Chapter 32

sargramostim (Leukine)

what CSF is similar to our GM-CSF

-sensitivity to cobalt and folic acid- deficiency anemia -severe pulmonary disease -heart disease

what are the contraindications to cyanocobalamin:

-stimulates the production of megakaryocytes and thrombopoietin -functionally equivalent to our IL-11 -Is used to enhance the production of platelets in patients who are at risk for thrombocytopenia caused by cancer chemotherapy

what does oprelvekin (Neumega) do:

increases the production of neutrophils (most common type of granulocyte)

what does the G-CSF do:

-respiratory failure -intracranial hemorrhage -retinal hemorrhage -MI

what happens if you have over 100k leukocyte count?

to reduce severe neutropenia in adults with certain malignancies *self administration kit*

what is TBO-filgrastim (Granix) use for:

it is when RBCs have a diminished capacity to deliver oxygen to tissues

what is anemia:

for chronic neutropenia or neutropenia secondary to chemotherapy

what is filgrastim primarily used for

for chronic neutropenia or neutropenia secondary to chemotherapy

what is filgrastim primarily used for:

it is filgrastim bonded to PEG

what is pegfilgrastim

to produce a rapid increase in the number of neutrophils in patients who have suppressed immune system

what is the goal of CSF pharmacotherapy:

for maintenance therapy after normal B12 levels have been restored by parenteral route

what is the intranasal spray for cyanocobalamin (Nascobal) used for:

oprelvekin (Neumega)

what is the most used drug to enhance platelet production:

filgrastim (Granix, Neupogen)

what is the prototype drug for CSFs:

only bacteria

what synthesizes vitamin B12:

must receive iron supplements to compensate for increase RBC production

what to remember when given epoetin alfa (what must patients take under this therapy)

Oral vitamin B12 is only effective if patient has sufficient amount of intrinsic factor

when is oral vitamin b12 only effective?

bone marrow

where does hematopoiesis occur?

-increase neutrophil production in the bone marrow -enhance phagocytic and cytotoxic functions of existing neutrophils

2 MOA of filgrastim:

-SubQ injection over IV route decrease adverse effects. -Do not administer within 24 hours before or after chemotherapy because chemo will destroy filgrastim (Neupogen)

Administration Alerts filgrastim:

-Given SubQ over IV to prevent AE. -Do not shake the vial because this may deactivate the drug. -Monitor rate of Hgb increase.

Administration Alerts for epoetin alfa:

-Hypokalemia (Increased RBC uses all potassium) -join paint -anaphylaxis -nasopharyngitis

Adverse effect of cyanocobalamin:

Erythropoiesis-stimulating factors Generic: darbepoetin alfa

Aranesp (what is the generic name)

Can cause thromboembolic events

Black Box Warning for epoetin alfa:

-PT undergoing chemotherapy -receiving bone marrow or stem cell transplants -who have certain malignancies

CSF pharmacotherapy is indicated for:

Allergies to any drugs, foods, or other substances such as latex.

Contraindications for filgrastim:

-Uncontrolled HTN -Hgb higher than 10 g/ dl -history of MI or embolic stroke -worsening of cancer

Contraindications of epoetin alfa (Proctrit, Epogen)

Androgens (increases response)

Drug-drug interaction for epoetin alfa

if patient has hypersensitivity to E.coli proteins don't take this. (E.coli is used to produce Filgrastim drug)

E.coli and Filgrastim relationship:

Erythropoiesis-stimulating factors Generic: epoetin alfa

Epogen (what is the generic name)

To improve platelet function in pt with chronic immune thrombocytopenic purpura (ITP) -They increase platelet count by activating the natural receptor for thrombopoietin

Functions of romiplostim (Nplate) and eltrombopag (Promacta)

it treat neutropenia in pt treated for acute myelogenous leukemia and patients who are having autologous bone marrow transplants

GM-CSF sargramostim for:

to produce a rapid increase in the number of neutrophils in patients who have suppressed immune system

Goal of all CSFs:

Colony-Stimulating factors // Granulocyte-CSF Generic: filgrastim

Granix (what is the generic name)

Colony-Stimulating factors // GM-CSF Generic: sargramostim

Leukine (what is the generic name)

Erythropoietin (EPO) is a hormone produced primarily by the kidneys. epoetin alfa resembles EPO

MOA of epoetin alfa:

Colony-Stimulating factors Generic: pegfilgrastim

Neulasta (what is the generic name)

Platelet enhancers generic: oprelvekin

Neumega (what is the generic name)

Colony-Stimulating factors // Granulocyte-CSF Generic: filgrastim

Neupogen (what is the generic name)

Platelet enhancers generic: romiplostim

Nplate (what is the generic name)

Monitor BP trends, hold if patient is hypertensive & notify MD

Nursing Implications for epoetin alfa

phlebotomy

OD treatment for Epoetin alfa:

No OD treatment

OD treatment for cyanocobalamin

hematopoiesis

Process of blood cell formation is called:

Erythropoiesis-stimulating factors Generic: epoetin alfa

Procrit (what is the generic name)

Platelet enhancers generic: eltrombopag

Promacta (what is the generic name)

IV and SubQ (preferred)

Route for epoetin alfa:

subQ or IM: weekly, biweekly, monthly Intranasal Spray: Once a week *Oral vitamin is available but ONLY for vitamin supplementation*

Routes for cyanocobalamin (Nascobal) and how often do you give it:

-pallor of skin and mucous membrane -Decreased exercise tolerance -Fatigue and lethargy, dizziness, fainting -Increased respiratory rate and heart rate

Signs and symptoms of anemia:

hematopoietic growth factors

They are natural hormones that promote some aspect of blood formation:

Filgrastim

This CSF is similar to our natural G-CSF

filgrastim (Granix, Neupogen)

This drug is primarily used for chronic neutropenia or neutropenia secondary to chemotherapy:

oprelvekin (Neumega)

This drug is used to enhance the production of platelets in patients who are at risk for thrombocytopenia caused by cancer chemotherapy

oprelvekin (Neumega)

This drug stimulates the production of megakaryocytes and thrombopoietin

sargramostim

This drug treats neutropenia in pt treated for acute myelogenous leukemia and patients who are having autologous bone marrow transplants

romiplostim (Nplate) and eltrombopag (Promacta)

This improves platelet function in pt with chronic immune thrombocytopenic purpura (ITP)

romiplostim (Nplate) and eltrombopag (Promacta)

This increases platelet count by activating the natural receptor for thrombopoietin

TBO-filgrastim (Granix)

This is a newer form of filgrastim

cyanocobalamin (Nascobal)

This is indicated for patients with B12 anemia deficiency:

visual impairment

This may occur during the therapy of oprelvekin (Neumega)

no treatment for OD

Treatment for OD for filgrastim?

-hemorrhage -COPD -Anemia -high altitude

What are disease/conditions that can cause severe hypoxia:

The anemia must be secondary to the chemotherapy, not the cancer itself. (otherwise, it can increase mortality)

What do you need to remember when darbepoetin alfa is given as an adjunctive agent in cancer treatment:

stimulate both neutrophil and macrophage production

What does GM-CSF do:

it decreases renal excretion of the molecule, for a sustained duration of action

What is PEG molecule?

approved for anemia associated with chemotherapy and chronic renal failure

What is darbepoetin alfa approved for?

fluid retention *Visual impairment may occur during therapy of this drug*

What is the primary adverse effect of oprelvekin (Neumega)

reduction in oxygen reaching the kidneys (once it response, serum levels of erythropoietin may increase as much as 1,000 fold in response to severe hypoxia)

What is the primary signal for the increase secretion of erythropoietin:

There is a higher risk for developing acute myeloid leukemia or myelodysplastic syndrome

What is the risk when CSFs are given to patients undergoing chemotherapy for breast cancer:

-Do not shake vial, it may deactivate the drug -visibly inspect solution for particulate matter

What must you remember when administrating epoetin alfa:

kidneys

What secretes erythropoietin

iron deficient patients and vitamin depleted states

When is epoetin alfa be less effective? when it is given to "what kind of patients"?

do not administer 24 hours before or after chemotherapy with cytotoxic drugs because effectiveness of the drug can decrease.

administration alert for Filgrastim:

darbepoetin alfa has a longer DOA, so can be administered one a week or once in 2 weeks

advantage of darbepoetin alfa than epoetin alfa?

-Severe hypertension -stroke -MI -PE

adverse effects of epoetin alfa:

Erythropoiesis-stimulating factors trade: Aranesp

darbepoetin alfa (what is the trade name)

functionally identical to human erythropoietin It is effective for disorders caused by defficiency of RBC -Anemia -CRF -Chemotherapy

describe epoetin alfa and what it is for:

pegfilgrastim has a more sustained duration of action because of the molecule PEG)

difference of filgrastim vs pegfilgrastim:

Platelet enhancers trade: Promacta

eltrombopag (what is the trade name)

Erythropoiesis-stimulating factors Trade: Epogen, Procrit

epoetin alfa (what is the trade name)

Colony-Stimulating factors // Granulocyte-CSF trade: Granix, Neupogen

filgrastim (what is the trade name)

Vitamin supplements -cyanocobalamin (Nascobal) -folic acid Iron salts -ferrous sulfate (Feosol, others)

most common Antianemic drugs:

absence of intrinsic factor

most common cause of vitamin b12 deficiency:

IL-11

oprelvekin (Neumega) is functionally equivalent to our:

Platelet enhancers trade: Neumega

oprelvekin (what is the trade name)

Colony-Stimulating factors trade: Neulasta

pegfilgrastim (what is the trade name)

epoetin alfa

prototype for erythropoietin drugs:

Platelet enhancers trade: Nplate

romiplostim (what is the trade name)

SubQ only

route for oprelvekin (Neumega)

romiplostim (Nplate): SubQ eltrombopag (Promacta): PO

route for romiplostim (Nplate) and eltrombopag (Promacta)

GM-CSF

sargramostim is similar to the human?

Colony-Stimulating factors // GM-CSF trade: Leukine

sargramostime (what is the trade name)

-Hypertension -tachycardia -headache -edema

side effects of epoetin alfa:

Polycythemia

term for too mane erythrocytes:

erythropoietin

the formation of RBC is regulated by the hormone:

hormones and growth factors

the process of hematopoiesis is regulated by:

oprelvekin (Neumega)

this drug is functionally equivalent to IL-11

cyanocobalamin (Nascobal)

this is a purified form of vitamin B12

IL-11

this is secreted by monocytes and lymphocytes that signal cells in the immune system to respond to an infection