Anemia/Minerals/Vitamins

Question 1

Iron preparations/ Ferrous sulfate side effects

Answer 1

GI distress: nausea, heartburn, constipation; harmless dark green or black colored stools (expected).

Question 2

Iron preparations/ Ferrous sulfate nursing care: take iron with what? why?

Answer 2

• Take iron with vitamin C (orange juice); ascorbic acid helps improve absorption.

Question 3

Iron preparations/ Ferrous sulfate interactions

Answer 3

• Antacids, tea, coffee, milk (dairy) reduce absorption of iron. Allow at least two hours between.
• Iron will decrease absorption of tetracycline and fluoroquinolones.
• Liquid formulations stain teeth, drink through a straw; rinse mouth after

Question 4

Iron preparations/ Ferrous sulfate:
Oral administration

Answer 4

• Do not crush tablets
• Take iron on an empty stomach (1 hr before meals), w a glass of OJ, helps w absorption
• Take with food if GI adverse distress occurs. (This might increase adherence to therapy even though absorption is decreased)

Question 5

Duration of treatment with iron preparations

Answer 5

Treatment can take 1-2 months for iron deficiency anemia

Question 6

Evaluation of iron preparations

Answer 6

complete blood cell count (CBC): hemoglobin, hematocrit, and iron levels; increased activity tolerance

Question 7

Uses of vitamin B12

Answer 7

vitamin B12 deficiency, vegetarian diet, pernicious anemia (loss of intrinsic factor)

FYI:
- pernicious` anemia is an autoimmune condition that prevents the body from absorbing vitamin B12
* Without enough vitamin B12, there are fewer RBCs

Question 8

Administration of vitamin B12

Answer 8

IM (preferred - pernicious anemia), intranasal gel, sublingual

Question 9

Uses/indications of epoetin alfa

Answer 9

anemia caused by deficient erythropoietin production (chronic kidney disease/renal failure, chemotherapy).

Question 10

Contraindication of of epoetin alfa

Answer 10

uncontrolled hypertension

Question 11

A/E of epoetin alfa

Answer 11

hypertension, thrombotic events, MI, stroke (monitor level of consciousness) esp. with hemoglobin >12 g/d

Question 12

What to monitor for epoetin alfa

Answer 12

Monitor hemoglobin, hematocrit levels, and BP frequently

Question 13

Normal serum potassium ranges

Answer 13

3.5-5.0 mEq/L

Question 14

Uses of calcitriol/vitamin D

Answer 14

vitamin D deficiency; osteoporosis; hypocalcemia

Question 15

Contraindications of calcitriol/vitamin D

Answer 15

high levels of calcium in blood (hypercalcemia) or high levels of vitamin D

Question 16

Toxicity of calcitriol/vitamin D

Answer 16

hypertension, fatigue, anorexia, nausea, vomiting, abdominal cramps, ataxia, bone pain. If not recognized and treated, can progress to kidney damage.

Question 17

Normal calcium range

Answer 17

8.5 – 10.5 mEq/mL

Question 18

With calcium supplements, you can get hypercalcemia if you take it in excess. Symptoms of hypercalcemia include:

Answer 18

◦ Constipation, cardiac dysrhythmias
◦ Calcium will bind with tetracyclines and decrease absorption of tetracyclines.
◦ Calcium supplements interfere with absorption of bisphosphonates.

Question 19

Know what should not be given if blood calcium levels are high.

Answer 19

◦ If serum calcium levels are high, do not take calcitriol or calcium supplements.

Question 20

Know the use of sodium polystyrene sulfonate.

Answer 20

Uses: to treat hyperkalemia; to decrease serum potassium level

Question 21

Uses of Calcitonin

Answer 21

treat osteoporosis; lower calcium levels in blood (not bones). Inhibits the activity of osteoclasts, which are cells that break down bone.

Question 22

Sodium polystyrene sulfonate is the generic name of what

Answer 22

Kayexalate

Question 23

What is calcitonin derived from?

Answer 23

Derived from salmon (fish)

Question 24

Side effects of calcitonin

Answer 24

flushing, nausea, rhinitis, nasal irritation, signs of hypersensitivity (rash, anaphylaxis)

Question 25

Calcitonin: what do you do if nasal irritation occurs?

Answer 25

need to switch nostrils

Question 26

St John's wort: -St John's wort can _______ plasma concentration of _______ St John's wort alleviates _______; can cause serotonin syndrome when combined with other antidepressants, decreases the effectiveness of ____ _______, _______, warfarin, digoxin, calcium channel blockers, steroids, wear sunscreen due to phototoxicity

Answer 26

St John's wort: -St John's wort can **decrease** plasma concentration of **cyclosporine** St John's wort alleviates depression; can cause serotonin syndrome when combined with other antidepressants, decreases effectiveness of **oral contraceptives, cyclosporine, warfarin, digoxin, calcium channel blockers, steroids**, wear sunscreen due to phototoxicity.

Question 27

Gingko biloba: improves blood flow to the brain. Avoid use if taking _______ or _______ medication due to ______ risk of _______

Answer 27

Gingko biloba: improves blood flow to the brain. Avoid use if taking antiplatelet or anticoagulant medication due to increased risk of bleeding.

Question 28

Echinacea: stimulates the ______ ______; adverse effects: ______ _______, especially in patients who are allergic to _____ (______)

Answer 28

stimulates the immune system; adverse effects: allergic reactions, especially in patients who are allergic to **plants** (ragweed)

Question 29

Melatonin

Answer 29

assess sleep patterns