Pharmacology Ch. 48 & 49 Drugs Affecting Coagulation & Anemia
Which medication is an example of an antiplatelet?
Clopidogrel
Epoetin alfa (Epogen/Procrit, Retacrit) is used to treat anemia when patients are no longer able to produce erythropoietin in the liver. True or False
False
Heparin should be administered with caution because currently there is no antidote in the case of an overdose. True or False
False
Patients taking iron supplements should be encouraged to take them when eating a breakfast that includes eggs and milk to assist with absorption. True or False
False
Thrombolytic agents are currently used to dissolve clots in patients who have suffered a cerebrovascular accident (CVA) within the last 3 months. True or False
False
Warfarin's onset of action usually occurs in 8 to 12 hours and lasts for 1 to 2 days. True or False
False
What agents are used for iron deficiency anemia?
Ferrous sulfate (prototype) -ferrous fumarate -ferrous gluconate -ferrous sulfate exsiccated -ferumoxytol -iron dextran -iron sucrose -sodium ferric gluconate complex
What agents are used for megaloblastic anemias?
Folic Acid (Prototype) Hydroxocobalamin -folic acid derivatives -leucovorin -levoleucovorin -vitamin B12 -cyanocobalamin
How is megaloblastic anemia treated?
Folic acid and Vitamin B12
Megaloblastic anemia usually results from insufficient amounts of ________ or ________
Folic acid, vitamin b12
Which is an antiplatelet agent?
Prasugrel
What are Erythropoiesis stimulating agents?
Epoetin alfa (Epogen, Procrit,Retacrit) (prototype) Darbepoetin alfa (Aranesp) Methoxy polyethylene glycol-epoetin beta (Mircera)
Patients with classic hemophilia, also known as hemophilia A, need to be given replacement of which to treat bleeding episodes or when having surgery?
Factor VIII
What agents are used for sickle cell anemia?
Hydroxyurea (prototype) -crizanlizumab -voxelotor
Erythropoietin agents are contraindicated in the presence of uncontrolled ______ due to risk of worsening the condition
Hypertension
Hydroxocobalamin is available in?
IM form
Pharmacokinetics of Erythropoiesis Stimulating Agents are given by:
IV (intravenously) or Subcutaneous Injection
LEVOLEcovorin (Fusilev,Khapzory) is ONLY available in what form?
IV AND PO, varies in indication
Which route is ideal for patients that have chronic kidney disease with iron deficiency anemia?
IV iron
Erythropoiesis stimulating agents may be given:
IV or Subcutaneous injections
Anemia that occurs when there is not sufficient folic acid or vitamin B12 to adequately create the stromal structure needed for healthy red blood cells is called:
megaloblastic.
Vitamin B 12 is necessary for cell divsion but also the maintenance of ____________ __________ in nerve tissue
myelin sheath
iron should be taken with with food if what is experienced?
nausea, indigestion, vomiting
How can folic acid be administered?
oral, IM, and IV and subcutaneous forms
Dissolve ferrous salts in _______ juice to improve the taste.
orange
What are contraindicatios and cautions for folic acid and B12?
allergy presence to the drugs if nasal erosion or ulcers are present it might alter absorption of drug
Adverse effects of folic acid?
allergic reactions, pain and discomfort at injeciton site
What type of medication is heparin?
Anticoagulant
iron absorption decreseases with:
antacids, substances with calcium, magnesium, tetracyclines (antibiotic) or cimetidine. - should be spaced at least 2 hours if they need to be taken
iron is not absorbed if taken with:
antiacids, eggs, milk, calcium containing substances, coffee or tea
hypersensitivity reactions have been associated with the ________ form of iron.
parenteral
If absorption issues are suspected how is folic acid administered?
parenteral form
Iron agents are not indicated for people that have:
peptic ulcers, colitis, or regional enteritis can cause irritation to tissues and exacerbate disease
Which factor is an absolute contraindication to receiving a thrombolytic?
pregnancy, recent gastrointestinal bleed, hemorrhagic stroke, a known bleeding disorder, recent major surgery or trauma, history of intracranial vessel malformation, and uncontrolled hypertension
If iron is give by IM what method should be used?
z track method - avoid subcutaneous tissue
What should be avoided when a patient is on warfarin?
Intramuscular (IM) injections
Which is used for treatment of iron-deficiency anemia in patients with chronic kidney disease?
Iron sucrose (Venofer)
What causes the pain associated with a sickle cell crisis?
Ischemia - Ischemia, or lack of oxygen due to the clumping of the sickled cells, causes the pain associated with a sickle cell crisis.
How does warfarin work?
It suppresses vitamin K and "thins" the blood.
How is sickle cell disease diagnosed?
Low hematocrit level and sickled cells on a blood smear
What erythropoietin agent is NOT indicated for patient with anemia due to cancer therapy?
Methoxy polyethylene glycol-epoetin beta (Mircera)
Which is a topical hemostatic agent that is applied directly to an injured area to promote clotting?
Microfibrillar collagen (Avitene)
How should intravenous (IV) heparin be administered?
On a pump with guardrails
LEUcoVORIN is available in what form?
Oral, IM, IV
What can be experienced with IM administration iron?
Pain - should be switched to oral or IV form
What is the antidote for heparin?
Protamine sulfate
Erythropoiesis is the process of producing which?
Red blood cells
If erythropoetin agent is administered to an anemia patient with normal renal function, what can it cause?
Severe anemia due to exogenous substance decreasing endogenous levels fall and do not stimulate RBC production
Vitamin K is used to reverse the effects of which?
Warfarin
What are the anti-platelet drug that are administered via IV?
-abciximab (ReoPro) -eptifibatide (generic) -tirofiban (Aggrastat)
4 Etiologies of Anemia are:
1. bleeding ⬇️ decrease RBC 2. hemolysis destroy RBC 3. RBC production ineffective 4. bone marrow failure
The average lifespan of an RBC (red blood cell) is how many days?
120
What classification of medications does warfarin fall under?
Anticoagulant
adverse effects of iron agents include
GI upset, anorexia, nausea, vomiting, diarhea, dark stools, and constipation
What lab value should be monitored for a patient on warfarin?
International normalized ratio (INR)
cyanocobalamin (calomist, nascobal, vibisone) are available in what form ?
Nasal spray, oral, sublingual, IM, subcutaneous injections
Which treatment may stop the progression of a sickle cell crisis?
Supplemental oxygen
Which is not a complication of sickle cell disease?
Thyroid dysfunction -
Low erythropoietin levels are commonly seen in ____________ failure
renal
Epoeting Alfa is a treatment associated with chronic ______ failure, treatment of _______ infection, or _________ in cancer patients, reduce need for allogenic blood transfusions Route:
renal, HIV, chemotherapy subcutaneous
Iron products are used to ______ iron in cases of iron deeficiency anemia, or blood ____ leading to lower iron levels
replace, loss
Iron can be administered via which routes?
route, IV , IM injection
liquid iron preparation should be taken by a _______ to prevent teeth from _____
straw, staining
Place iron drops on the back of the ______ to prevent staining of the teeth.
tongue
A patient is ordered subcutaneous heparin every 8 hours. When the patient asks what this medication is for, what is the nurse's best answer?
"It is to prevent you from developing a blood clot." Rationale:Subcutaneous heparin every 8 hours is given to prevent clots. Intravenous (IV) heparin is administered to prevent clots and to keep current clots from getting bigger.
How long does it take to see improvement after taking iron medications? how long to return to a stable iron level
2-3 weeks 6-10 months
How long does it take for warfarin to take effect?
3-4 days
A client asks the nurse what dose of acetylsalicylic acid (aspirin) is needed for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation?
300-325 mg/d is the usual dosage to reduce risk of death or nonfatal MI in patients with a past history of MI or with angina.
What is an expected hemoglobin level for a patient with sickle cell disease?
5 to 11 mg/dL
Onset of hemoglobin increase after administration of erythropoietin agents after first dose takes:
7-15 days
A patient is on a heparin infusion. Which lab value is used to titrate this medication?
Activated partial thromboplastin clotting time (aPTT)
A patient is able to walk only short distances due to intermittent claudication. Which does the nurse expect the provider to prescribe?
Cilostazol (generic)
iron toxicity can cause severe ______ toxicity, come, even death because:
CNS, high iron level are toxic to nerve cell membrane
Adverse affects of erythropoiesis stimulating agents include:
CNS: headache, fatigue, asthenia, and dizziness, potential seizure. GI: Nausea, vomiting, diarrhea CV: hypertension, edema, chest pain, DVT,
Erythropoietin (EPO) stimulating drugs should be used when hemoglobin level is no more than 11 g/dL, it can in crease risk of ________ events and _______ growth in cancer patients
CV, tumor
Hydroxocobalamin last longer than?
Cyanocobalamin since is not at tightly bound to proteins
folic acid is necessary for the production of?
DNA, RBC, WBC and Platelets
Plasma contains which?
Electrolytes
A patient is on a heparin infusion. How does the nurse know if the medication is infusing at a therapeutic rate?
The activated partial thromboplastin clotting time (aPTT) is 1.5 to 2.5 times the normal time.
How do anticoagulants work?
Thin the blood to prevent clots and stop clots from getting bigger.
Although erythropoiesis is an ongoing process, only about 1% of the body's red blood cells are destroyed and replaced daily. True or False
True
Coagulation is the multistep process that changes blood form a fluid state to a solid state to help plug holes in the vascular system. True or False
True
Folic acid is essential for cell division in many different types of tissue. True or False
True
Heparin is the drug of choice for breast or chestfeeding who have DVT (deep vein thrombosis) because it does not enter human milk. True or False
True
Patients with pernicious anemia do not produce the intrinsic factor necessary for the absorption of vitamin B12. True or False
True
What vitamin enhances the absorption of iron but increase the GI side effects
Vitamin C
some adverse effects of parenteral iron is associated with severe ________ reactions, local _______, _______ of the tissues and phlebitis
anaphylactic, irritation, stain
Which intervention should be implemented for patients on any medications that increase the risk of bleeding?
bleeding gums, bruising, dark stools.
if iron serum levels increase it can cause
coma and even death
dark, tarry or green stools should not be of _________ when taking iron drugs
concern color remains as long as you are taking the drug
iron products commonly cause:
constipating, nausea, dark stools, GI upset
what is a common problem with iron drugs?
constipation
What is an antidote if iron becomes toxic
deferasirox (exjade, Jadenu), deferipron (ferriprox), deferoxamine mesylate (desferal)
One of the causes of ineffective RBC production is low levels of _________________
erythropoietin
The kidneys are responsible for producing _________________, a hormone crucial for RBC production
erythropoietin
Renal failure can lead to low levels of _____________________, which in turn causes ineffective ____________RBC production
erythropoietin, RBC
When the kidneys are no longer able to produce ________________, RBC production becomes ______________
erythropoietin, ineffective
contraindications for iron include:
hemochromatosis (excessive iron) anemia that is not iron deficiency, it can cause toxicity
Erythropoietin agents are contraindicated in the presecence of uncontrolled ___________ due to the risk of worsening the conditon.
hypertension
adverse effects of hydroxocobalamin?
itching, transitory exanthema (widely spread rash), mild diarrhea, anaphylactic reaction, heart failure, pulmonary edema, hypokalemia, pain at injection site
