Drugs for hematopoietic disorders HEMATOPOIESIS – is the formation of blood cells. So obviously its indicated when patients have -anemia -low h&h. normal is 12-18 -dialysis patients -chemo/cancer patients -HIV patients Theses are all patients that lack RBCs and that have a shot immune system bc of it . Epoetin Alfa (Epogen, Procrit) Erythropoiesis stimulating drug (Erythropoietin) – to increase RED BLOOD CELLS. Most closely resembles erythropoietin. Admin : SQ route, usually 3x/week. SQ preferred over IV bc SQ has< doses needed and slower absorption. SI (Special instructions)- keep refrigerated. NEVER SHAKE the vial because it may DEACTIVATE THE DRUG. YOU NEED TO TAKE IRON SUPPLEMENTS BECAUSE THE EFFECTIVENESS OF EPOETIN ALFA IS GREATLY REDUCED IF PT HAS IRON DEFICIENCY OR VITAMIN DEPLETION. – encourage intake of meats, dairy, eggs, fortified cereals and breads, leafy green vegetables, citrus fruits, dried beans and peas. Contraindications: DO NOT GIVE TO PATIENTS W HTN- medication can raise their BP even more d/t increase of RBC formation ( risk > in first 3 months of medication admin) Theres R/O MI/Stroke/TIAs in patients w severe CKD who are on dialysis and taking this med. s/e:HTN, tachy, MI, CVA, PE. Sometimes used for CA patients. But it can worsen the CA . benefits must outweigh the risks * BLACK BOX WARNING: r/o serious cardiovascular and thromboembolic events increased w this medication. Overdose: polycythemia; TOO MANY RBCS * CAN BE CORRECTED BY PHLEBOTOMY s/s of too many RBCS: tiredness, SOB, HA, blurred vision, sleep disorders, joint pain (bc too many rbcs are being made in the bones) , itchy skin, numbness and or tingling. >> This can result in thickening of the blood, slow blood flow and eventually blood clots. _____________________________________________________________________________________
FILGASTRIM (Granix, neupogen, Zanxio) Increases neutrophil production WBC – TO INCREASE WHITE BLOOD CELLS. Granulocyte CSF (colony stimulation factor) – Stimulating factor that triggers the production of WBC. So, it has 2 primary functions : to increase neutrophil production AND to increase the cytotoxic and phagocytic strength of the neutrophils that already exist (TO MAKE THEM STRONGER) Indications: use this medication for people w low WBCs OBVI, patients w CA on chemo, patients w life threatening bacterial infections secondary to severe neutropenia. HIV immunosuppressed patients. PATIENTS W WEAKENED IMMUNE. Remember low WBCS- PRONE TO INFECTION. SI- do not handle prefilled syringe if u is allergic to latex bc the cap contains rubber that is made from latex. Admin: SQ or IV. SQ has < AE. DO NOT ADMINISTER WITHIN 24 HRS OF CHEMOTHERAPY. (It will decrease effectiveness of med) NORMAL NEUTROPHIL COUNT: 2500-7000 This med’s target range is to get neutrophils 1500-10,000- When WBCs reach 10,000 NOTIFY MD bc > than that = serious a/e; resp failure, IC hemorrhage, retinal hemorrhage, and MI . SO YOU WILL NEED FREQUENT LABWORK *. Filgrastim may be STOPPED when WBC levels reach 10,000. S/E: fatigue, *BONE PAIN*, bp trending down, low temp (neutropenic fever), rash, epistaxis, < platelets, N/V A/E: CAPILLARY LEAK SYNDROME (?) – when medicine from blood to body tissues and causes LOW BP and SWELLING(ANASARCA) __________________________________________________________________________________ Anemia is caused bc blood has < capacity to carry O2. Occurs d/t hemorrhage, > erythrocyte destruction or insufficient erythrocyte synthesis. s/s HA, dizziness, tachy, fatigue, pallor of skin/mucus membranes, >RR, confusion, weakness, cold hand/feet. CYANOCOBALAMIN (VIT B12) (nascobal) Supplement. To increase b12 in patients w b12 deficiency anemia.
VIT B12 deficiency is usually not due to lack of B12 in diet. Only small amount of vit b12 needed from diet. Cause of deficiency is usually due to lack of INTRINSIC FACTOR. ( Intrinsic factor must be present in order for B12 to be absorbed from the intestine. ) What causes lack of intrinsic factors? Sx removal of the stomach or inflammatory diseases of the stomach. Admin: PO, SQ,IM,PO preps mixed w fruit juice , admin quickly bc ascorbic acid affects stability of B12. (Intranasal usually taken after B12 levels stabilize as a PPX/maintenance therapy) ORAL admins: Can only be given and will ONLY be EFFECTIVE in pts that HAVE INTRINSIC FACTOR IF NO INTRINSIC FACTOR PRESENT- give IM ! CONTRAINDICATIONS: don’t give to pts w pulmonary issues or heart disease bc of potential for NA+ retention caused. (Hypokalemia can also be a s/e) – Will need to monitor K+ , NA+ LEVLS periodically. IN MOST CASES, TX IS OFTEN LIFELONG Most serious a/e of < B12 is Pernicious/megaloblastic anemia . It’s a type of anemia that affects the hematologic system as well as the nervous system . s/s : memory loss, confusion, unsteadiness, tingling or numbness, delusions, mood disturbances, hallucinations,. a/e can be permanent if not treated. _____________________________________________________________________________________ FERROUS SULFATE ( Feosol) Antianemic drug, IRON SUPPLEMENT Use for people w low iron levels. S/e: Black/green tarry stools are normal. Most frequent S/E is → GI UPSET. Admin: PO, LIQUID, IV, IM. (Ztrack method if given med IM) ZTRACK method is used bc it helps ensure that the medication is reaching the right muscle and not leaking into other tissue. Iron is a strong med. Do NOT take w food, can < ABSORPTION of iron by 50-70 %. Antacids also reduce absorption. TAKE ON AN EMPTY STOMACH Do not give 1 hr before bedtime and/or admit 1 hr before/ 2 hrs after meal . Patients should not lie down 30-60 mins after admin to prevent GI upset/reflux. IRON liquid PO can STAIN teeth. To prevent staining mix w water or fruit juice and drink through straw placed and positioned in back of throat ( to bypass teeth) . staining is temporary. ALSO remember that OJ increases ABSORPTION . Or strawberries. (Foods high in VIT C.)
SI : Monitor labs HCT/HGB for Iron levels. > IRON = TOXIC. S/S OF IRON TOXICITY: dizziness, low bp, tachy, HA, fever, SOB, fluid in lungs, graysish-blue color in skin, jaundice, seizures. In case of iron intoxication: antidote is de(Fe)roxamine (Des[Fe]ral) – its given IV. Works by binding to iron, and removing it through kidneys. * Will turn urine REDDISH BROWN COLOR. Food high in iron : fortified cereal, beef, shellfish, dried fruit, beans, lentils, dark leafy greens, dark chocolate, quinoa, mushrooms, squash seeds.