parenteral  Iron Dextran (Dexiron®)  Iron sucrose (Venofer®)  Ferric gluconate (Ferrlecit®) Natural Health Product (NHP) forms  Proferrin  Feramax Ferrous/Iron Preparations Supplements differ in their elemental iron content: Ferrous salt Elemental Iron Typical dosing Content found in (tabs/day) 300mg Ferrous gluconate 35 mg or 11.6% iron 3-4 300 mg tabs/day Ferrous sulphate 60 mg or 20% iron 3-4 324 mg tabs/day Ferrous fumarate 100 mg or 33% iron 2-3 300 mg tabs/day (Palafer) Ferrous/Iron Preparations Contraindications  Allergy  Hemochromatosis (iron overload)  Other types of anemia (i.e. hemolytic) Adverse Effects  Several GI adverse Effects  Nausea  Vomiting,  Constipation  Diarrhea  Dark stools  Stomach cramps/pain  May discolour teeth Ferrous/Iron Preparations Adverse Effects  Parenteral Administration  Injection site pain  Anaphylaxis (iron dextran) Adverse Event  Iron Toxicity/Overdose Ferrous/Iron Preparations Iron Toxicity/Overdose  Excess iron accumulation  Serum iron level >54 micromol/L  May also occur from accidental ingestion (i.e. children)  Corrosive effects on GI mucosa and can cause hemodynamic and metabolic effects  Iron can be seen on abdominal x-rays if large dose ingested Manifestations  Nausea  Diarrhea  Hematemesis  Pallor  Cyanosis  Shock  Coma Ferrous/Iron Preparations Iron Toxicity/Overdose Treatment  Based on manifestations (directed by OPC)  Supportive measures  Airway management (ventilation, oxygen, suctioning)  Correcting acid-base imbalance  IV fluids  Blood  Vasoactive drugs  GI tract decontamination –bowel irrigation to remove iron  Iron chelation therapy with IV deferoxamine in severe cases (coma, shock, seizures) Ferrous/Iron Preparations NURSING CONSIDERATIONS  Patients may have difficulty tolerating certain formulations  Slow-release forms are available but may not be absorbed as well  Older adults respond well to lower doses  Parenteral forms when PO supplements fail, or iron deficiency related to ESRD/hemodialysis  Gi Absorption of Iron  Enhanced by ascorbic acid (Vitamin C)  Decreased by antacids, calcium  Decreases absorption of certain antibiotics (tetracyclines, quinolones) Ferrous/Iron Preparations PATIENT EDUCATION  Dark stool with iron is normal and harmless  Managing constipation/diarrhea  Dilute iron syrups and use a straw  Do not chew/crush tablets  Take with lots of fluid  Sit-up for 30 min after taking to decrease esophageal irritation  Store iron out of reach of children  Do not substitute iron supplements  May take iron with food if GI upset Ferrous/Iron Preparations Nursing Considerations  Do not substitute formulations  IM iron is given deep IM using Z-track technique in large muscle  IV iron- epinephrine on hand, monitor for anaphylaxis  IV iron- orthostatic hypotension  Be alert to iron toxicity Cyanocobalamin (Vitamin B12) Mechanism of Action  Replacing Body’s Deficiency of Vitamin B (Water soluble Vitamin)  B12 has a key role as a coenzyme for many metabolic reactions including a key role in blood cell production Indication for Use  Pernicious anemia (inability to absorb B12)  Megaloblastic anemia  Production of abnormal large underdeveloped red blood cells  Caused by B12 deficiency Cyanocobalamin (Vitamin B12) Administration  Cyanocobalamin is water soluble so comes readily in PO forms  PO forms of Cyanocobalamin  Chewable  Sublingual  liquid forms  IM  Deep IM injection is preferred (100mcg IM Monthly once levels stable)  PO forms require presence of intrinsic factor for absorption Cyanocobalamin (Vitamin B12) Contraindications  Allergy  Hereditary optic nerve atrophy (Leber’s disease) Adverse effects  Large does can lead to the following  Itching  Transient diarrhea  Flushing/fever Cyanocobalamin (Vitamin B12) Adverse Events  Little to none  Difficult to reach toxic levels/overdose as it is water soluble Cautions PO absorption is decreased by the presence of the following drugs  Anticonvulsants  Aminoglycoside antibiotics  Long-acting potassium supplements ANEMIA DRUGS - General Considerations Patient Education  Report signs of worsening anemia or iron toxicity  Dietary suggestions depending on type of anemia (example?)  Foods to avoid? Include?  B12 better absorbed with food Nursing Considerations  Assess for anemia manifestations (i.e. SOB, fatigue), treatment response  Assess diet and provide dietary suggestions  Be alert to drug interactions (i.e. vitamin b12….)  Monitor labs (Hgb, Hct, specialized tests –example?)