anemia pharm

Question 1

epoetin alfa: classification and MOA

Answer 1

ethropoeisis stimulating agent

moa: mimics human erythropoietin (stimulates production of RBC in bone marrow)

Question 2

epoetin alfa: indications

Answer 2

-chronic kidney disease
-HIV infection on drug therapy
-anemia from chemo
-pre-op pt with anemia

Question 3

epoetin alfa: route

Answer 3

SQ

Question 4

epoetin alfa: FDA recommendations

Answer 4

weigh the risks vs benefits
do not initiate therapy if Hgb > 10
use the lowest dose possible to reduce the need for transfusion

Question 5

epoetin alfa: contraindications

Answer 5

chronic kidney disease: increased mortality and serious CV events

cancer: increased mortality and tumor progression

surgery pt: increased thromboembolic events and mortality

Question 6

epoetin alfa: nursing implications

Answer 6

monitor BP before and during therapy (pt can become hypotensive)
monitor Hgb levels
*recommend iron supplements

Question 7

dietary iron types

Answer 7

heme and non-heme iron

Question 8

heme iron

Answer 8

40% of the iron in meat, poultry, and fish
well absorbed

Question 9

non-heme iron

Answer 9

60% of iron in animal tissue
all the iron in plants - fruits, veggies, grains, nuts
not easily absorbed

Question 10

ferrous sulfate: MOA

Answer 10

taken up by bone marrow cells to make hemoglobin

Question 11

ferrous sulfate: indications

Answer 11

iron therapy

for iron deficiency or prevention of

Question 12

ferrous sulfate: adverse effects

Answer 12

GI disturbances, teeth staining, tarry stools

Question 13

dosage issues with iron therapy

Answer 13

ferrous sulfate only contains 20% elemental iron by weight
(ex: if a pt needs 100mg of elemental iron, they will get a 500mg dose)

Question 14

iron therapy interactions

Answer 14

antacids reduce absorption
food helps prevent GI side effects - but decreases absorption by 50-70%

*so take on empty stomach or with SMALL AMT of food, if needed

Question 15

iron toxicity

Answer 15

early signs of OD: N/V/D, stomach pain
*leading cause of poisoning death in children

Question 16

iron dextran: class/route and indication

Answer 16

parenteral iron (IM or IV)

-clear diagnosis of iron deficiency
-oral iron is intolerable or ineffective

Question 17

iron dextran: side effects

Answer 17

BLACK BOX WARNING: potentially fatal anaphylaxis (when IV)

Question 18

iron dextran: safety implications

Answer 18

only use when ABSOLUTELY necessary
have epipen and CPR equipment readily available
small test dose before a full dose

Question 19

disadvantages of giving iron dextran IM

Answer 19

persistent pain and discoloration at injection site, tumors, risk of anaphylaxis

Question 20

cyanocobalamin: indication and route

Answer 20

(vit B12)
for vitamin B12 deficiency
preferred route: oral (can also be given intranasally)

Question 21

cyanocobalamin: side effects

Answer 21

hypokalemia (natural response of increased RBC production)

Question 22

when taking cyanocobalamin, what should you be cautious of?

Answer 22

folic acid - it will correct anemia but masks a B12 deficiency

Question 23

folic acid: MOA

Answer 23

converts to the active form of folic acid after administration

Question 24

folic acid: indications

Answer 24

treatment of folic acid deficiency anemia
prophylaxis of folate deficiency
initial treatment of severe anemia from vitamin B12 deficiency

Question 25

adverse effects of folic acid

Answer 25

none
pt may feel flushed