Anemia Medications-MJ

Question 1

What are the three indications that would diagnose a person with anemia?

Answer 1

Decreased number of RBC
Decrease in size of RBC
Decrease in content of RBC

Question 2

What test determine anemia?

Answer 2

Hemoglobin

Question 3

What is the normal Hgb for males?

Answer 3

12-15 gm/dL

Question 4

What is the normal Hgb for females?

Answer 4

14-17 gm/dL

Question 5

What are the 4 ingredients that make up RBC?

Answer 5

Iron
Vit. B-12
Folic Acid
Erythropoetin

Question 6

What is the most common nutritional deficiency?

Answer 6

Iron (5% of population)

Question 7

How much iron do women need?

Answer 7

15-18 mg/dL

Question 8

How much iron do men need?

Answer 8

8 mg/dL

Question 9

How much iron do infants need?

Answer 9

11 mg/dL

Question 10

What are some food sources of iron?

Answer 10

Egg yolks, muscle meats, beans, green leafy vegetables

Question 11

Does milk have iron?

Answer 11

No

*“milk babies”

Question 12

What is the name of iron given PO?

Answer 12

Ferrous sulfate

Question 13

What is the name of iron given IV?

Answer 13

Iron dextran

Question 14

Do we give iron IM?

Answer 14

You can, but it is rarely done

Question 15

What are the adverse effects of iron?

Answer 15

GI issues (nausea)
Dark/green black stool
Liquid ferrous sulfate can stain teeth

Question 16

If your patient is taking iron and they have dark/green black stool does that mean they are experiencing a sign and symptom of a GI bleed?

Answer 16

No; while melena is a S&S of a GI bleed (as in the case of warfarin), if a patient it taking iron this is a HARMLESS adverse effect

Question 17

How should we administer iron?

Answer 17

On an empty stomach because food with decrease the absorption of iron by 50-70%

Question 18

So iron causes GI issues (nausea). Pregnant women need lots of iron. They may already experience morning sickness. Is it okay if we tell them to take iron with food?

Answer 18

The best option would be to decrease the dosage of iron to a tolerable rate before you say they can take it with food

Question 19

What is the max dose of iron a day?

Answer 19

200 mg/d

Question 20

What are some meds that inhibit the absorption of iron?

Answer 20

Antacids (decreases iron absorption only)

Tetracyclines (decreases iron absorption and the tetracycline absorption)

Question 21

What does Vitamin C do to the absorption of iron?

Answer 21

Increases iron absorption

Question 22

Vitamin C increases iron absorption, but we tell patients not to take their iron with vitamin C. Why do we tell them that?

Answer 22

While Vit. C may increase the absorption of iron, it also increases the adverse effects! There is NO advantage to this. Don’t take vitamin C to increase absorption, simply, increase the iron dosage.

Question 23

Why do people have deficiency in vitamin B-12?

Answer 23

Impaired absorption

Question 24

What is pernicious anemia?

Answer 24

It is when the stomach has no intrinsic factor so B12 is not absorbed, the patient becomes anemic and can develop brain damage and die.

This can be treated!!

Question 25

What is the name of the version of B12 we give?

Answer 25

Cyanocobalamin

Question 26

How can we administer cyanocobalamin?

Answer 26

PO, intranasal, IM, or SQ

Question 27

What are the adverse effects of cyanocobalamin?

Answer 27

It is pretty well tolerated | HYPOkalemia is an adverse effect but it is rare

Question 28

Why do people have folic acid deficiencies?

Answer 28

Poor diets (alcoholics) and malabsorption (example of the GI disorder sprue)

Question 29

What are the consequences of taking folic acid?

Answer 29

Same as vitamin B12 minus the neurological damage that can occur with B12 and pernicious anemia

Question 30

How can we administer folic acid?

Answer 30

PO, IM, IV, SQ

Question 31

Is it normal to give an injection of folic acid?

Answer 31

No; injections are ONLY given to those with SEVERE absorption issues

Question 32

What are the short term adverse effects of folic acid?

Answer 32

There are none

Question 33

What are the long term adverse effects of folic acid?

Answer 33

Cancer

Question 34

What happens with EPO if a patient has chronic kidney disease?

Answer 34

Diseased kidneys don't make EPO like they are supposed to. EPO normally go to red bone marrow when there are not enough RBC so that the bone marrow will stimulate the production of them. Patients with chronic kidney disease don't make EPO like they are supposed to and don't go to the red bone marrow so the red bone marrow can't stimulate the production of RBC

Question 35

What are the two EPO meds?

Answer 35

Epoetin alfa | Darbepoetin alfa

Question 36

What is the therapeutic goal for epoetin alfa?

Answer 36

Decrease the need for transfusion

Question 37

What kind of patients take EPO drugs?

Answer 37

Anemia due to chronic renal failure Chemo induced anemia HIV infected patients taking zidovudine (AZT)

Question 38

What are the 3 adverse effects of taking EPO?

Answer 38

Hypertension Cardiovascular effects Cancer patients can have tumor progression

Question 39

What is the most common adverse effect of taking an EPO?

Answer 39

Hypertension

Question 40

Can you take an EPO if you have uncontrolled hypertension?

Answer 40

No

Question 41

30% of dialysis patients have to ____ the BP medication when starting EPO. Why?

Answer 41

Increase; EPO can cause hypertension

Question 42

Another adverse effect of EPO is cardiovascular effects? What does this mean?

Answer 42

EPO can increase the risks of MI, HF, stroke, etc

Question 43

What can EPOs do to tumors?

Answer 43

Stimulate the tumors to grow

Question 44

T/F. In patients taking EPOs, we want the Hgb to increase quickly.

Answer 44

FALSE!! That is dangerous!

Question 45

Since we don't want Hgb to increase quickly in patients taking EPO, in a 2 week period, Hgb should NOT rise by more than __.

Answer 45

1 gm/dL

Question 46

T/F. EPO should only be taken if they are really needed. Once Hgb gets to normal ranges, we stop taking the medication.

Answer 46

False. Medication is stopped when the Hgb is at "NEAR" normal

Question 47

What is the level in which you stop the Hgb drug?

Answer 47

Hgb greater than 11

Question 48

T/F. Before administering an EPO we need to shake the bottle.

Answer 48

FALSE. EPO=a protein! The protein in the drug will break if you shake it

Question 49

How do we store EPO?

Answer 49

In the fridge. DO NOT FREEZE