RBC Pharm

Question 1

Ferrous Sulfate

Answer 1

–oral form of iron

Question 2

Indications for iron supplementation

Answer 2

–treat and prevent iron deficiency anemia
–treat blood loss

Question 3

interactions for iron supplements

Answer 3

–decrease absorption with antacids
–increase absorption with Vitamin C

Question 4

adverse effects of iron supplements

Answer 4

–GI (nausea, heartburn, constipation)
–metallic taste
–staining of teeth
–fatal iron toxicity
–leading cause of poisoning death in children

Question 5

chelating agent for iron supplements

Answer 5

deferoxamine/Desferal

Question 6

parenteral form of iron supplementation

Answer 6

iron dextran

Question 7

how should oral iron be taken?

Answer 7

through a straw

Question 8

specifics of oral iron administration (tablets)

Answer 8

–best absorbed on empty stomach
–do not crush or chew
–do not give with antacids or calcium supplements
–taking with food decreases gastric irritation, but shouldn’t be done forever (first couple of weeks okay)

Question 9

specifics of oral iron administration (liquid)

Answer 9

–give with straw and dilute in OJ to increase absorption
–monitor for teeth staining with liquid form

Question 10

specifics of parenteral iron administration

Answer 10

–give test dose
–IM: use 1.5-inch needle with Z track technique to prevent skin staining

Question 11

black box warning for iron dextran

Answer 11

have epi available for possible allergic reaction (dextran portion of med)

Question 12

diet for B12 deficiency

Answer 12

–meat
–salmon and cod
–milk and dairy
–eggs

Question 13

medication for B12 deficiency

Answer 13

cyanocobalamin

Question 14

diet for folate deficiency

Answer 14

–leafy green veggies
–legumes
–organ meats
–fortified grains

Question 15

medications for folate deficiency

Answer 15

–multivitamin supplements
–OTC folic acid supplements

Question 16

indications for cyanocobalamin

Answer 16

–low B12
–pernicious anemia
–bariatric surgery patients (1mg lifelong)
–surgeries where part of or whole stomach is removed

Question 17

oral amount of cyanocobalamin recommended

Answer 17

1-2mg daily

Question 18

specifics about injectable cyanocobalamin

Answer 18

–IM weekly until levels are almost normal, then monthly
–more rapid improvement
–indicated for patients with severe deficiency or neuro sx
–well tolerated

Question 19

indications for folic acid supplementation

Answer 19

–treat folic acid deficiency anemia
–in pregnant women to prevent neural tube defects

Question 20

usual dose of prescription strength folic acid

Answer 20

1-5 mg daily; tablets or liquid

Question 21

usual dose of OTC folic acid

Answer 21

400 mcg/daily

Question 22

MOA of erythropoietin stimulating agents

Answer 22

–stimulates erythropoiesis
–increases Hgb and reticulocyte counts

Question 23

indication for epoetin alfa

Answer 23

–ONLY when Hgb is <10 g/dL
–treatment of anemia due to chronic kidney disease
–HIV patient on drug zidovudine
–people on chemo
–autoimmune hemolytic anemia

Question 24

route for epoetin alfa

Answer 24

IV and SQ

Question 25

monitoring for epoetin alfa

Answer 25

–weekly blood tests to monitor Hgb with goal of <11 to decrease risk for clotting (polycythemia)
–evaluate iron status before and during treatment

Question 26

side effects of epoetin alfa

Answer 26

–HTN and serious CV events
–progression of certain cancers
–injection site problems, bone pain, headache

Question 27

black box warning for epoetin alfa

Answer 27

patients had higher chance for stroke and heart attack if admin ESAs to a target Hgb > 11

Question 28

nursing implications for ESAs

Answer 28

–do not give if it has been shaken or frozen
–protect from light
–do not dilute or mix with other drugs
–contraindicated in patients with uncontrolled HTN
–may be given IVP
–levels of Hgb begin to rise in about 2 weeks