Pharmacology Chapter 54, Anemia Drugs

1 Adequate fluid intake with iron tablets decreases the chances of stomach upset and increases drug absorption. The oral tablets are consumed in the correct prescribed dosage; therefore, they are not to be crushed and consumed in a powdered form. The patient needs to maintain a sitting position at least for 30 minutes after taking the oral dose to prevent esophageal irritation. Liquid solutions of iron need to be diluted with fluids according to the manufacturer's instructions and consumed using a straw to prevent discoloration of the teeth.

What instructions are given to a patient who is prescribed oral iron tablets? 1 "Take the iron tablets with plenty of fluids." 2 "Take the iron tablets in a powdered form." 3 "Take an iron tablet just before going to bed." 4 "Take the iron tablet after dissolving it in water using a straw."

2 Tarry stools, vomiting, and epigastric pain are the side effects associated with oral iron supplements. The nurse instructs the patient to expect these adverse effects so that the patient does not panic. Fatigue is a symptom of anemia. It is relieved upon administration of oral iron supplements. Yellow urine is an adverse effect associated with folic acid therapy. Hypertension is a side effect associated with the administration of epoetin alfa

What is a side effect associated with oral iron therapy? 1 Fatigue 2 Tarry stools 3 Yellow urine 4 Hypertension

4 Ferumoxytol is an injectable iron product that can be injected directly through the intravenous route without dilution. It has the advantage of being given as an intravenous push over 1 minute. Unlike iron sucrose, ferumoxytol need not be diluted and infused over 2.5 to 3.5 hours to prevent adverse effects. Ferumoxytol does not need a test dose, because it does not trigger an anaphylactic reaction. Ferumoxytol can be used to treat anemia caused by renal failure.

What is the difference between ferumoxytol and other anemia drugs? 1 It can be diluted and infused over 2.5 to 3.5 hours. 2 It can be given to the patient only after a test dose. 3 It can be used only for nutrition-related iron-deficiency anemia. 4 It can be administered undiluted as an intravenous push over 1 minute

2 Sickle cell anemia is a genetic disorder associated with excessive RBC destruction. It results from defects in the intrinsic factors of RBCs that cause excessive RBC destruction. Pernicious anemia is caused by a deficiency of folic acid. Megaloblastic anemia is caused by a deficiency of vitamin B12 or folic acid. Iron-deficiency anemia is caused by blood loss, childbirth, or a deficiency of dietary iron. Topics

What is the genetic disorder that is associated with excessive red blood cell (RBC) destruction? 1 Pernicious anemia 2 Sickle cell anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

3 Hypotension is the most common adverse effect of iron sucrose. Dyspnea is associated with doses higher than 125 mg of ferric gluconate. Anaphylactic reactions are associated with iron dextran and have been reported in 0.3% of patients. Adverse effects associated with folic acid are rare, but yellow discoloration of urine is observed.

What is the most common adverse effect of iron sucrose? 1 Dyspnea 2 Anaphylaxis 3 Hypotension 4 Yellow discoloration of urine

3 Erythropoiesis involves the maturation of precursors of nucleated red blood cells (RBCs) into hemoglobin-filled, nucleus-free erythrocytes. It takes place in the circulation, where nucleated RBCs undergo a 24- to 36-hour maturation process to become mature, fully functional RBCs. The breakdown of RBCs takes place in the liver. The heart pumps the blood to all the organs; it has no role in erythropoiesis. The primary function of the kidneys is filtration. The kidneys are involved in the production of the hormone erythropoietin, which helps in the maturation of RBCs; however, they are not the site of erythropoiesis.

Where does the process of erythropoiesis take place in the human body? 1 Liver 2 Heart 3 Blood 4 Kidneys

2, 3, 4, 5 Contraindications for erythropoiesis-stimulating agents (ESAs) include known drug allergy. Use in patients with head or neck cancers, or in patients at risk for thrombosis, is controversial because these medications increase tumor growth and risk for thrombosis. Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above 10 g/dL for cancer patients and 12 g/dL for renal patients. Renal failure is not a contraindication of erythropoiesis-stimulating agents.

Which are known contraindications for use of erythropoiesis-stimulating agents in patients? Select all that apply. 1 Renal failure 2 Cancer of the neck 3 History of thrombosis 4 Uncontrolled hypertension 5 Hemoglobin level of 15 g/d

1 Iron dextran is an injectable iron formulation that may cause an anaphylactic reaction in the patient. Therefore, a test dose of iron dextran is injected, and the patient is monitored for any adverse reactions. The risk of precipitating an anaphylactic reaction is much lower with iron sucrose. Therefore, a test dose is not required for this iron formulation. Ferric gluconate injectable formulations have fewer adverse effects; hence, the complete prescribed dose can be administered. Ferrous fumarate is an oral formulation that is 33% elemental iron. This oral drug is not known to cause anaphylactic reactions.

Which drug requires a test dose to ensure safe medication administration? 1 Iron dextran 2 Iron sucrose 3 Ferric gluconate 4 Ferrous fumarate

4 Constipation and a change in the color of stool to darker or green are the most common complaints with iron supplementation and are expected. Flatus, fatigue, and heartburn are not common and expected adverse effects of iron supplementation.

Which is a common expected adverse effect of iron supplementation? 1 Flatus 2 Fatigue 3 Heartburn 4 Constipation

1 Ferrous fumarate is contraindicated in patients with cirrhosis of the liver. The liver is the storage site for iron. During cirrhosis, the liver lacks the ability to store iron, and all the iron taken as ferrous fumarate accumulates in the blood, leading to toxicity. Heart attack is an adverse event if epoetin alfa is administered in patients with hemoglobin levels above 12 g/dL. Renal failure is associated with a decrease in the hormone erythropoietin. In this case, iron supplements are given along with epoetin alfa. Anemia caused by ovarian cancer can be treated with epoetin alfa along with iron supplements.

For what disease should the nurse assess in a patient before administering ferrous fumarate? 1 Cirrhosis 2 Heart attack 3 Renal failure 4 Ovarian cancer

214.5 Ferrous fumarate iron salts are available as 325-mg tablets. They are 33% elemental iron. Therefore, one tablet provides 107.25 mg of elemental iron. Thus, two tablets will provide 107.25 × 2 = 214.5 mg, which rounds up to 215.

How much elemental iron would a patient receive if administered two tablets (each containing 325 mg) of ferrous fumarate iron salts? Record your answer using a whole number. _______mg

1 Iron dextran is a colloidal solution of iron and dextran that can be administered by the intravenous or intramuscular route. It has the potential to cause anaphylactic reactions in some patients. Because of this, a test dose of the drug is initially administered by the intravenous route before administering the full dose. It is not administered by the subcutaneous route because of limited effectiveness. Administration of the full dose may lead to an anaphylactic reaction in the patient.

Iron dextran is prescribed for a patient with severe iron-deficiency anemia. How will the nurse administer the drug? 1 Administer a test dose by the intravenous route. 2 Administer a test dose by the subcutaneous route. 3 Administer the full dose by the intravenous route. 4 Administer the full dose by the subcutaneous route.

3 Fatigue is one of the symptoms of anemia. Cytoplasmic defects in the red blood cells (RBCs) make them appear hypochromic (paler in color than normal). The patient is on NSAID therapy; therefore, the patient has a risk of developing gastrointestinal bleeding. This may lead to iron-deficiency anemia. Sickle cell anemia is a genetic disorder caused by a deficiency of glucose-6-phosphate dehydrogenase. Pernicious anemia is caused by a deficiency of vitamin B12. Folic acid deficiency anemia is caused by a deficiency of folic acid; however, it may not lead to fatigue.

The nurse notices that a patient exhibits severe fatigue. The medication history shows that the patient has been taking a nonsteroidal antiinflammatory drug (NSAID) medication for 3 months. What type of anemia may be present in the patient? 1 Sickle cell anemia 2 Pernicious anemia 3 Iron-deficiency anemia 4 Folic acid deficiency anemia

4 Hypertension is a side effect of epoetin; hence, the drug should not be given to patients with uncontrolled hypertension. Anemia, antiretroviral treatment for HIV/AIDS, and chronic renal failure are indications for the therapeutic use of epoetin.

The nurse would question the prescription for epoetin in a patient with which condition? 1 Anemia 2 HIV/AIDS 3 Chronic renal failure 4 Uncontrolled hypertension

1, 2 Iron-deficiency anemia is a type of cytoplasmic maturation anemia resulting in abnormal hemoglobin synthesis that is caused by blood loss and childbirth. Red blood cell (RBC) abnormalities caused by intrinsic factors are usually a result of a genetic defect such as sickle cell anemia, hereditary spherocytosis, and others. Pernicious anemia occurs as a result of B12 deficiency, which is used in the formation of new RBCs. Excessive RBC destruction that occurs as a result of extrinsic factors is caused by drug-induced antibodies.

What are the common causes of iron-deficiency anemia? Select all that apply. 1 Childbirth 2 Blood loss 3 Genetic defect 4 Vitamin B12 deficiency 5 Drug-induced antibodies

4 Severe iron toxicity results in coma, shock, or seizures. The primary health care provider should initiate the chelation therapy with deferoxamine immediately to decrease the serum iron levels. The decontamination of the gastrointestinal (GI) tract will remove any traces of iron present in the GI tract but cannot reduce the serum concentration of iron. Electrolyte infusion will not reduce the serum levels of iron. It is used to maintain the electrolyte balance in the body. Abdominal radiographs are used to determine the presence of any traces of iron in the gastrointestinal tract.

A child who accidently ingested an enteric-coated iron supplement develops seizures and is immediately hospitalized. The serum iron concentration is found to be 350 mcg/dL. What intervention should the nurse expect the provider to prescribe to reduce the serum iron levels? 1 Bowel irrigation 2 An electrolyte infusion 3 Abdominal radiographs 4 Administration of deferoxamine

3 Intrinsic factor is required for the absorption of vitamin B12. It is produced by the stomach lining. Patients who have undergone gastrectomy may have a deficiency of intrinsic factor, resulting in poor absorption of vitamin B12. It may lead to pernicious anemia, wherein the new red blood cells appear larger than normal. The anemia was probably not caused by fecal occult blood loss, bone marrow depression, or renal pathology, because the patient does not have a corresponding history for these conditions.

A patient had a total gastrectomy 12 months ago. The nurse learns that the patient has been eating a well-balanced diet rich in vitamin B12, folic acid, iron, and other micronutrients. Despite this, the patient is diagnosed with anemia. What is the most likely cause of anemia in this patient? 1 Fecal occult blood loss 2 Bone marrow depression 3 Poor absorption of vitamin B12 4 Deficiency of renal erythropoietin

1 Many individuals find that they need to take oral iron products with meals or food because of the commonly encountered adverse effect of gastrointestinal upset, even though altered absorption occurs. However, the patient should avoid taking iron with dairy products; antacids or milk products should be consumed at least 1 to 2 hours before or after the oral dosage of iron. Fruits, proteins, and vegetables all can alter the absorption of iron, but not to the extent of milk or antacids.

A patient informs the nurse she must take her iron with a meal to prevent stomach upset. To increase the uptake of oral iron, which food group will the nurse instruct the patient to avoid? 1 Dairy 2 Fruits 3 Proteins 4 Vegetables

3 The iron in oral iron supplements is absorbed better when taken along with foods rich in ascorbic acid. The absorption of iron is enhanced in the presence of the ascorbic acid in orange juice. The absorption of iron from iron supplements does not depend on the time of the day, but rather on the food items taken along with it. The calcium present in milk decreases the absorption of iron; therefore, milk should be avoided.

A patient is prescribed oral iron supplements. What advice should the nurse give to the patient about taking iron supplements? 1 "Take the supplement with milk." 2 "Take the supplement at bed time." 3 "Take the supplement with orange juice." 4 "Take the supplement in the early morning."

2 The presence of normochromic and macrocytic RBCs in the blood smear indicates that the patient has RBC nuclear maturation defects. These defects are caused by a deficiency of folic acid or vitamin B12. Pernicious anemia is caused by a deficiency of vitamin B12. Hence, folic acid supplements are ineffective in patients with pernicious anemia. Sickle cell anemia is an RBC abnormality caused by a genetic disorder. Megaloblastic anemia is caused by folic acid deficiency. If the patient had megaloblastic anemia there would have been an improvement in the patient's condition with the use of folic acid supplements. Iron-deficiency anemia involves hypochromic and microcytic RBCs.

A patient who was diagnosed with anemia is prescribed folic acid supplements but shows no improvement in hemoglobin levels. The patient's blood smear shows normochromic and macrocytic red blood cells (RBCs). Which syndrome may be present in the patient? 1 Sickle cell anemia 2 Pernicious anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

1 Iron supplements increase the efficacy of erythropoiesis-stimulating agents by promoting the maturation of erythrocytes. Iron supplements enhance the absorption of erythropoiesis-stimulating agents. Erythropoiesis-stimulating agents work effectively when iron stores in the body are adequate. Iron does not affect the elimination of erythropoiesis-stimulating agents from the body but helps in their absorption. Adverse effects of erythropoiesis-stimulating agents include hypertension, fever, and headache, which are not prevented by iron supplements.

A patient with chronic renal disease is prescribed an iron supplement along with erythropoiesis-stimulating agents. What is the reason for prescribing an iron supplement with erythropoiesis-stimulating agents? 1 To improve the efficacy of erythropoiesis-stimulating agents 2 To decrease the absorption of erythropoiesis-stimulating agents 3 To increase the elimination of erythropoiesis-stimulating agents 4 To reduce the adverse effects of erythropoiesis-stimulating agents

2 Erythropoiesis is the process of maturation of red blood cells. It is facilitated by erythropoietin, which is secreted by the kidneys. The secretion of erythropoietin decreases in chronic renal failure, leading to anemia, which manifests as fatigue. Exercise may cause temporary fatigue that subsides after rest. Because the patient eats a well-balanced diet, folic acid deficiency is unlikely. The anemia is probably not caused by a deficiency of iron, because the patient has a well-balanced diet.

A patient with chronic renal failure who eats a well-balanced diet reports fatigue and lightheadedness. What is the most likely reason for fatigue in the patient? 1 The patient has been exercising. 2 The patient lacks erythropoietin. 3 The patient lacks folic acid in the diet. 4 The patient has iron-deficiency anemia.

4 Oral iron supplements should be taken at least 2 hours after taking antacids, because the presence of antacids decreases the absorption of iron. Iron supplements should not be administered along with meals, because the presence of food also decreases the absorption of iron from the gastrointestinal tract. The absorption of iron is inhibited if administered with antacids. Therefore iron should not be administered along with antacids. It is advisable to dilute the iron supplements with plenty of water to avoid discoloration of tooth enamel. However, this is not the nurse's most important advice.

A patient with hyperacidity is diagnosed with iron-deficiency anemia. The prescription contains oral antacid preparations and oral iron supplements. What is the most important advice the nurse gives to the patient? 1 "Take the iron supplements with meals." 2 "Take the iron supplements along with antacids." 3 "Take the iron supplements with plenty of water." 4 "Take the iron supplements at least 2 hours after taking antacids."

22.5 3 mg/kg/day × 7.5 kg = 22.5 mg/day dosage

A pediatric patient is ordered ferrous fumarate for iron-deficiency anemia. The dose prescribed is 3 mg/kg/day. The patient's weight is 7.5 kg. What amount will the nurse administer per day? Record your answer to one decimal place. _____ mg

2 The nurse advises the patient to eat green leafy vegetables and fruits. Consuming a diet rich in folic acid will help the patient to recover quickly. Antacids consumed with folic acid are known to decrease drug absorption. Maintaining a sitting position for about an hour is not needed with folic acid; however, a sitting position would relieve esophageal irritation in patients consuming iron supplements. Consuming folic acid would result in yellow discoloration of the urine but does not have any effect on the color of stools.

A pregnant patient is diagnosed with folic acid deficiency anemia. The primary health care provider prescribes oral folic acid. What other instructions will the nurse give the patient to promote health? 1 "Take the drug along with antacid medications." 2 "Include fruits and green vegetables in your diet." 3 "Sit upright for at least 1 hour after taking the drug." 4 "Report immediately if your stools are tarry and black."

3 Iron sucrose tends to cause hypotension in patients who are elderly and underweight. Therefore, the nurse should monitor the patient's blood pressure when administering the drug. Fluid intake does not have any effect on iron sucrose administration; therefore, it is not a primary intervention. Temperature and respiratory rate are unlikely to be affected by iron sucrose.

An elderly and malnourished patient is prescribed iron sucrose for anemia. What will the nurse monitor in the patient to ensure safe administration of the drug? 1 Fluid intake 2 Temperature 3 Blood pressure 4 Respiratory rate

4 Ferrous fumarate is the oral iron supplement available in the form of 100 mg and 325 mg tablets. The 100 mg tablets should be administered as six to eight tablets per day. Patients can take two to three 325 mg tablets per day. Ferrous sulfate is also an oral iron supplement available in the form of tablets administered as two to three tablets per day. Ferumoxytol and ferric gluconate are available in the form of injections given via the intravenous or subcutaneous route.

An oral iron supplement (100 mg) is prescribed to a patient with iron-deficiency anemia. The nurse advises the patient to take six to eight tablets per day. Which iron supplement is most likely prescribed to the patient? 1 Ferumoxytol 2 Ferrous sulfate 3 Ferric gluconate 4 Ferrous fumarate

3 The Z-track method is used for the administration of injectable drugs through the intramuscular route. Oral iron supplements can be ingested directly by the oral route. The Z-track method cannot be used for intravenous or subcutaneous administration.

Which route of administration is associated with the Z-track method? 1 Oral 2 Intravenous 3 Intramuscular 4 Subcutaneous

4 Overdose of epoetin alfa in patients undergoing chemotherapy causes hypertension, vomiting, and nausea. Administration of epoetin alfa in a patient who has a hemoglobin level of 12 g/dL or more can lead to serious adverse effects like stroke and myocardial infarction from high blood pressure. Hematemesis (vomiting blood) is a sign of toxicity caused by iron supplements. Excess iron supplementation can cause constipation. This difficulty in defecation can be minimized by increasing fluid and fiber intake in the diet. Hyperglycemia is an immediate effect of injecting iron preparations such as iron sucrose and iron dextran.

The hemoglobin level in a patient undergoing chemotherapy is 8.5 g/dL. After intravenously administering epoetin alfa for a week, the nurse observes the patient's hemoglobin levels have increased to 11.7 g/dL. Which potential complication might result if the nurse continues with the drug administration? 1 The patient may experience hematemesis. 2 The patient may have difficulty defecating. 3 The patient may have increased sugar levels. 4 The patient may have increased blood pressure.

4 Epoetin alfa has a slower onset of action when administered through the subcutaneous route compared with other routes. The drug requires more time to be absorbed in the bloodstream when given via the subcutaneous route. Epoetin alfa is not prescribed for the oral route. The intravenous route shows a quick onset of action, and the intramuscular route provides prolonged action.

Which route of administration results in a slow onset of action of epoetin alfa? 1 Oral 2 Intravenous 3 Intramuscular 4 Subcutaneous

1 A genetic defect can cause abnormalities in the structure of red blood cells. Sickle cell anemia is the only type of anemia that is caused by a genetic defect. Pernicious anemia is caused by a deficiency of cyanocobalamin (vitamin B12). Megaloblastic anemia is caused by a deficiency of folic acid. Iron-deficiency anemia is caused by a deficiency of dietary iron.

Which type of anemia is caused by a genetic defect? 1 Sickle cell anemia 2 Pernicious anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

4 Bone marrow is involved in the formation of new blood cells. The bone marrow produces erythrocytes, leukocytes, and thrombocytes. The liver is involved in the storage of iron and the destruction of red blood cells (RBCs) in the body. The heart is involved in the circulation of blood. Kidneys secrete the hormone erythropoietin, which is involved in the maturation of RBCs.

Which part of the body is associated with the formation of new blood cells? 1 Liver 2 Heart 3 Kidney 4 Bone marrow