CH 32 DRUGS FOR HEMATOPOIETIC DISORDERS

HEMATOPOIETIC GROWTH FACTORS Suffix

( - alfa)

COLONY-STIMULATING FACTORS (CSFs) Suffix

(- stim) endings

When should a RN hold a PLATELET ENHANCER?

12 hrs before and after radiation therapy.

What is ANEMIA?

A problems that involves tissue perfusion.

cyanocobalamin (Crystamine) Nursing Responsibilities

Assess Respiratory, Cardiac, SOB, Monitor K+ Levels, Edema, ^ Vit. B12 Intake.

What diease do RNs need to assess for for Pts taking Hematpoetic drugs?

Assess for and prevent thromboembolic disease

Why do RN's monitor with EKGs for Pts taking COLONY-STIMULATING FACTORS (CSFs)?

Assess for dysrhythmias, ^HR, HTN, ST segment depression on EKG.

HEMATOPOIETIC GF Side effects

Asthenia (severe Muscle weakness), N/V/D, weakness, chest pain, edema, wt gain, tachycardia, H/A, fever

Why do ANTIANEMIC AGENTS Pts need to avoid dairy?

B/C it can decrease absorption of the the iron.

Why do RNs monitor for Mental or behavioral changes?

B12 is a neurotransmitter so changes may occur as they near the next injection date.

HEMATOPOIETIC GF Side effects

Bone pain (from stimulating the bone marrow), HTN, seizures, Pain in joints,

What are filgrastim (Neupogen, Granix) Side effect's?

Bone pain, thrombocytopenia, joint pain, HTN, flu like symptoms.

What should an RN assess for if a Pt is on a medication that can cause Fluid Volume Overload?

Cardiac status, SOB, Respiratory Distress.

Why is it important to not shake an HEMATOPOIETIC GF medication vial?

Causes denaturation of the proteins and it becomes inactive.

cyanocobalamin (Crystamine) Indication

Chronic peptic ulcer disease, which causes scaring that may need to be removed.

HEMATOPOIETIC GF Adverse reactions

Clotting of AV shunt, HTN, Polycythemia (A lot of cells in the blood), Increases risk for Thromboembolic disease.

What are COLONY-STIMULATING FACTORS (CSFs) Side effects?

Decreased liver and renal function, bone pain

How is the ANTIANEMIC AGENTS admin via IM?

Deep Z-track b/c it Is irritating to tissues and can stain it.

What is the best way to take oral liquid iron solution?

Diluted in a glass with some juice and by using a stray to prevent staining the teeth.

What is the RN responsibility for the unused portion of a HEMATOPOIETIC GF drug?

Discard, do not preserve.

cyanocobalamin (Crystamine) Indication

Elderly that have atrophy to the stomach lining so the cells there are not producing the intrinsic factor.

ANEMIAS Signs and SXs

Fatigue, lethargy, dizziness, syncope, ^ RR & ^HR (b/c the body is trying to composite for the lack of O2 to the tissues.) & Heart Failure

What are oprelvekin (Neumega) Side effects?

Fever, H/A, edema, Wt gain, tachycardia, dysrhythmias, bone pain & flu like symptoms.

Ferrous sulfate (Feosol) Side effects

GI disturbance (Give w/ OJ), N, heartburn, peptic ulcer, constipation, dark green or black stools.

iron dextran (Dexferrum)

Given IM or IV (Only given IV for severe depletion of iron stores)

HEMATOPOIETIC GROWTH FACTORS Route

Given SQ, or IV. Improves HGB & HCT in 2-6 weeks

romiplostim (Nplate) & eltrombopag (Promacta) route

Given oral or subQ

COLONY-STIMULATING FACTORS (CSFs) Route

Given subQ or short IV infusion when the pt is at the NADIR period of their chemotherapy.

What foods have Folic acid in them?

Green leafy veggies, OJ, Liver, Legumes

Why do RNs monitor Hematocrit at least twice weekly for Pts taking HEMATOPOIETIC GF?

Hct should rise 5-6 points in 2 months. Needs to be steady rise. Report a Hct of 4 points in two weeks or a value over 36%. The rapid increases causes problems. Men 40-54% Women 38-57%

What are romiplostim (Nplate) & eltrombopag (Promacta) Use for?

Idiopathic thrombocytopenic purpura ITP, Low platelet count and purple lesions,

Where does Hematopoiesis start?

In the stem cells of red bone marrow

COLONY-STIMULATING FACTORS (CSFs) Action

Increases WBC (leukopoiesis) and Decreases risk for infection.

HEMATOPOIETIC GROWTH FACTORS Side effect

Increases blood viscosity by putting out more RBCs

What Pt education is important for Pts with Neutropenia?

Infection prevention and recognition. i.e. Avoid crowds, wash hands

Nursing responsibilities HEMATOPOIETIC GF

Instruct client on dietary sources of iron, folic acid and B12, all are required to produce RBCs

Why do RNs Use HEMATOPOIETIC GF cautiously in clients with HTN?

It ^ the # of cells in blood volume that will ^ blood viscosity, this will ^ PVR making HTN worse.

What foods have Iron in them?

Liver, meats, eggs, wheat germ, whole or enriched grains, legumes, Dark green veggies, Cook with Iron skillets,

What is darbepoetin alfa (Aranesp) used for?

Longer acting form. Given weekly for patients with chemo therapy and renal failure.

How is pegfilgrastim (Neulasta) diffent from the prototype drug?

Longer action, longer lasting

What is Ferrous sulfate/Iron essential for?

Metabolism & Energy.

What will hinder Irons absorption?

Milk, Dairy or Food in the stomach will decrease the absorption of Iron

Why are INTRINSIC FACTORS important to have?

Needed so the body can absorb and utilize B12. B12 can not be used without it.

What does sargramostim (Leukine) treat?

Non-Hodgkins lymphoma, and autologous (their own bone marrow) bone marrow transplantation

What foods have B12 in them?

Only animal products.

What will help Irons absorption?

Orange juice or Vitamin C in the stomach will help the absorption of Iron.

What are some for Signs and SXs ANEMIA?

Pallor in skin and mucus membranes, Decreased exercise tolerance (b/c not enough O2 is getting to the cells)

What is NADIR?

Pts at the peak action of their chemotherapy so their cells counts are the lowest.

Why do RNs Monitor iron store status for Pts taking HEMATOPOIETIC GF?

Pts may need supplements, they need a good iron storage to make Hbg and Hct

cyanocobalamin (Crystamine) Indication

Pts that have had gastric surgery and a part of the stomach was removed.

What is cyanocobalamin (Crystamine)?

Purified form of Fit. B12.

Why do RN's monitor for respiratory distress in Pts taking COLONY-STIMULATING FACTORS (CSFs)?

Risk of Fluid Volume Overload

HEMATOPOIETIC GROWTH FACTORS Action

Same biologic action as endogenous erythropoietin that our bodies produce. Stimulates erythropoiesis in the bone marrow to produce stem cells and RBC.

What is filgrastim (Neupogen, Granix) Used for?

Severe, chronic neutropenia, cancer patients with neutropenia, AIDS, and aplastic anemia,

What does filgrastim (Neupogen, Granix) do?

Stimulates the production of neutrophils in the bone marrow.

What are INTRINSIC FACTORS secreted by?

The parietal cells of the stomach

Why do RNs perform Neuro Assessments on Pt taking HEMATOPOIETIC GF?

They are at risk for seizures. It is important for the 1st 90 days because the Hematocrit is rising rapidly.

Why is it important to know that HEMATOPOIETIC GROWTH FACTORS are Synthetic substances?

They are not a blood competent (Not Blood Products) so the can be accepted to people with Religious affiliations.

Why do RN's monitor CBC for Pts taking COLONY-STIMULATING FACTORS (CSFs)?

To get a baseline and to see the drugs effectiveness.

What were HEMATOPOIETIC GROWTH FACTORS Originally developed for?

To help Pts with chemo to increase there cell count so they can keep getting there chemo.

What is oprelvekin (Neumega) Used for?

Treats chemotherapy induce thrombocytopenia, Can be used in other pts with severe thrombocytopenia.

What is Hematopoiesis dependent on?

Vit B, Vit C, Iron and other Minerals and Nutrients

What is used to treat ANEMIA?

Vitamins and minerals used to treat anemia and enhance O2 carrying capacity of the blood.

Iron Deficiency Anemia Indications

Women during the menstrual ages, Pts with gastric or peptic ulcers have slow bleeding, Pts on nutrient lacking diets.

HEMATOPOIETIC GF Indication

anemias associated with renal failure, and severe anemia associated with AIDS

HEMATOPOIETIC GF Indication

chemotherapy induced anemia, and in some pts prior to surgery to increase the RBC and 02 carrying capacity.

WHat are some ANTIANEMIC AGENTS?

cyanocobalamin (Crystamine, Nascobal), folic acid (Folvite), and ferrous sulfate (Feosol)

What is the prototype for the class HEMATOPOIETIC GROWTH FACT

epoetin alfa (Epogen, Procrit)

cyanocobalamin (Crystamine) route

given IM or SubQ or nasal spray. Given Monthly for life.

What is oprelvekin (Neumega) route?

given sub-q only

How is sargramostim (Leukine) different from the prototype drug?

granulocyte-macrophage-CSF

PLATELET ENHANCER Action

increase the number of platelets (thrombocytopoiesis)

ANTIANEMIC AGENTS Nursing precautions

instruct on foods high in iron

ANTIANEMIC AGENTS Nursing precautions

instruct on prevention of constipation

ANTIANEMIC AGENTS Nursing precautions

instruct to take on empty stomach Or w/ OJ

Iron Deficiency Anemia

most common cause of nutritional deficiency (lack of iron intake, or slow loss of blood)

Ferrous sulfate (Feosol) Route

po, IM, IV (Only given IV for severe depletion of iron stores)

cyanocobalamin (Crystamine) side effects

rare, could get mild allergy, Hypokalemia

Ferrous sulfate (Feosol) Side effects

stains teeth, is irritating to tissues, Anaphylaxis (occurs more with IV route)

Hematopoiesis

the process of blood cell formation

What is cyanocobalamin (Crystamine) Used for?

to tx pernicious anemia (No intrinsic factor causing a Vit. B12 deficiency)

Ferrous sulfate (Feosol) Use

tx iron deficiency anemia