Download Chapter_55

CHAPTER 55
Anemia Drugs
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Hematopoiesis

Formation of new blood cells



Red blood cells (RBCs)
White blood cells (WBCs)
Platelets
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
2
Hematopoiesis (cont’d)

RBCs




Manufactured in bone marrow
Immature RBCs are reticulocytes
Life span is 120 days
More than one third of an RBC is made of
hemoglobin


Heme: red pigment, contains iron
Globin: protein chain
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
3
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
4
Anemias

Maturation defects



Cytoplasmic
Nuclear
Excessive destruction of RBCs (hemolytic
anemias)

Intrinsic RBC abnormalities
 Extrinsic mechanisms
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
5
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
6
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
7
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
8
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
9
Iron




Essential mineral in the body
Oxygen carrier in hemoglobin and myoglobin
Stored in the liver, spleen, and bone marrow
Iron deficiency results in anemia
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
10
Iron (cont’d)


Dietary sources: meats, certain vegetables
and grains
Dietary iron must be converted by gastric
juices before it can be absorbed
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
11
Iron (cont’d)

Some foods enhance iron absorption





Orange juice
Veal
Fish
Ascorbic acid
Some foods impair iron absorption

Eggs*
 Corn
 Beans*
 Cereal products containing phytates
* Also common dietary sources of iron
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
12
Iron (cont’d)


Supplemental iron may be given as a single
drug or as part of a multivitamin preparation
Oral iron preparations are available as
ferrous salts


ferrous fumarate, ferrous gluconate, ferrous
sulfate
Parenteral



iron dextran
ferric gluconate (Ferrlecit)
iron sucrose (Venofer)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
13
Iron: Indications


Prevention and treatment of iron-deficiency
syndromes
Administration of iron alleviates the symptoms
of iron-deficiency anemia, but the underlying
cause of the anemia should be corrected
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
14
Iron: Adverse Effects





Most common cause of pediatric poisoning
deaths
Causes nausea, vomiting, diarrhea,
constipation, stomach cramps, and pain
Causes black, tarry stools
Liquid oral preparations may stain teeth
Injectable forms may stain skin and cause
pain upon injection
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
15
Parenteral Iron

Iron dextran



May cause anaphylactic reactions, including fatal
anaphylaxis
Test dose is usually given, and then remainder of
dose is given after 1 hour
Used less frequently now; replaced by newer
products
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
16
Parenteral Iron

Ferric gluconate and iron sucrose



Used for patients with chronic renal disease and
iron-deficiency anemia
Less risk of anaphylaxis
Hypotension is the most common adverse effect
and is related to infusion rate
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
17
Folic Acid



Water-soluble, B-complex vitamin
Essential for erythropoiesis
Primary uses



Folic acid deficiency
During pregnancy to prevent neural tube defects
Malabsorption syndromes are the most
common cause of deficiency
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
18
Folic Acid (cont’d)



Should not be used until actual cause of
anemia is determined
May mask symptoms of pernicious anemia,
which requires treatment other than folic acid
Untreated pernicious anemia progresses to
neurologic damage
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
19
Other Blood-Forming Drugs


cyanocobalamin (vitamin B12)
erythropoietin (Epogen, Procrit)
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
20
Nursing Implications




Assess patient history and medication history,
including drug allergies
Assess for potential contraindications
Assess baseline laboratory values, especially
Hgb, Hct, reticulocytes, others
Obtain nutritional assessment
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
21
Nursing Implications (cont’d)



Ferrous salts are contraindicated in patients
with ulcerative colitis, PUD, liver disease, and
other GI disorders
Keep away from children because oral
forms may look like candy
Iron dextran is contraindicated in all anemias
except for iron-deficiency anemia
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
22
Nursing Implications (cont’d)


For liquid iron preparations, follow
manufacturer’s guidelines on dilution and
administration
Instruct patient to take liquid iron preparations
through a straw to avoid staining tooth
enamel
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
23
Nursing Implications (cont’d)


Oral forms of iron should be taken between
meals for maximum absorption, but may be
taken with meals if GI distress occurs
Oral forms should be given with juice, but not
with milk or antacids
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
24
Nursing Implications (cont’d)


Patients should remain upright for 15 to 30
minutes after oral iron doses to avoid
esophageal corrosion
Patients should be encouraged to eat foods high
in iron/folic acid
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
25
Nursing Implications (cont’d)



For iron dextran, a small test dose should be
given
After 1 hour, if no reaction, the remainder of
the dose can be given
Administer deeply into a large muscle mass
using the Z-track method
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
26
Nursing Implications (cont’d)


For IV doses of iron dextran, give carefully
according to manufacturer’s instructions
Have resuscitative equipment available in
case of anaphylactic reaction
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
27
Nursing Implications (cont’d)



Determine cause of anemia before
administering folic acid
Administer oral folic acid with food
Folic acid may also be given IV and added to
total parenteral nutrition solutions
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
28
Nursing Implications (cont’d)

Monitor for therapeutic responses




Improved nutritional status
Increased weight, activity tolerance, well-being
Absence of fatigue
Monitor for adverse effects
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
29