NURS 309: MEDS TO STIMULATE BONE MARROW

Epoetin Alfa – Class & Action

A client is prescribed epoetin alfa. What is its mechanism of action?

Epoetin Alfa – Therapeutic Use

What is epoetin alfa used for?

Treatment of anemia, especially in chronic kidney disease, chemotherapy-induced anemia, and anemia due to zidovudine therapy. It also reduces need for RBC transfusions postoperatively.

Epoetin Alfa – Nursing Assessment

What should the nurse assess?

Monitor CBC (Hgb, Hct, RBC trends), iron studies (transferrin saturation), blood pressure, signs of thrombosis, allergic reactions, and anemia improvement.

Epoetin Alfa – Administration

How is epoetin alfa administered?

IV or subcutaneous injection. IV may be given undiluted or diluted with 0.9% sodium chloride and administered via IV line or dialysis access. Do not shake vial; ensure solution is clear and colorless.

Epoetin Alfa – Common Side Effects

What side effects may occur?

Hypertension, headache, and temporary skin rash.

Epoetin Alfa – Adverse Effects

Which serious adverse effects require immediate attention?

Seizures, stroke, myocardial infarction, heart failure, thromboembolic events, severe hypertension, and serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis).

Epoetin Alfa – Drug Interactions

What interaction is important?

More heparin may be required during dialysis due to increased clotting risk.

Epoetin Alfa – Contraindications

Who should NOT take epoetin alfa?

Clients with uncontrolled hypertension, serious hypersensitivity reactions, or prior pure red cell aplasia from ESAs. Avoid in neonates/infants receiving benzyl alcohol–containing formulations.

Epoetin Alfa – Precautions

Who requires caution?

Clients with cardiovascular disease, history of seizures, and those with Hgb >11 g/dL (increased risk of thrombotic events). Hypertension must be controlled before and during therapy.

Epoetin Alfa – Client Teaching

What should clients be taught?

Report signs of hypertension, stroke, chest pain, or clotting immediately. Understand need for regular lab monitoring. If self-injecting, learn proper technique and safe disposal of needles/supplies.

It is an erythropoiesis-stimulating agent (ESA) that stimulates bone marrow progenitor cells to produce RBCs & prevents RBC apoptosis, increasing Hgb & Hct levels.

Filgrastim – Class & Action

A client is prescribed filgrastim. What is its mechanism of action?

Filgrastim – Therapeutic Use

What is filgrastim used for?

Treatment and prevention of neutropenia, especially in clients receiving chemotherapy, radiation therapy, or bone marrow transplant.

Filgrastim – Nursing Assessment

What should the nurse assess?

Vital signs, CBC (especially neutrophil count), LDH, uric acid, alkaline phosphatase. Monitor for bone pain, left upper quadrant or shoulder pain (splenic rupture), and respiratory status for ARDS.

Filgrastim – Administration

How is filgrastim administered?

Subcutaneous or IV infusion. Refrigerate medication. Do not shake. Do not administer within 24 hours of chemotherapy or bone marrow transplant. Discard if left unrefrigerated >24 hours.

Filgrastim – Common Side Effects

What side effects may occur?

Bone pain, injection site pain, mild allergic reactions, thrombocytopenia, and splenomegaly.

Filgrastim – Adverse Effects

Which serious adverse effects should be monitored for?

Splenic rupture, severe bone pain, leukocytosis, anaphylaxis, and acute respiratory distress syndrome (ARDS).

Filgrastim – Drug Interactions

What interactions are important?

Chemotherapy may reduce effectiveness if given too close together. Lithium may increase neutrophil release.

Filgrastim – Contraindications

Who should NOT take filgrastim?

Clients with hypersensitivity to filgrastim or E. coli–derived products. Use caution in myeloid malignancies and preexisting heart disease.

Filgrastim – Precautions

Who requires caution?

Clients undergoing chemotherapy or radiation therapy, those at risk for ARDS, and clients with hematologic malignancies or cardiovascular disease.

Filgrastim – Client Teaching

What should clients be taught?

Report severe bone pain, abdominal or shoulder pain (possible splenic rupture), or signs of allergic reaction. Understand purpose is to increase white blood cells and reduce infection risk.

It is a leukopoietic colony-stimulating factor (CSF) that stimulates bone marrow to produce & release neutrophils by promoting proliferation & differentiation of immature WBCs.

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