pharm test 4 - prototypes

what are the two prototypes in the replacement category of hematopoetic drugs

iron (ferrous sulfate) and B12

what are the two prototypes in the stimulators category of hematopoetic drugs

epoetin and filgrastim

what patient would iron be used for

a 24 year olf with heavy menstrual bleeding - with fatigue, dizziness and pallor as symptoms

what patient would B12 be used for

a 60 year old with pernicious anemia - with fatigue, numbness and tingling as symptoms

what patient would epoetin be used for

a 68 year old with chornic kidney disease

• S&S: Hgb 8.2, fatigue, SOB on exertion

what patient would filgrastim be used for

52 year old recieving chemo for breast cancer

• S&S: WBC 1.0, temp 101.3F

what is another name for ferrous sulfate

iron

therapeutic class for ferrous sulfate

anti-anemic drug

ferrous sulfate - pharmacologic class

iron supplement

ferrous sulfate MOA

provides iron needed to help make hemoglobin

Adverse/side effects of ferrous sulfate

GI effects - especially constipation. take only until anemia is corrected

• monitor H&H regularly - EXCESS IRON IS TOXIC

Can turn stool dark/green, increase dietary fiber to avoid constipation

administration of ferrous sulfate

monitor for IV infaltration, z-track when giving IM, DONT CRUSH TABLETS, take 1 hr before or 2 hrs AFTER meals/other meds.

drug-drug interactions with ferrous sulfate

MANY - take ALONE!! avoid antacids (reduces absorption) and dairy. Foods high in vitamin C can increase absorption.

• keep out of reach for children - TOXIC AT HIGH DOSES

antidote for ferrous sulfate

desferal - binds to iron to excrete

what is another name for Vitamin B12

cyanocobalamin

therapeutic class - cyanocobalamin

drug for anemia

cyanocobalamin pharmacologic class

vitamin supplement

MOA (and admin) for cyanocobalamin

indicated for patients with B12 deficiency anemia

• can be given IM, IV or nasal routes

adverse effects of cyanocobalamin

uncommon - anaphylaxis is possible (but rare)

patient education for cyanocobalamin

onset is days to weeks

• there is a possible link betwen depresssion and lack of B12

CI for cyanocobalamin

severe pulmonary disease, heart disease DUE TO potential sodium retention

drug-drug interactions with cyanocobalamin

decrease absorption with alcohol, neomycin

what does epoetin alpha do

stimulates RBC production

therapeutic class of epoetin alpha

erythropoiesis stimulating drug

pharmacologic calss of epoetin alpha

erythropoietin

MOA for epoetin alpha

action = stimulates production of RBC’s

administration of epoetin alpha

given subQ 2-3x/week until desired response (2-6 weeks)

• DO NOT SHAKE VIAL

adverse effects of epoetin alpha

HTN may occur in up to 30% of pts recieving drug (monitor closely for first 2 weeks)

• can also cause headahce, fever and nausea

Black box warning for epoetin alpha

increased risk of cardiovascular and thrombolic events (including MI, stroke, DVT) → USE LOWEST DOSE POSSIBLE

generally, what does filgrastim do

boosts neutrophils

therapeutic class of filgrastim

drug for increasing neutrophil production

pharmacologic class of filgrastim

colony-stimulating factor (CSF)

MOA for filgrastim

stimulates bone marrow to make and release neutrophils

• shortens length of neutropenia, often given to patients after chemotherapy or tem cell transplantation

administration of filgrastim

usually given SubQ or slow IV

• do not give 24 hours before or after chemotherapy

what do you frequently monitor when giving filgrastim

CBC (complete blood count) with differential

• includes: RBC, WBC of each type (differential), platelets, Hgb, Hct, mean corpuscular volume (the size of RBCs)

adverse effects of filgrastim

bone pain, nausea, epistaxis, decreased platelet counts, fatigue, fever