Drugs Affecting the Vascular System and Blood

Question 1

HMG-CoA reductase inhibitors (statins) - inhibit cholesterol synthesis in the liver

Answer 1

Prototype: - Antilipemic drug classifications

Question 2

Bile acid sequestrants
Cholesterol absorption inhibitors
Fibrates
Vitamin B
Omega-3 fatty acids

Answer 2

Others to help lower cholesterol; sometimes on multiple drugs - Antilipemic drug classifications

Question 3

Blocks HMG-CoA (enzyme helps facilitate synthesis of cholesterol) reductase from completing synthesis of cholesterol in the liver - effective way reduce cholesterol levels in pats with hyperlipidemia; block production of cholesterol

Answer 3

MoA: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)

Question 4

At HS (highest rates cholesterol synthesis at HS) - most effective

Answer 4

Admin: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)

Question 5

renal impairment, liver disease - works directly in liver so more dangerous affect to those who have underlying liver disease so if have impairment needs be cautious, heavy alcohol use, pregnancy category X - need lot cholesterol/essential for adequate fetal development

Answer 5

Caution: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)

Question 6

GI effects (cramping, diarrhea, constipation), potential for liver damage (LFTs done periodically; q1yr), myalgias (muscle pain - mild (not notice them) to severe: severe = concerned; ask about muscle pains; in multiple areas of the body; present is sign statins causing muscle breakdown and release myoglobin and puts risk for developing rhabdomyolysis - prob is myoglobin put in bloodstream and sent to kidneys and really toxic to kidneys and put into AKI; must report immediately anything above mild); Toxic: rhabdomyolysis with AKI; lot have no issues

Answer 6

AE: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)

Question 7

monitor liver and kidney function (toxicity) - LFTs and kidney func periodically to make sure not damaging liver, risk for AKI; teach to report myalgias for further assessment, no grapefruit juice (interacts where statins not metabolized - increases levels in blood - higher risk for rhabdomyolysis), lifestyle modification for high cholesterol

Answer 7

Nursing: - HMG-CoA Reductase Inhibitors: Prototype: atorastatin (Lipitor)

Question 8

Block platelet plug; affect where form platelet plug; inhibit platelets from sticking together - harder to form plug
More preventative measures - mild drugs that affect coag

Answer 8

Antiplatelet agents

Question 9

Block products of clotting cascade
More potent drugs; used for variety conditions; used for treatment blood clots

Answer 9

Anticoag

Question 10

Inhibit platelet aggregation (COX inhibitor)

Answer 10

MoA: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)

Question 11

Prevention of MI, TIA, ischemic CVA in high-risk populations (primary or secondary prevention); most pats taking aspirin to prevent or at high risk of CV events

Answer 11

Indication: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)

Question 12

81-325 mg PO daily (81 mg is a “baby aspirin”)

Answer 12

Dose: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)

Question 13

GI irritation (N/V, epigastric pain); bleeding - GI bleeding, hematuria, easy bruising; tinnitus (with toxicity)

Answer 13

AE: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)

Question 14

take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)

Answer 14

Nursing: - Antiplatelet Agent/Salicylate: Prototype: Aspirin (ASA)

Question 15

Inhibit platelet aggregation (alters signaling to platelets that crucial aiding in wanting to stick together)

Answer 15

MoA: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)

Question 16

prevent blood clot w/hx of MI, ischemic stroke, or PAD - prevent another CV event and prevent arterial blood clot for PAD pats; prevent blood clot with cardiac stent or bypass graft - prevent platelets sticking together to stent/graft - not long-term use, used until tissue grown over stent put in to decrease risk of clot

Answer 16

Indications: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)

Question 17

Bleeding - major AE - not forming platelet plug means easier bleeding - can be fatal, flulike syndrome, dizziness, easy bruising, rash, pruritus

Answer 17

AE: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)

Question 18

hold 5 days prior to procedure - higher risk for more bleeding, bleeding precautions - soft bristel toothbrush used, electric razor, avoid injury/trauma

Answer 18

Nursing: - Antiplatelet Agent: Prototype: clopidogrel (Plavix)

Question 19

Indication for medication (usually prevention blood clots associated with CV events, stent placement, PAD)
Clinical manifestations of bleeding/easy bruising notice with pats

Answer 19

Assessment:- Nursing considerations/antiplatelet agents

Question 20

Bleeding precautions
Avoid injury and falls
Hold prior to procedure/surgery
Educate patient on medication - imp; need understand sig of taking it

Answer 20

Interventions:- Nursing considerations/antiplatelet agents

Question 21

Disrupt clotting cascade making it difficult for blood to clot; inhibits clotting cascade; harder for blood to clot
Already have clot: used so blood clot not further extended, clot not move to other areas of body, body can take care of clot on its own; DOES NOT BREAK UP A CLOT

Answer 21

Anticoags:

Question 22

Complication: ischemic stroke (embolus)
Treatment goals for disorder: prevent blood clot in atria
clots can form in atria because dysonchrous sequencing of squeeze so high risk for strokes
Drug therapy: warfarin, rivaroxaban

Answer 22

Chronic atrial fibrillation - Common Clotting disorders/comps/treatment goals

Question 23

Complication: tissue hypoxia/death
Treatment goals for disorder: clot lysis; restore perfusion
Drug therapy: alteplase - thrombolytic - restores perfusion quickly

Answer 23

Ischemic stroke - Common Clotting disorders/comps/treatment goals

Question 24

Complication: PE
Treatment goals for disorder: slow clot growth; inhibit propagation; inhibit new clots
fine if stays where is; prob if moves
Drug therapy: SQ heparin/enoxaparin, warfarin, rivaroxaban - anticoag; lot options for drugs

Answer 24

Deep vein thrombosis (DVT) - Common Clotting disorders/comps/treatment goals

Question 25

Complication: tissue hypoxia/death Treatment goals for disorder: slow clot growth; inhibit new glots; clot lysis; surgical Serious condition Drug therapy: IV heparin drip, alteplase - treatment variable

Answer 25

Pulmonary embolism (PE) - Common Clotting disorders/comps/treatment goals

Question 26

Measure diff parts of clotting cascade Ref range: 11-12.5 sec Significance of pharmacology: prolonged: warfarin therapy For warfarin Time takes for blood to clot

Answer 26

Prothrombin time (PT) - Diagnostics lab: clotting time

Question 27

Measure diff parts of clotting cascade Ref range: 0.7-1.8 Significance of pharmacology: standard measure for PT; measurement for adjusting warfarin therapy Therapeutic goal: 2.0-3.0 For warfarin adjust warfarin dosing; standarized; therapeutic goal - harder for body form blood clot so want prolonged bleeding time; if under goal - means not have prolonged bleeding time Time takes for blood to clot

Answer 27

International normalized ratio (INR) - Diagnostics lab: clotting time

Question 28

Measure diff parts of clotting cascade Ref range: 21-35 sec Significance of pharmacology: prolonged: heparin therapy; measurement for adjusting heparin therapy Therapeutic goal: 45-70 sec Time takes for blood to clot

Answer 28

Activated partial thromboplastin time (aPTT) - Diagnostics lab: clotting time

Question 29

All anticoagulants have adverse effect of bleeding (non-fatal and fatal) Reduce risk for injury and falls when given these drugs - fall because if hits their head; worry about a brain bleed Implement bleeding precautions Contraindications: Drug-drug:

Answer 29

anticoags/thrombolytics: gen nursing considerations

Question 30

Primary AE of drug - extension of MoA; high alert drugs due to bleeding; need give right doses to pats Non-fatal: Hematuria, epistaxis, bruising Fatal: Hemorrhagic stroke (bleeding in brain), internal bleeding, GI bleeding (older adult high risk)

Answer 30

All anticoagulants have adverse effect of bleeding (non-fatal and fatal)

Question 31

Pregnancy (except heparin/enoxaparin - molecules to large to pass through fetal/placental barrier so those are drugs of choice), hx bleeding disorders - exacerbates prob, hx of bleed/bleeding disorders - exacerbates prob, thrombocytopenia (low platelets - bleed easier)

Answer 31

Contraindications:

Question 32

antiplatelet agents (increase risk for bleeding because inhibit ability clot through diff pathways), NSAIDs (risk for bleeding, esp GI bleeding), herbals (all increase bleeding when taken together)

Answer 32

Drug-drug:

Question 33

Disrupts clotting cascade; prolongs bleeding time

Answer 33

MoA: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 34

Prevent or treat DVT (SQ - 3 injections); treat PE (IV drip)

Answer 34

Indications: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 35

Pork allergy; Pork abstention religion (Judaism, Muslim) - heparin and enoxaparin (LMWH) derived from pigs

Answer 35

Contraindication: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 36

Bleeding, heparin-induced thrombocytopenia (HIT - platelet counts lowered because heparin therapy), bruising at injection site (SQ)

Answer 36

AE: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 37

Rotate/monitor injection sites for SQ (do not admin IM - absorb quicker and higher risk for suffering more AE), monitor platelet count; monitor aPTT (therapeutic 45-70 sec)

Answer 37

Nursing: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 38

protamine sulfate (heparin short half-life, stop infusion; reverse heparin; most OD on heparin on drip - usually just stop drip and short half-life get out body within hours so usually no need for reversal agent)

Answer 38

Reversal agent: - Indirect Thrombin Inhibitor (Anticoagulant): Prototype: Heparin

Question 39

Disrupts clotting cascade; prolongs bleeding time; molecule smaller than helparin and longer action time; adv: admin less often - just two injections

Answer 39

MoA: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 40

prevention or treatment of DVT

Answer 40

Indications: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 41

Pork allergy; Pork abstention religion (Judaism, Muslim)

Answer 41

Contraindication: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 42

bleeding; bruising at injection site

Answer 42

AE: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 43

Adm. deep SQ; do not aspirate or massage site; do not remove air bubble from prefilled syringe - seals medication in; rotate/monitor injection sites; monitoring of clotting time not necessary; not need monitor labs - affects clotting cascade in diff area; weight based doses; not admin with heparin

Answer 43

Nursing: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 44

protamine sulfate

Answer 44

Reversal agent: - Low molecular weight heparin (Anticoagulant): Prototype: Enoxaparin (Lovenox)

Question 45

GI effects (n/v since PO), bleeding

Answer 45

AE: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 46

antibiotics (monitor INR during therapy - causes prolonged bleeding time, more warfarin stays in bloodstream then need so higher risk for bleeding; draw this to monitor to make sure not too prolonged and not at risk for bleed), amiodarone (increased risk of bleeding), herbals (increased risk of bleeding)

Answer 46

Drug-drug: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 47

Monitor PT/INR (therapeutic goal INR 2.0-3.0); see special considerations; first oral anticoagulant drug on market; time onset delayed; not admin with rivaroxaban; will bridge with enoxarpin as tyring to get to therapeutic level

Answer 47

Nursing: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 48

vitamin K - liver K to work with and produces clotting factors - supercede action warfarin and allow blood clot faster and reverse action warfarin because too high

Answer 48

Reversal agent: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 49

Interfere with hepatic synthesis of vitamin K-dependent clotting factors - liver synthesizes lot clotting factors and this interferes ones that are vit-K dependent; prolongs bleeding time; more for maintenance

Answer 49

MoA: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 50

Chronic a-fib (most often used); artificial heart valves; prevent/treat DVT, PE - outpat option

Answer 50

Indications: - Vitamin K Antagonist (Anticoagulant): Prototype: Warfarin (Coumadin)

Question 51

Daily (usually in the evening or HS) If INR is greater than 3.0: HOLD med and call prescribing provider - pat at risk for bleeding Expect an order for Vitamin K if INR is greater than 4.0 (PO or SQ) - prescribed dependent on how high INR

Answer 51

Dosing: - Warfarin special considerations

Question 52

Dose change = next lab draw in 3 days - warfarin onset time is delayed; 36+ hours for changes to coag to take effect; dangerous if not check it again Long term monitoring (INR stable) = INR drawn weekly or monthly

Answer 52

Lab draws: - Warfarin special considerations

Question 53

Teach patient to maintain consistent intake (avoid) vitamin K-containing foods (high intake may decrease warfarin effect) - since inhibiting vitamin K clotting factors; impacts INR so dose on intake taking

Answer 53

Diet: - Warfarin special considerations

Question 54

Kale Collard greens Spinach Brussel sprouts Broccoli Asparagus Sauerkraut Soybeans Edamame

Answer 54

Foods high in Vit K - GREEN

Question 55

St. John's Wart Garlic Gingko Ginger root Chamomile

Answer 55

Herbals to avoid with Warfarin

Question 56

Disrupt clotting cascade; prolongs bleeding time

Answer 56

MoA: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 57

PO

Answer 57

Route: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 58

chronic a-fib; prevent DVT and PE

Answer 58

Indications: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 59

bleeding

Answer 59

AE: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 60

no blood monitoring required; no dietary considerations; much easier for pat take; risk for fatal bleeding less

Answer 60

Nursing: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 61

Andexxa (coag factor Xa (recombinant))

Answer 61

Reversal agent: - Factor Xa Inhibitor (Anticoagulant): Prototype: rivaroxaban (Xarelto)

Question 62

Assessment: Interventions: Too much always let prescriber know and let HCP know what seeing

Answer 62

Initial management anticoag OD

Question 63

Clinical manifestations of bleeding and vital signs (HR/BP/O2 sat - unstable with internal bleeding) - esp if know given too much

Answer 63

Assessment: - Initial management anticoag OD

Question 64

Notify provider - let know VS and what seeing Draw labs as ordered: Hemoglobin/hematocrit (worried about bleeding), platelets if on heparin therapy (bleeding, HIT); clotting times (PT/INR, aPTT) Administer fluids (normal saline) and/or packed-red blood cells as ordered - blood transfusion Administer reversal agent as ordered

Answer 64

Interventions: - Initial management anticoag OD

Question 65

Local fibrinolysis (acute clot lysis); break up the clot

Answer 65

MoA: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)

Question 66

Systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI); Local: central venous catheter occlusion - no major AE because not going into pat just sitting in line

Answer 66

Indications: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)

Question 67

bleeding, hypotension, bradycardia, tachycardia

Answer 67

AE: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)

Question 68

many; when used systemically sig assessment that appropriate for pat because can have detrimental effects because potent

Answer 68

Contraindications: - Thrombolytic Agent: Prototype: alteplase (Activase; tPA)

Question 69

Physical assessment with focus on cardiovascular and s/s bleeding Labs: aPPT, PT/INR, H/H, platelets Major Drug-drug: more than 1 anticoagulant/antiplatelet (ie; ASA, warfarin), herbal supplements, antibiotic therapy

Answer 69

Assessment - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes

Question 70

Risk for injury Ineffective tissue perfusion

Answer 70

Nursing Diagnosis - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes

Question 71

Therapeutic effect with limited adverse effects (ie; absence of DVT, PE, stroke) - absence of blood clots Client understanding of drug therapy, adverse effects, safety

Answer 71

Expected Outcomes - Drugs affecting blood coag/thrombolytic agent: nursing assessment/diagnosis/outcomes

Question 72

Bleeding precautions Reduce risk for falls Hold for procedures Educate client: s/s bleeding; lab monitoring and diet if indicated

Answer 72

Nursing: drugs affecting blood coag: interventions

Question 73

Therapeutic response: absence of blood clots, restored perfusion Adverse effects: monitor s/s bleeding most important! Teaching (was it effective?)

Answer 73

Nursing: drugs affecting blood coag: eval

Question 74

The onset of warfarin is 36-48 hours. The patient will not be anticoagulated during this time. The diagnosis of a DVT warrants the need for more immediate anticoagulation to reduce the risk of complications, such as PE. The patient will be prescribed enoxaparin because it achieves anticoagulation quickly (onset 3-5 hours; duration 12 hours) and will provide anticoagulation until the warfarin's action takes effect. When the patient's INR is therapeutic on warfarin (2.0-3.0), the enoxaparin will be discontinued. This entire process is referred to as "bridging".

Answer 74

The nurse on a medical-surgical unit is caring for a client who has just been diagnosed with a deep vein thrombosis (DVT) in the right lower extremity. The primary care provider has prescribed enoxaparin 70 mg SQ every 12 hours with the first dose STAT. In addition, the provider has prescribed warfarin 5 mg PO daily and a PT/INR draw in 3 days. Why has the primary care provider prescribed both medications simultaneously?

Question 75

In which situation could a thrombolytic agent be safely used? A.CVA within the last 2 months B.Acute MI within the last 3 hours C.Recent, serious GI bleeding D.Obstetrical delivery

Answer 75

Answer: B Rationale: Blood clots can cause myocardial infarction and alteplase can be used to dissolve the clot. Other answers are contraindications to thrombolytic agents.

Question 76

Antiplatelet drugs would be useful in which of the following? Select all that apply. A.Maintaining the patency of grafts B.Decreasing the risk of fatal MI C.Preventing re-infarction after MI D.Dissolving a PE E.Preventing thromboembolic stroke

Answer 76

Answer: A, B, C, E Rationale: Antiplatelet drugs are used for the prevention of cardiovascular events. Thrombolytic agents are used to dissolve blood clots which are the cause of a pulmonary embolism.

Question 77

A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin. 1.The patient asks, “will the warfarin dissolve the clot in my leg?” What is the nurse’s best response?

Answer 77

Warfarin will not dissolve the existing clot, but it will help prevent additional clot formation.

Question 78

A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin. 2.The nurse plans to assess the patient’s lab work before administering the warfarin. What blood test(s) are important to monitor for patients taking warfarin, and what is the therapeutic range?

Answer 78

When a patient is taking warfarin, the nurse should closely monitor INR and PT levels to verify they are in normal range to prevent bleeding complications. Specifically, the therapeutic range for INR is between 2.0 to 3.0 depending upon the indication.

Question 79

A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin. 3.The nurse knows that the patient will need to monitor his diet when taking warfarin. What dietary instructions should be provided to the patient?

Answer 79

Dietary instructions should be provided to maintain a consistent intake of foods high in vitamin K like leafy green vegetables. Daily changes in intake of foods that are high in vitamin K will influence the effectiveness of warfarin, as well as the patient’s INR levels used to maintain the warfarin levels in therapeutic range.

Question 80

A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin. 4.The nurse plans to provide patient education regarding this newly prescribed medication. Outline education topics to cover with this high-risk medication.

Answer 80

Patient education should emphasize bleeding precautions, avoidance of NSAIDs and aspirin, the need for routine therapeutic monitoring, and when to call the provider with signs of increased bleeding

Question 81

A patient who was treated in the hospital for a DVT in his left leg has been prescribed warfarin. 5.What is the reversal agent for warfarin?

Answer 81

The reversal agent for warfarin is vitamin K

Question 82

RBCs carry O2 Decreased RBCs -> decreased Hgb synthesis -> decreased blood flow -> hemorrhage -> increased O2 consumption by tissues Kidneys O2 sensor - sense decreased O2 and release EPO to stim production RBC

Answer 82

Review normal erythropoiesis

Question 83

provides Erythropoietin factor controlling rate of RBC production to stimulate body to produce RBC

Answer 83

MoA: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 84

Disorders of RBC formation to decrease need for blood transfusions; renal failure (kidneys O2 sensory and have ESRD and kidneys not functioning not make RBC normally because missing stim from kidneys), antineoplastic treatments/agents (chemo for cancer; AE: decreasing RBC count)

Answer 84

Indications: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 85

IV/SQ (mostly SQ)

Answer 85

Route: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 86

Angina, caution in CHF

Answer 86

Contraindications: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 87

Fatigue, bone pain, edema, hypertension (HTN) - too much med start overcrowd sys with volume, headache, fever (DVT, CVA, MI has occurred)

Answer 87

AE: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 88

Monitor CBC weekly (track Hbg and RBC (both should go up but not too much) - dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal Hgb above 10 - adequate levels so not symptomatic with anemia; hold if Hgb > 12 because not want overshoot too far

Answer 88

Nursing: - Anemia drugs: Erythropoiesis-Stimulating Agent: Prototype: Epoetin Alfa (Procrit)

Question 89

Replace iron losing to get more Fe stores; required for hemoglobin formation

Answer 89

MoA: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate

Question 90

Iron deficiency, iron-deficiency anemia - replace Fe losing to help low Hgb and anemia occurring

Answer 90

Indications: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate

Question 91

antacids/dairy reduce absorption sig - not getting Fe need

Answer 91

Drug-Drug/Food: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate

Question 92

GI upset (HARD ON GI SYS), dark tarry stools (can look like upper GI bleed - look at med list and up to HCP on what want to do), constipation (teach: adequte fluids and exercise): see these common

Answer 92

AE: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate

Question 93

monitor labs (Hgb, iron); take w/o food for best absorption - cannot if cannot tolerate given full glass water or something curb nausea; take with Vit C to increase absorption; Do not take within one hour of bedtime (GERD); Do not crush or empty capsules; reassess Hgb after 3 months initiating therapy - not frequent labs; Keep out of reach of children-fatal if overdosed (toxic to GI sys and cause multiorgan sys failure when very severe)

Answer 93

Nursing: - Anemia drugs: Agents for Iron Deficiency Anemia: Prototype: ferrous sulfate

Question 94

Replaces vitamin B12; required for Hgb formation

Answer 94

MoA: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)

Question 95

B12 deficiency anemia, pernicious anemia

Answer 95

Indications: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)

Question 96

Monthly SQ/IM (pernicious anemia); not PO since cannot absorb it originally

Answer 96

Dosage/Route: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)

Question 97

rare; usually well tolerated; not usually OD on and cause Hgb way elevated; not worry about if take as prescribed

Answer 97

AE: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)

Question 98

monitor labs for therapeutic response (Hgb, B12 if relevant); Teach pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for lifetime because no cure

Answer 98

Nursing: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: Cyancobalamin (Vitamin B12)

Question 99

Required for erythropoiesis

Answer 99

MoA: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid

Question 100

Folic acid deficiency anemia (if diet changes ineffective), alcoholism/liver disease, pregnancy prevention of neural tube defects so take to ensure have enough

Answer 100

Indications: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid

Question 101

urine turns bright yellow

Answer 101

AE: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid

Question 102

monitor H/H, nutritional status, therapeutic response

Answer 102

Nursing: - Anemia drugs: Agents for Megaloblastic Anemias: Prototype: folic acid

Question 103

What instructions should the nurse include in teaching a client about ferrous sulfate? Select all that apply. A.Take with milk to avoid GI upset B.This medication may cause constipation C.Keep away from children D.Stools may turn green E.Periodic blood tests needed to evaluate effect

Answer 103

Answer: B, C, E Rationale: Ferrous sulfate will not turn stool green but can cause black, tarry stools. Dairy products can reduce the absorption of ferrous sulfate and should be avoided. Ferrous sulfate can cause constipation, is fatal to children if overdosed, and Hgb will be monitored for therapeutic effects.