Mod 6: Hematologic

Comprehensive vocabulary flashcards detailing hematologic drugs, iron supplementation, sickle cell therapies, growth factors, anticoagulants, and antiplatelet agents based on NURS 653 lecture content.

Ferrous sulfate

Oral iron supplement providing $20\% - 30\%$ elemental iron per mg ($65\,mg$ elemental iron in a $325\,mg$ tablet).

Ferrous gluconate

Oral iron supplement providing $10\% - 14\%$ elemental iron per mg ($27\,mg$ elemental iron in a $270\,mg$ tablet).

Ferrous fumarate

Oral iron supplement providing $33\%$ elemental iron per mg ($150\,mg$ elemental iron in a $450\,mg$ tablet).

Polysaccharide-iron complex

Iron formulation providing $15\,mg$ iron in $1\,mL$ drops or $125\,mg$ elemental iron in $5\,mL$ liquid, available in combination with folic acid and Vitamin B12.

Ferric maltol (Accrufer)

Prescription-only oral iron preparation delivering $30\,mg$ elemental iron per capsule.

Parenteral iron preparations

Intravenous iron formulations consisting of iron oxyhydroxide surrounded by a carbohydrate shell, including iron dextran, sodium ferric gluconate complex, and iron sucrose.

Iron Intoxication

Acute poisoning that causes necrotizing gastroenteritis, shock, metabolic acidosis, coma, and death. Usually accidental.

Hemochromatosis

Chronic condition treated with scheduled phlebotomies when genetic; or Deferoxamine or Deferasirox when secondary to frequent transfusions.

Vitamin B12 (cobalamin)

Essential nutrient whose uncorrected deficiency causes neurological defects; administered parenterally as Cyanocobalamin or Hydroxocobalamin, or OTC in oral/sublingual tablets.

Folic Acid (Vitamin B9)

Vitamin administered preconceptionally or during pregnancy ($0.4\,mg$ daily standard dose; $4\,mg$ PO daily for high risk) to prevent neural tube defects, where $1\,mg$ PO equals $1.67$ dietary folate equivalents.

Hydroxyurea (Hydrea; Droxia; Siklos)

Sickle cell disease medication without a Black Box warning that inhibits DNA synthesis, increases fetal hemoglobin, RBC water content, RBC deformability, and alters RBC endothelial adhesion.

SE: Photosensitivity

Contraindicated with pregnancy and breastfeeding.

Monitor creatinine at baseline/periodically and CBCs.

L-glutamine (Endaril)

Sickle cell treatment that reduces oxidative damage in sickled RBCs, requiring no routine monitoring, but carrying a potential severe side effect of hypersplenism.

Crizanlizumab (Adakveo)

Monthly IV infusion for sickle cell disease that binds P-selectin and blocks ligand formation to prevent RBC adherence to vascular endothelium.

SE: Infusion Site Reactions

Erythropoietin stimulating agents

Epoetin alfa, Darbepoetin alpha, Methoxy polyethylene glycol-epoetin beta

Indicated for anemia associated with renal failure or anemia secondary to chemotherapy, HIV tx, AIDS, or bone marrow transplantation.

SE: HTN & Thrombosis

Myeloid Growth Factors

Filgrastim, Sargramostim, Plerixafor

Stimulate neutrophil production and mobilization of hematopoietic stem cells, used post-chemotherapy for neutropenia.

SE: fever, arthralgias, capillary damage w/ edema

Filgrastim

Overall has a lower SE profile, but has the side effect of bone pain.

Oprelvekin (interleukin-11)

Megakaryocyte growth factor that stimulates megakaryocytic progenitors and increases platelet counts post-chemotherapy.

Romiplostim

Thrombopoietin receptor agonist indicated for chronic idiopathic thrombocytopenia in patients who have failed conventional treatments.

Eltrombopag

Oral thrombopoietin receptor agonist indicated for refractory thrombocytopenia with restricted use due to severe risks of hemorrhage and hepatotoxicity.

Avatrombopag

Oral thrombopoietin receptor agonist indicated for the treatment of refractory thrombocytopenia.

Fostamatinib

Kinase inhibitor used as a secondary option in immune thrombocytopenia (ITP) that stops platelet destruction.

Enoxaparin (Lovenox)

Low molecular weight heparin with a $4.5-7$ hour half-life carrying a Black Box warning for spinal/epidural hematomas, used for DVT prophylaxis and ischemic cardiovascular complications.

Dalteparin (Fragmin)

Low molecular weight heparin with a $3-5$ hour half-life administered once daily for DVT prophylaxis, extended VTE treatment, unstable angina, and Non-Q wave MI.

Fondaparinux (Arixtra)

Factor Xa inhibitor anticoagulant with a $17-24$ hour half-life indicated for DVT prophylaxis and DVT/PE treatment.

Warfarin

Oral anticoagulant requiring PT/INR monitoring, reversed with Vitamin K and factor replacement via plasma, preferred in mechanical heart valves, severe renal impairment, and antiphospholipid syndrome.

Dabigatran etexilate (Pradaxa)

Direct thrombin inhibitor prodrug requiring BID dosing in its original packaging without crushing or opening, not affected by food.

Rivaroxaban (Xarelto)

Direct factor Xa inhibitor taken QD with food requiring a bolus dose, associated with a slightly higher risk of GI bleeding.

Apixaban (Eliquis)

Direct factor Xa inhibitor with lower bleeding risk (Beers preferred) requiring BID dosing and a bolus dose, featuring $25\%$ renal elimination.

Edoxaban (Lixiana, Savaysa)

Direct factor Xa inhibitor administered QD following initial parenteral anticoagulation.

Aspirin

Antiplatelet agent that irreversibly inhibits thromboxane synthesis by blocking cyclooxygenase, with effects lasting until new platelets are produced.

Tirofiban (Aggrastat)

Platelet glycoprotein IIb/IIIa receptor binder indicated for non-ST acute coronary syndrome requiring renal dosage adjustments.

Eptifibatide

Infusion-only platelet glycoprotein IIb/IIIa receptor binder indicated for acute coronary syndrome and percutaneous coronary intervention (PCI).

Clopidogrel (Plavix)

ADP receptor antagonist carrying a Black Box warning regarding diminished antiplatelet effect in CYP2C19 poor metabolizers.

Prasugrel (Effient)

ADP receptor antagonist carrying a Black Box warning for severe bleeding risk, indicated for acute coronary syndrome.

Vorapaxar (Zontivity)

Protease-activated receptor-1 agonist carrying a Black Box warning for bleeding, indicated for thrombotic event risk reduction.

Dipyridamole

Phosphodiesterase 3 inhibitor used for myocardial perfusion imaging and as an adjunct for thromboembolism prevention associated with cardiac valves.

Cilostazol

Phosphodiesterase 3 inhibitor carrying a Black Box warning for congestive heart failure (CHF), indicated for treatment of intermittent claudication.

Desmopressin acetate

Agent that elevates plasma concentrations of von Willebrand factor and factor VIII, used preoperatively in mild hemophilia or von Willebrand disease.

Antiplasmin agents

Medications such as aminocaproic acid and tranexamic acid used for the prevention and management of acute bleeding in patients with hemophilia.