Pharmacology Ch. 48 & 49 Drugs Affecting Coagulation & Anemia

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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


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