Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 55 Anemia Drugs

2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hematopoiesis  Formation of new blood cells  Red blood cells (RBCs)  White blood cells (WBCs)  Platelets

3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Hematopoiesis (cont’d)  RBCs  Manufactured in bone marrow  Immature RBCs are reticulocytes  Life span is 120 days  More than one third of an RBC is made of hemoglobin  Heme: red pigment, contains iron  Globin: protein chain

4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5 Anemias  Maturation defects  Cytoplasmic  Nuclear  Excessive destruction of RBCs (hemolytic anemias)  Intrinsic RBC abnormalities  Extrinsic mechanisms

6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

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10 Iron  Essential mineral in the body  Oxygen carrier in hemoglobin and myoglobin  Stored in the liver, spleen, and bone marrow  Iron deficiency results in anemia

11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Iron (cont’d)  Dietary sources: meats, certain vegetables and grains  Dietary iron must be converted by gastric juices before it can be absorbed

12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Iron (cont’d)  Some foods enhance iron absorption  Orange juice  Veal  Fish  Ascorbic acid  Some foods impair iron absorption  Eggs*  Corn  Beans*  Cereal products containing phytates * Also common dietary sources of iron

13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Iron (cont’d)  Supplemental iron may be given as a single drug or as part of a multivitamin preparation  Oral iron preparations are available as ferrous salts  ferrous fumarate, ferrous gluconate, ferrous sulfate  Parenteral  iron dextran  ferric gluconate (Ferrlecit)  iron sucrose (Venofer)

14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Iron: Indications  Prevention and treatment of iron-deficiency syndromes  Administration of iron alleviates the symptoms of iron-deficiency anemia, but the underlying cause of the anemia should be corrected

15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Iron: Adverse Effects  Most common cause of pediatric poisoning deaths  Causes nausea, vomiting, diarrhea, constipation, stomach cramps, and pain  Causes black, tarry stools  Liquid oral preparations may stain teeth  Injectable forms may stain skin and cause pain upon injection

16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Parenteral Iron  Iron dextran  May cause anaphylactic reactions, including fatal anaphylaxis  Test dose is usually given, and then remainder of dose is given after 1 hour  Used less frequently now; replaced by newer products

17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Parenteral Iron  Ferric gluconate and iron sucrose  Used for patients with chronic renal disease and iron-deficiency anemia  Less risk of anaphylaxis  Hypotension is the most common adverse effect and is related to infusion rate

18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Folic Acid  Water-soluble, B-complex vitamin  Essential for erythropoiesis  Primary uses  Folic acid deficiency  During pregnancy to prevent neural tube defects  Malabsorption syndromes are the most common cause of deficiency

19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Folic Acid (cont’d)  Should not be used until actual cause of anemia is determined  May mask symptoms of pernicious anemia, which requires treatment other than folic acid  Untreated pernicious anemia progresses to neurologic damage

20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Other Blood-Forming Drugs  cyanocobalamin (vitamin B 12 )  erythropoietin (Epogen, Procrit)

21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess patient history and medication history, including drug allergies  Assess for potential contraindications  Assess baseline laboratory values, especially Hgb, Hct, reticulocytes, others  Obtain nutritional assessment

22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Ferrous salts are contraindicated in patients with ulcerative colitis, PUD, liver disease, and other GI disorders  Keep away from children because oral forms may look like candy  Iron dextran is contraindicated in all anemias except for iron-deficiency anemia

23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For liquid iron preparations, follow manufacturer’s guidelines on dilution and administration  Instruct patient to take liquid iron preparations through a straw to avoid staining tooth enamel

24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Oral forms of iron should be taken between meals for maximum absorption, but may be taken with meals if GI distress occurs  Oral forms should be given with juice, but not with milk or antacids

25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal corrosion  Patients should be encouraged to eat foods high in iron/folic acid

26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For iron dextran, a small test dose should be given  After 1 hour, if no reaction, the remainder of the dose can be given  Administer deeply into a large muscle mass using the Z-track method

27 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  For IV doses of iron dextran, give carefully according to manufacturer’s instructions  Have resuscitative equipment available in case of anaphylactic reaction

28 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Determine cause of anemia before administering folic acid  Administer oral folic acid with food  Folic acid may also be given IV and added to total parenteral nutrition solutions

29 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Improved nutritional status  Increased weight, activity tolerance, well-being  Absence of fatigue  Monitor for adverse effects