Hematologic Drugs PDF

Can you memorize them? RBC: Male: 4.5 M to 5.5 M Female: 4.5 M to 5 M WBC: 5,000 to 10,000 per mm3 Platelet: 200T to 400T per mm3 Hgb: Male: 12 to 16 g/dL Female: 14 to 18 g/dL Hct: Male: 40% to 54% Female: 31% to 47%  Significance RBC – Decreases in RF...

Can you memorize them? RBC: Male: 4.5 M to 5.5 M Female: 4.5 M to 5 M WBC: 5,000 to 10,000 per mm3 Platelet: 200T to 400T per mm3 Hgb: Male: 12 to 16 g/dL Female: 14 to 18 g/dL Hct: Male: 40% to 54% Female: 31% to 47%  Significance RBC – Decreases in RF, infective carditis, anemia Increases in HD WBC – Increases in infectious and inflammatory disease of the heart Hct – Increases in hypovolemia and excessive diuresis Decreases in anemia Hgb – Decreases in various anemias Increases in polycythemia, CHF  Hematopoietics 1. Iron products 2. Vitamins 3. Biologic Response Modifiers  Iron Mechanism of Action Supplement and replace depleted iron stores in the bone marrow to assist in erythropoiesis Pharmacokinetics Absorption: duodenum and upper jejunum Distribution: bound to transferrin Metabolism: closed system Excretion: urine, feces, sweat, breastmilk Drug Examples: Ferrous sulfate (Feosol, Fer-Iron) Iron dextran (DexFerrum) Ferrous gluconate (Fergon) Indications: Prevent and treat iron deficiency and IDA Dietary supplement for iron  Contraindications  Hypersensitivity  Hemochromatosis  Hemosiderosis  Hemolytic anemias Adverse Reactions: N & V HA Constipation Staining at IM site Dark stools Localized phlebitis Diarrhea Stain teeth GI distress Hypersensitivity reaction  Nursing Responsibilities  Administer drug according to prescribed route - For oral administration  administer between meals If GI distress occurs, administer with meals Administer tab with juice/water but not with milk or antacids Dilute liq iron preparations and administer with a straw Nursing Responsibilities - For IM administration  use the Z track technique - For IV administration Check institutional policy before administering IV Use the IV route in these situations: - insufficient muscle mass for deep IM - impaired absorption from muscle caused by stasis/edema - possibility of uncontrolled IM bleeding - massive and prolonged parenteral therapy  Nursing Responsibilities Before IV administration, give an initial test dose On completion of IV iron dextran infusion, flush the vein with 10 mL of 0.9% NaCl solution Tell the pt to rest for 15 to 30 mins after IV administration  Monitor the pt’s CBC, Hgb and plasma iron level  Check for constipation  Tell the pt to continue the regular dosing schedule after missing a dose  Nursing Responsibilities  Caution parents to be aware of iron poisoning in children and contact their pediatrician immediately - s/sx of posisoning: -N&V - diarrhea - GI bleeding  Instruct the pt to drink 2 L of fluid daily, increase fiber intake and to exercise regularly  Nursing Responsibilities  Advise pt to avoid antacids, coffee, tea, dairy products, eggs and whole grain breads for 1 hour before and 2 hours after taking oral preparations  Inform the pt that iron preparations may turn stool dark green or black  Vitamins Mechanism of Action Replace depleted vitamin stores Pharmacokinetics Absorption: Vit B12 - simple diffusion Folic acid – hydrolysis in GI tract Distribution: tissues and protein bound Metabolism: liver Excretion: Vit B12 - urine, bile, breastmilk Folic acid – urine, feces, breastmilk Drug Examples Cyanocobalamin (Nascobal) Vitamin B12 (Betalin 12) Folic acid (Folvite) Indications Treat Vitamin B12 deficiency  Adverse Reactions Vit B12  HA  Asthenia  Infection  Paresthesia  Nausea  Itching  Mild diarrhea  Rash Folic acid  Allergic reaction/allergic bronchospasm  Nursing Responsibilities  Inform pts with pernicious anemia that they will require monthly injections of vit B12 for the rest of their lives  Take seizure precautions in pt receiving large doses of folic acid while on anticonvulsant therapy  Encourage the pt to eat foods rich in Vit B12  Monitor laboratory test result  Check folate levels in a pts who is receiving more than 10 mcg daily of vit B12  Monitor the pt’s potassium level during the first 48 hrs of treatment Biologic Response Modifiers Mechanism of Action Stimulate RBC production in the bone marrow by boosting the production of erythropoietin Pharmacokinetics Absorption: SC, IV Distribution: vascular space Metabolism: Unknown Excretion: Unknown Drug Examples Darbepoetin alfa (Aranesp) Epoetin alfa (Epogen, Procrit) Indications  Anemia associated with chronic renal failure, end stage renal disease, chemotherapy  Decrease the need for perioperative blood transfusions in surgery pts Contraindications – Hypersensitivity – Uncontrolled HPN Adverse Reaction  HPN  Seizures  Iron deficiency  Increased risk of thrombotic events  Myalgia  HA  Nursing Responsibilities  Monitor Hgb and Hct frequently  Institute seizure precautions and closely monitor for pt’s neurologic status  Frequently monitor the pt’s BP  Teach the pt of family the proper technique for SC injection  Anticoagulants Mechanism of Action Prevent extension and formation of clots by inhibiting factors in the clotting cascade Pharmacokinetics Absorption: IV or SC Distribution: varies Metabolism: liver Excretion: urine Drug Examples – Heparin sodium – Warfarin sodium (Coumadin) – Enoxaparin sodium (Lovenox) Indications Thromboembolic disorders Ischemic complications Unstable angina in PTCA Contraindications  Hypersensitivity  Ulcer disease  Recent surgery  Cancer  Active bleeding  Severe thrombocytopenia  Uncontrolled bleeding  Adverse Reactions Hyperlipidemia Pain at injection site Thrombocytopenia Nausea Hemorrhages Constipation Spinal hematoma Insomnia Fever  Interactions Effects Chloramphenicol, metronidazole, ↑ risk of bleeding and enhance thrombolytics, valproic acid, effect of warfarin quinidine Alcohol, barbiturates, ↑ risk of clotting and may ↓ effects contraceptives, foods high in Vit, K of warfarin ASA, NSAIDs ↑ risk of bleeding Nursing Responsibilities Don’t give heparin by IV route Minimize venipunctures and injections; apply pressure to all puncture sites Know that heparin is given initially because of its rapid action; the pt may then be started on warfarin which takes several days to reach a therapeutic level  Nursing Responsibilities  Once therapeutic levels are reached, heparin will be discontinued and the pt will be maintained on warfarin  Know that heparin directly affects PTT and warfarin directly affects PT  Inject SC heparin into the abdomen;don’t aspirate or rub the injection site and rotate injection sites  Antidote: protamine sulfate (heparin) phytonadione (warfarin)  Nursing Responsibilities  Assess for sign and symptoms of bleeding  Monitor Hgb and clotting factor and platelet levels  Instruct the pt to use a soft toothbrush and an electric razor  Caution pts not to increase dietary Vit K or drastically and suddenly change their diet  Teach the pt about the importance of routine laboratory tests  Thrombolytics Mechanism of Action Activate plasminogen, leading to its conversion to plasmin Pharmacokinetics Absorption: IV Distribution: circulation Metabolism: liver Excretion: varies Drug Examples – Streptokinase (Streptase) – Urokinase (Abbokinase) – Reteplase (Retavase) Indications: Lysis of thrombi Massive pulmonary emboli, DVT, acute ischemic stroke and acute MI Contraindications  Recent streptococcal infection  Active internal bleeding  Recent stroke  Ulcer disease  Recent surgery  Cancer  Uncontrolled HPN  Adverse Reactions Bleeding and arrhythmias Hypersensitivity reactions Urticaria Fever Hemorrhage Interactions Effects ASA, NSAIDs, dextran ↑ risk of bleeding Aminocaproic acid Inhibits streptokinase and reverse its fibrinolytic effects  Nursing Responsibilities  Know that thrombolytic should be administer only when the pt’s hematologic function and clinical response can be monitored  Assess s/sx of bleeding; monitor coagulation values and implement appropriate safety measures to prevent bleeding  Antidote: Aminocaproic acid  Minimize venipunctures, injections and other invasive procedures  Nursing Responsibilities Monitor Hgb and clotting factor and platelet levels Frequently monitor the pt’s VS for indications of bleeding or hypotension Check peripheral pulse Keep typed and cross matched blood on hand  Antiplatelet Drugs Mechanism of Action Interfere with platelet aggregation in different drug-specific and dose-specific ways, preventing thromboembolic events Pharmacokinetics Absorption: varies Distribution: widely distributed Metabolism: liver Excretion: bile, urine, feces Drug Examples – ASA (Aspirin) – Clopidogrel (Plavix) – Ticlopidine (Ticlid) – Cilostazol (Pletal) Indications Prophylaxis for thromboembolic events and intermittent claudication  Adverse Reactions  Bleeding  HA  Pancytopenia  Rash  Neutropenia  Infection  Thrombotic  Nausea thombocytopenic  Pain at the injection purpura site  Dizziness  Diarrhea  Abnormal stools  Nursing Responsibilities Monitor the pt for bruising or bleeding Assess for s/sx of bleeding Monitor Hgb and clotting factor and platelet levels Minimize venipunctures and injections; apply pressure to all puncture site