Hematologic- Pharmacology
A nurse is teaching a client about taking ferrous sulfate to treat iron-deficiency anemia. What instructions should the nurse include?
-Eat iron-enriched foods A client who has iron-deficiency anemia should increase iron intake by eating foods such as egg yolks, wheat germ, meat, and fish. -Spread the dosage across each day Spreading out the iron intake throughout the client's waking hours allows the bone marrow to maximize the production of RBCs. -Take the drug on an empty stomach Food reduces the absorption of ferrous sulfate. The client should take the drug on an empty stomach to increase drug absorption. If GI effects are troublesome, they can take the drug with food. -Increase dietary fiber Ferrous sulfate can cause constipation. The client should increase fiber and fluid intake and exercise more often or more intensely.
A nurse is administering epoetin intravenously to a client who has renal failure. Which action should the nurse take?
Administer via IV bolus over 1 to 3 min Instructions for administering the drug include administering it via IV bolus over 1 to 3 min.
A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to thrombus in cerebral vessel. What drug should the nurse expect to administer?
Alteplase Alteplase is a thrombolytic drug, meaning it can dissolve existing thrombi, whereas anticooagulant/antiplatelet drugs do not. An acute ischemic cerebrovascular even is often caused by the occlusion of a cerebral vessel by a thrombus. Administration of alteplase should be within 3 hours of original onset of symptoms for the drug to be effective.
A nurse is caring for a client who is about alteplase therapy to treat pulmonary embolism. What drug should the nurse have available in the event of a severe adverse reaction?
Aminocaproic acid, a coagulator, inhibits fibrinolysis and stops excessive fibrinolytic bleeding, a severe adverse effect of alteplase.
Which drugs alter the formation of the platelet plug, inhibit platelet adhesion and aggregation by blocking receptors sites on the platelet membrane?
Antiplatelet Drugs Aspirin, Plavix Reduce risk of recurrent TIAs or strokes Reduce death or nonfatal MI MI prophylaxis Anti-inflammatory Analgesic, and antipyretic effects
Thrombolytics (urokinase)
Break down the thrombus that has been formed by stimulating the plasmin system. (kidney enzyme that directly converts plasminogen to active plasmin, thus inducing thrombolysis) • Tenecteplase (TNKase) *primarily indicated only for patients allergic to STREPTOKINASE
A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which action should the nurse take?
Clarify the prescription with the provider Hyponatremia and fluid retention can occur with the administration of desmopressin, an antidiuretic hormone used in the treatment of hemophilia A. The client's sodium level is below the expected range of 136 to 145 mEq/L. The nurse should notify the provider of the client's current sodium level and clarify the prescription prior to administration.
A nurse is caring for a client who has chronic stable angina. The nurse should identify that what drug inhibits the actions of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?v
Clopidogrel Clopidogrel is an antiplatelet medication that blocks the ADP receptors on platelets, preventing platelet aggregation. This effect is irreversible and lasts the lifespan of the platelets (7 to 10 days).
Thromboembolic Disorder
Conditions that predispose a person to the formation of clots and emboli
A nurse is monitoring a client following ferrous sulfate administration. The nurse should the client for what adverse effect?
Constipation Oral iron supplementation is associated with constipation. The nurse should encourage the client to consume adequate amounts of fiber and fluids in their diet to minimize this effect.
A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma-derived factor IX. The nurse should explain that recombinant factor IX therapy practically eliminates the risk for..?
Creutzfeldt-Jakob disease Recombinant factor IX is safer than the plasma-derived formulation because it practically eliminates the risk for Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources.
A nurse is caring for a client who is taking ferrous sulfate to treat iron deficiency anemia and develops toxicity. Which drug should the nurse expect to use to treat this complication?
Deferoxamine Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.
A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which topic to promote the effectiveness of the drug?
Dietary modifications Warfarin is an anticoagulant drug that functions by inhibiting the action of vitamin K. Many foods, such as green, leafy vegetables, are rich in vitamin K. The client should maintain a consistent intake of vitamin K to avoid excesses or deficits and ensure the therapeutic effects of warfarin are consistent.
A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for what adverse reaction?
Edema Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. The nurse should monitor fluid intake and output for clients receiving this drug.
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which adverse effect?
Enlarged Spleen With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen. The nurse should tell the client to monitor and report abdominal pain or fullness.
Which drugs are given frequently for prophylaxis against DVT, especially in hospitals post op?
Factor Xa Inhibitors Knee and hip post surgical patients are at high risk of DVT rivaroxaban• apixaban *Note they both have "xa" in them - Xa inhibitors and suffix is "ban"
Prototype drug for iron preparations
Ferrous sulfate
A nurse is caring for a client who is about to begin factor VIII therapy to treat hemophilia A. When administering factor VIII, which action should the nurse take?
Have emergency equipment ready Factor VIII can cause a hypersensitive reaction and anaphylaxis. The nurse should monitor the client for hives, fever, wheezing, and difficulty breathing and have emergency equipment and drugs readily available.
A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which adverse effect?
Headache Alteplase, a thrombolytic drug, can cause intracranial bleeding. The nurse should monitor the client for changes in level of consciousness, headache, one-sided weakness, and other indications of intracranial bleeding.
A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). What medication should the nurse expect the client to be taking in addition to the alteplase?
Heparin Heparin therapy should be initiated before alteplase therapy and continued for at least 48 to 72 hr after the fibrinolytic therapy to reduce the risk of additional clot formation.
A nurse is caring for a client who is about to begin taking epoetin. An increase in whaat laboratory values should indicate to the nurse that the therapy is effective?
Hgb Epoetin, an erythropoietic growth factor, increases the production of RBC's for clients who have anemia due to chronic renal failure or chemotherapy.
What kind of foods should patients avoid when receiving nasal vitamin b12?
Hot foods, to avoid removal from nasal passages before absorption
A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for what adverse effect?
Hypertension Epoetin, an erythropoietic growth factor, can cause hypertension. The nurse should monitor the client's BP before and during therapy and inform the provider if it increases.
How is low molecular weight heparin (lovenox) administered?
IV administrated to patients on hemodialysis or with unstable angina or flat Q-wave myocardial infarction, which is followed by subcutaneous (SC) administration
Coagulation Disorders
Immune thrombocytopenic purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) Hemophilia Von Willebrand disease Hemolytic uremic syndrome Disseminated intravascular coagulation (DIC)
Know the lab values for INR levels.
In healthy people an INR of 0.8-1.2 is considered normal. 2-3.5 times baseline *1.6 - 4.2 secs (INR stands for international normalized ratio and is measured with a blood test called PT-INR. PT stands for prothrombin time. The test measures how much time it takes for your blood to clot and will determine if you're receiving the right dose of warfarin)
Causes of iron deficiency anemia
Inadequate stores during fetal development Deficient dietary intake Chronic blood loss Poor utilization of iron by the body
A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which mechanism?
Inhibiting cyclooxygenase action in platelets Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.
Lecture slide for blood vessel injury
Local vasoconstriction seals off small injury Platelet aggregation forms a platelet plug Hageman factor is activatedIntrinsic pathway converts prothrombin to thrombin to seal system Extrinsic pathway clots the blood that has leaked out of the vascular system
Which anemia is indicated by insufficient folic acid or vitamin B12 levels?
Megaloblastic Anemia
If a patient has pernicious anemia, can they take B12 in oral form?
No, since the patient lacks intrinsic factor that is needed to absorb B12.
A nurse should identify that clopidogrel is contraindicated for clients who have which condition?
Peptic Ulcer Disease Clients who have peptic ulcer disease should not take clopidogrel, because it can cause gastric bleeding.
Which anemia occurs when the gastric mucosa cannot produce intrinsic factor, and vitamin B12 cannot be absorbed?
Pernicious Anemia
If a patient with severe megaloblastic anemia starts receiving Vitamin B12 therapy, which levels should you monitor?
Potassium (the production of erythrocytes requires significant amounts of potassium. This sudden increase of hematopoiesis can drain the body of potassium, causing dangerously low levels of potassium).
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. What finding should the nurse identify as a possible indication of hemorrhage?
Rapid Pulse In the event of a moderate to severe hemorrhage, the volume of blood in the circulatory system decreases significantly, resulting in hypotension. Tachycardia is a compensatory mechanism of the heart that serves to combat the hypotension that results from the decreased volume of blood. Tachycardia can be detected by checking the client's pulse.
A nurse is caring for a client who is about to begin taking folic acid to treat megaloblastic anemia. The nurse should monitor which laboratory value to determine therapeutic effectiveness?
Reticulocyte count A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is essential for erythropoiesis. Clients who have a folic acid deficiency require a baseline reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring during folic acid therapy to determine effectiveness.
Causes of Folate deficiencies
Secondary to increased demand Absorption problems in the small intestine Drugs that cause folate deficiencies Secondary to the malnutrition of alcoholism
A nurse is caring for a client who is taking clopidogrel to prevent stent restenosis. The nurse should monitor the client for which of the following adverse reactions?
Thrombocytopenia Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The nurse should monitor the client's platelet count and also monitor for bruising, bleeding gums, and petechiae.
Conditions that predispose a person to the formation of clots and emboli
Thromboembolic Disorder
Which drugs break down the thrombus that has been formed by stimulating the plasmin system?
Thrombolytic
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for what complication?
Uncontrolled bleeding Aspirin is a salicylate (antiplatelet) that irreversibly binds to and inhibits platelet activation. Because the lifespan of a platelet is 7 to 10 days, this is the average span of time needed after discontinuing antiplatelet therapy with aspirin before its effects are no longer present and the chance of an uncontrolled bleeding event is decreased.
A nurse should assess a client who has megaloblastic anemia for indications of what vitamin deficiency?
Vitamin B12
Macrocytic/megaloblastic anemia
Vitamin B12 malabsorption or deficiency, folic acid deficiency
A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which drug should the nurse expect to administer to the client?
Vitamin K Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin.
A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 am dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action? a) Give a larger dose to increase the aPTT b) Give the dose as ordered and chart the results c) Check the client's vital signs prior to administering the dose d) Hold the dose and call to inform the result to the prescriber
d) Hold the dose and call to inform the result to the prescriber The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The client's value is 3.5 times control, which indicates clotting time is a bit too delayed and either the dosage will likely be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, to give the dose and chart the results, or to simply check the vital signs without holding the dose and calling the physician.
Microcytic anemia
iron deficiency
What must folic acid first be converted into, in order to be synthesized by the body?
tetraahydrofolic acid
High-Density Lipoproteins (HDL)
• Enter circulation as loosely packed lipids • Used for energy; pick up remnants of fats and cholesterol left in the periphery by LDL breakdown
Low-Density Lipoproteins (LDL)
• Enter circulation as tightly packed cholesterol, triglycerides, and lipids • Carried by proteins that enter circulation; broken down for energy or stored for future use as energy
Causes of Vitamin B12 deficiencies
• Poor diet or increased demand • Lack of intrinsic factor in the stomach
