Chapter 11 Drug Therapy for Hematopoietic Disorders PDF

Chapter 11 Drug Therapy for Hematopoietic Disorders Copyright © 2018 Wolters Kluwer · All Rights Reserved  Physiology Hematopoietic Growth Factors regulate the differentiation and proliferation of particular progenitor cells. growth factors control survival and proliferation of he...

Chapter 11 Drug Therapy for Hematopoietic Disorders Copyright © 2018 Wolters Kluwer · All Rights Reserved  Physiology Hematopoietic Growth Factors regulate the differentiation and proliferation of particular progenitor cells. growth factors control survival and proliferation of hematopoietic lineages and also transduce a genuine lineage-determining signal in hematopoiesis & Initiate cell maturation process Involved in numerous physiologic responses Hematopoiesis, inflammation Cellular proliferation and differentiation Wound healing; cellular and humoral immunity Hematopoietic Cytokines extracellular ligands that stimulate hematopoietic cells to differentiate into eight principle types of blood cells. Regulate many cellular activities Act as chemical messengers among cells Act as growth factors for blood cells Perform by binding to receptors on target cells Trigger alteration of gene expression in target cell(s) Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Physiology Colony-Stimulating Factors (CSFs) Stimulate production of RBCs, platelets Granulocytes Neutrophils, basophils, eosinophils Granulocyte–macrophages Monocyte–macrophages Other blood cell types Interferons Inhibit replication of viral and other cells Activate natural killer cells Interleukins Affect immunologic cell response Stimulatory Suppressive Copyright © 2018 Wolters Kluwer · All Rights Reserved  Physiology Erythropoietin: Hormone secreted by the kidneys Stimulates red cell differentiation, maturation, and proliferation Conditions that will trigger erythropoietin production include hemorrhage, anemia, COPD, and high altitude Immune system Detects and eliminates foreign substances that may cause tissue injury or disease Regulates tissue homeostasis and repair Immune system cells identify and remove injured, damaged, dead, or malignant cells. WBCs (leukocytes) that circulate in blood and lymphatic vessels or reside in lymphoid tissues Ability to circulate and migrate; major components of host defenses Especially important in phagocytic, immune processes Neutrophils (40-70%), eosinophils, (1-6%) basophils (1%), monocytes (2-10%), lymphocytes (20-45%) WBC’s, Hgb/Hct, RBC and Plt indicated on a CBC /CBC c Differential measures the number of each type of WBC *** Immune Function: Indicates host protection from a disease Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Anemia Factors Erythropoietin levels low Deficiency of iron or B12 Genetic predisposition Iron Deficiency Anemia Menstruating women Pregnancy / lactation Rapidly growing adolescents GI Bleed Pernicious anemia Rare < 0.1% of general population Deficiency of Vitamin B12 TX IM B12 injections/supplements Megaloblastic Anemia Larger than normal RBC’s/deficient number S/SX: glossy red tongue/diarrhea Deficiency of Vit B12 +/or folate TX IM B12 injections/folic acid supplements Sickle Cell Anemia Exclusively in African Americans Hydroxyurea: antimetabolite: helps prevent formation of “sickle”shaped cells Copyright © 2018 Wolters Kluwer · All Rights Reserved  RX Therapy Immunostimulants (Immunostimulator’s): Drugs that stimulate/enhance the immune system by inducing activation or by increasing any of its components Used to restore normal function or to increase the ability of the immune system to eliminate harmful invaders Copyright © 2018 Wolters Kluwer · All Rights Reserved  Erythropoiesis-Stimulating Agents Induces erythropoiesis leading to increase hemoglobin and hematocrit levels Examples Epoetin alpha Darbepoietin Therapeutic Actions Stimulates the production of RBCs in bone marrow Treatment of anemia in renal failure, AIDS, and cancer therapy Helps avoid blood transfusion necessity Pharmacokinetics IV/SQ Metabolized in serum / excreted in urine Contraindications Uncontrolled hypertension/Allergy/Normal renal functioning NURSING Monitor CBC for increase RBC, Hgb/Hct, increase energy, exercise tolerance **** BLACK BOX WARNING: Do not use in pt with Hgb of 12 g.dl or normal renal function Copyright © 2018 Wolters Kluwer · All Rights Reserved Granulocyte Colony Stimulating factors Stimulates blood cell production by bone marrow in pt’s with neutropenia (chemotherapy induced febrile neutropenia, acute myeloid leukemia, cancer patients receiving bone marrow transplants, or chronic idiopathic neutropenia) Examples FILGRASTIM Therapeutic Actions Stimulates neutrophil progenitor cell proliferation and differentiation in bone marrow = increase number of Mature neutrophils Pharmacokinetics: SQ/IV Completed absorbed over 4 days Adverse Effects: Fatigue/ flu like symptoms/Bone pain/thrombocytopenia (bleeding gums/ease of bruising) Nursing: Educate on methods to decrease/prevent infection/report side effects Copyright © 2018 Wolters Kluwer · All Rights Reserved Iron Deficiency Anemia: Examples / Therapeutic Actions Examples Adverse Effects Ferrous aspartate, Ferrous CNS effects gluconate GI effects!! Ferrous sulfate Other effects Iron dextran Therapeutic Actions Regain positive iron balance Treatment of iron deficient anemia Oral administration: Administer btwn meals if possible Pharmacokinetics (increase absorption/ascorbic acid can IV, PO also increase absorption) Z-track for IM - iron dextran If oral liquid, use straw (stains teeth) Absorbed in small intestine Possible drug-food interactions Antacids Contraindications Eggs Allergy Milk, coffee, tea Hemochromatosis Monitor GI activity: Hemolytic anemia C/O stomach upset PUD, colitis, enteritis Record/check bowel movements Medication is very constipating/may need a Normal iron balance daily stool softener with iron dose Copyright © 2018 Wolters Kluwer · All Rights Reserved